Non-Operative Treatment Options in Primary Glenohumeral Osteoarthritis: A Comprehensive Review
Main Article Content
Abstract
Primary glenohumeral joint osteoarthritis is a growing pathology with multifactorial aethiology that affects younger and older population. Treatment must be focused on reducing pain, regaining functionality, and slowing the course of the disease. Surgery and non-operative methods are available for treating it and are a frequent source of controversy, the latter being applied to patients with factors that may relatively contraindicate surgery. Practitioners must be acquainted with the therapeutic choices and the current status of the evidence. Given that nonsurgical therapy may be beneficial in relieving symptoms, it should be considered first-line treatment, particularly in low-demand individuals with symptoms that have shown themselves sub acutely. Literature is lacking of high quality evidence on this matter, and up to date, there have not been any high quality studies comparing different options. Optimal treatment of primary glenohumeral osteoarthritis depends on specifically patient´s needs, therefore a combination of all the resources available could represent the best option and result in better outcomes.
Article Details
How to Cite
MARTINI, Liborio Ingala; VELASQUEZ, Ausberto; ABACHE, Andres Franco.
Non-Operative Treatment Options in Primary Glenohumeral Osteoarthritis: A Comprehensive Review.
Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3410>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.18103/mra.v10i12.3410.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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4. Harkness EF, Macfarlane GJ, Silman AJ, Mcbeth J. Is musculoskeletal pain more common now than 40 years ago?: two population-based cross-sectional studies. Rheumatology. 2005;44:890-895. doi:10.1093/rheumatology/keh599
5. Glyn-Jones S, Palmer AJR, Agricola R, et al. Osteoarthritis. Lancet. 2015;386(9991):376-387. doi:10.1016/S0140-6736(14)60802-3
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8. Katz P. Function, disability, and psychological well-being. Adv Psychosom Med. 2004;25:41-62. doi:10.1159/000079057
9. Neer CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 1974;56(1):1-13. doi:10.2106/00004623-197456010-00001
10. Cole BJ, Yanke A, Provencher MT. Nonarthroplasty alternatives for the treatment of glenohumeral arthritis. J Shoulder Elbow Surg. 2007;16(5 SUPPL.). doi:10.1016/j.jse.2007.03.011
11. Millett PJ, boykin robert. Shoulder Osteoarthritis: Diagnosis and Management.; 2008. www.aafp.org/afp.
12. Boselli KJ, Ahmad CS, Levine WN. Treatment of glenohumeral arthrosis. American Journal of Sports Medicine. 2010;38(12):2558-2572. doi:10.1177/0363546510369250
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14. Saltzman BM, Leroux TS, Verma NN, Romeo AA. Glenohumeral Osteoarthritis in the Young Patient. J Am Acad Orthop Surg. 2018;26(17):E361-E370. doi:10.5435/JAAOS-D-16-00657
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16. Silverstein E, Leger R, Shea KP. The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med. 2007;35(6):979-985. doi:10.1177/0363546507300256
17. van der Meijden OA, Gaskill TR, Millett PJ. Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis. Orthopedics. 2012;2012. doi:10.1155/2012/160923
18. Denard PJ, Wirth MA, Orfaly RM. Management of glenohumeral arthritis in the young adult. J Bone Joint Surg Am. 2011;93(9):885-892. doi:10.2106/JBJS.J.00960
19. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008;90(5):970-979. doi:10.2106/JBJS.F.01116
20. Kwon YW, Eisenberg G, Zuckerman JD. Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial. J Shoulder Elbow Surg. 2013;22(5):584-594. doi:10.1016/J.JSE.2012.10.040
21. Leardini G, Perbellini A, Franceschini M, Mattara L. Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther. 1988;10(5):521-526. Accessed November 5, 2022. https://pubmed.ncbi.nlm.nih.gov/2856594/
22. Noël E, Hardy P, Hagena FW, et al. Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study. Joint Bone Spine. 2009;76(6):670-673. doi:10.1016/J.JBSPIN.2009.10.008
23. Valiveti M, Reginato AJ, Falasca GF. Viscosupplementation for degenerative joint disease of shoulder and ankle. J Clin Rheumatol. 2006;12(3):162-163. doi:10.1097/01.RHU.0000222057.02268.59
24. Brander VA, Gomberawalla A, Chambers M, Bowen M, Nuber G. Efficacy and safety of hylan G-F 20 for symptomatic glenohumeral osteoarthritis: a prospective, pilot study. PM R. 2010;2(4):259-267. doi:10.1016/J.PMRJ.2010.02.010
25. Colen S, Geervliet P, Haverkamp D, van den Bekerom MPJ. Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature. Int J Shoulder Surg. 2014;8(4):114-121. doi:10.4103/0973-6042.145252
26. Izquierdo R, Voloshin I, Edwards S, et al. Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg. 2010;18(6):375-382. doi:10.5435/00124635-201006000-00010
27. Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg. 2011;95(3):215-224. doi:10.1007/S12306-011-0138-3
28. Kim HM, Muhammad M, Heil SD, Smith MJ. Clinical Fate of Glenohumeral Osteoarthritis Following Intraarticular Corticosteroid Injection: An Analysis in 311 Shoulders. J Shoulder Elb Arthroplast. 2022;6:247154922210754. doi:10.1177/24715492221075446
29. Metzger CM, Farooq H, Merrell GA, et al. Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis. J Shoulder Elbow Surg. 2021;30(5):1128-1134. doi:10.1016/j.jse.2020.08.008
30. Kirschner JS, Cheng J, Creighton A, et al. Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial. Clin J Sport Med. 2022;32(6). doi:10.1097/JSM.0000000000001029
31. Chahla J, Cinque ME, Piuzzi NS, et al. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. J Bone Joint Surg Am. 2017;99(20):1769-1779. doi:10.2106/JBJS.16.01374
32. Murray IR, Geeslin AG, Goudie EB, Petrigliano FA, LaPrade RF. Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO): Platelet-Rich Plasma and Mesenchymal Stem Cells. J Bone Joint Surg Am. 2017;99(10):809-819. doi:10.2106/JBJS.16.00793
33. Centeno CJ, Al-Sayegh H, Bashir J, Goodyear SH, D Freeman M. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015;8:269-276. doi:10.2147/JPR.S80872
34. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042-1049. doi:10.1136/BJSPORTS-2014-093573
35. Soh E, Li W, Ong KO, Chen W, Bautista D. Image-guided versus blind corticosteroid injections in adults with shoulder pain: A systematic review. BMC Musculoskelet Disord. 2011;12. doi:10.1186/1471-2474-12-137
36. Patel DN, Nayyar S, Hasan S, Khatib O, Sidash S, Jazrawi LM. Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study. J Shoulder Elbow Surg. 2012;21(12):1664-1668. doi:10.1016/J.JSE.2011.11.026
37. Rijs Z, de Groot PCJ, Zwitser EW, Visser CPJ. Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res. 2021;479(11):2483-2489. doi:10.1097/CORR.0000000000001803
38. Macías-Hernández SI, Morones-Alba JD, Miranda-Duarte A, et al. Glenohumeral osteoarthritis: overview, therapy, and rehabilitation. Disabil Rehabil. 2017;39(16):1674-1682. doi:10.1080/09638288.2016.1207206
39. Guo JJ, Wu K, Guan H, et al. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients. Orthopedics. 2016;39(4):e634-e641. doi:10.3928/01477447-20160606-02
40. Onishi K, Utturkar A, Chang E, Panush R, Hata J, Perret-Karimi D. Osteoarthritis: A Critical Review. Crit Rev Phys Rehabil Med. 2012;24(3-4):251-264. doi:10.1615/CRITREVPHYSREHABILMED.2013007630
41. Menge TJ, Boykin RE, Byram IR, Bushnell BD. A comprehensive approach to glenohumeral arthritis. South Med J. 2014;107(9):567-573. doi:10.14423/SMJ.0000000000000166
42. Manca A, Dragone D, Dvir Z, Deriu F. Cross-education of muscular strength following unilateral resistance training: a meta-analysis. Eur J Appl Physiol. 2017;117(11):2335-2354. doi:10.1007/S00421-017-3720-Z
43. Crowell MS, Tragord BS. Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report. J Orthop Sports Phys Ther. 2015;45(6):453-461. doi:10.2519/JOSPT.2015.5887
44. MacHado GC, Abdel-Shaheed C, Underwood M, Day RO. Non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain. BMJ. 2021;372. doi:10.1136/BMJ.N104
45. Gordo AC, Walker C, Armada B, Zhou D. Efficacy of celecoxib versus ibuprofen for the treatment of patients with osteoarthritis of the knee: A randomized double-blind, non-inferiority trial. J Int Med Res. 2017;45(1):59-74. doi:10.1177/0300060516673707
46. Wenham CYJ, Hensor EMA, Grainger AJ, et al. A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis. Rheumatology (Oxford). 2012;51(12):2286-2294. doi:10.1093/RHEUMATOLOGY/KES219
47. da Costa BR, Reichenbach S, Keller N, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2017;390(10090):e21-e33. doi:10.1016/S0140-6736(17)31744-0
48. Zeng C, Wei J, Persson MSM, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med. 2018;52(10):642-650. doi:10.1136/BJSPORTS-2017-098043
49. Malik, A. T., Bishop, J. Y., Neviaser, A., Jain, N., & Khan, S. N. What are the costs of glenohumeral osteoarthritis in the year prior to a total shoulder arthroplasty (TSA)? Physician and Sportsmedicine. 2020; 48(1), 86–97. https://doi.org/10.1080/00913847.2019.1632159
2. Kerr R, Resnick D, Pineda C, Haghighi P. Osteoarthritis of the glenohumeral joint: a radiologic-pathologic study. AJR Am J Roentgenol. 1985;144(5):967-972. doi:10.2214/AJR.144.5.967
3. Petersson CJ. Degeneration of the gleno-humeral joint. An anatomical study. Acta Orthop Scand. 1983;54(2):277-283. doi:10.3109/17453678308996570
4. Harkness EF, Macfarlane GJ, Silman AJ, Mcbeth J. Is musculoskeletal pain more common now than 40 years ago?: two population-based cross-sectional studies. Rheumatology. 2005;44:890-895. doi:10.1093/rheumatology/keh599
5. Glyn-Jones S, Palmer AJR, Agricola R, et al. Osteoarthritis. Lancet. 2015;386(9991):376-387. doi:10.1016/S0140-6736(14)60802-3
6. Khazzam M, Gee AO, Pearl M. Management of Glenohumeral Joint Osteoarthritis. J Am Acad Orthop Surg. 2020;28(19):781-789. doi:10.5435/JAAOS-D-20-00404
7. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14(6):756-760. doi:10.1016/S0883-5403(99)90232-2
8. Katz P. Function, disability, and psychological well-being. Adv Psychosom Med. 2004;25:41-62. doi:10.1159/000079057
9. Neer CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 1974;56(1):1-13. doi:10.2106/00004623-197456010-00001
10. Cole BJ, Yanke A, Provencher MT. Nonarthroplasty alternatives for the treatment of glenohumeral arthritis. J Shoulder Elbow Surg. 2007;16(5 SUPPL.). doi:10.1016/j.jse.2007.03.011
11. Millett PJ, boykin robert. Shoulder Osteoarthritis: Diagnosis and Management.; 2008. www.aafp.org/afp.
12. Boselli KJ, Ahmad CS, Levine WN. Treatment of glenohumeral arthrosis. American Journal of Sports Medicine. 2010;38(12):2558-2572. doi:10.1177/0363546510369250
13. Chillemi C, Franceschini V. Shoulder Osteoarthritis. Arthritis. 2013;2013:1-7. doi:10.1155/2013/370231
14. Saltzman BM, Leroux TS, Verma NN, Romeo AA. Glenohumeral Osteoarthritis in the Young Patient. J Am Acad Orthop Surg. 2018;26(17):E361-E370. doi:10.5435/JAAOS-D-16-00657
15. Ansok CB, Muh SJ. Optimal management of glenohumeral osteoarthritis. Orthop Res Rev. 2018;10:9-18. doi:10.2147/ORR.S134732
16. Silverstein E, Leger R, Shea KP. The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med. 2007;35(6):979-985. doi:10.1177/0363546507300256
17. van der Meijden OA, Gaskill TR, Millett PJ. Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis. Orthopedics. 2012;2012. doi:10.1155/2012/160923
18. Denard PJ, Wirth MA, Orfaly RM. Management of glenohumeral arthritis in the young adult. J Bone Joint Surg Am. 2011;93(9):885-892. doi:10.2106/JBJS.J.00960
19. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008;90(5):970-979. doi:10.2106/JBJS.F.01116
20. Kwon YW, Eisenberg G, Zuckerman JD. Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial. J Shoulder Elbow Surg. 2013;22(5):584-594. doi:10.1016/J.JSE.2012.10.040
21. Leardini G, Perbellini A, Franceschini M, Mattara L. Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther. 1988;10(5):521-526. Accessed November 5, 2022. https://pubmed.ncbi.nlm.nih.gov/2856594/
22. Noël E, Hardy P, Hagena FW, et al. Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study. Joint Bone Spine. 2009;76(6):670-673. doi:10.1016/J.JBSPIN.2009.10.008
23. Valiveti M, Reginato AJ, Falasca GF. Viscosupplementation for degenerative joint disease of shoulder and ankle. J Clin Rheumatol. 2006;12(3):162-163. doi:10.1097/01.RHU.0000222057.02268.59
24. Brander VA, Gomberawalla A, Chambers M, Bowen M, Nuber G. Efficacy and safety of hylan G-F 20 for symptomatic glenohumeral osteoarthritis: a prospective, pilot study. PM R. 2010;2(4):259-267. doi:10.1016/J.PMRJ.2010.02.010
25. Colen S, Geervliet P, Haverkamp D, van den Bekerom MPJ. Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature. Int J Shoulder Surg. 2014;8(4):114-121. doi:10.4103/0973-6042.145252
26. Izquierdo R, Voloshin I, Edwards S, et al. Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg. 2010;18(6):375-382. doi:10.5435/00124635-201006000-00010
27. Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg. 2011;95(3):215-224. doi:10.1007/S12306-011-0138-3
28. Kim HM, Muhammad M, Heil SD, Smith MJ. Clinical Fate of Glenohumeral Osteoarthritis Following Intraarticular Corticosteroid Injection: An Analysis in 311 Shoulders. J Shoulder Elb Arthroplast. 2022;6:247154922210754. doi:10.1177/24715492221075446
29. Metzger CM, Farooq H, Merrell GA, et al. Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis. J Shoulder Elbow Surg. 2021;30(5):1128-1134. doi:10.1016/j.jse.2020.08.008
30. Kirschner JS, Cheng J, Creighton A, et al. Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial. Clin J Sport Med. 2022;32(6). doi:10.1097/JSM.0000000000001029
31. Chahla J, Cinque ME, Piuzzi NS, et al. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. J Bone Joint Surg Am. 2017;99(20):1769-1779. doi:10.2106/JBJS.16.01374
32. Murray IR, Geeslin AG, Goudie EB, Petrigliano FA, LaPrade RF. Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO): Platelet-Rich Plasma and Mesenchymal Stem Cells. J Bone Joint Surg Am. 2017;99(10):809-819. doi:10.2106/JBJS.16.00793
33. Centeno CJ, Al-Sayegh H, Bashir J, Goodyear SH, D Freeman M. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015;8:269-276. doi:10.2147/JPR.S80872
34. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042-1049. doi:10.1136/BJSPORTS-2014-093573
35. Soh E, Li W, Ong KO, Chen W, Bautista D. Image-guided versus blind corticosteroid injections in adults with shoulder pain: A systematic review. BMC Musculoskelet Disord. 2011;12. doi:10.1186/1471-2474-12-137
36. Patel DN, Nayyar S, Hasan S, Khatib O, Sidash S, Jazrawi LM. Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study. J Shoulder Elbow Surg. 2012;21(12):1664-1668. doi:10.1016/J.JSE.2011.11.026
37. Rijs Z, de Groot PCJ, Zwitser EW, Visser CPJ. Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res. 2021;479(11):2483-2489. doi:10.1097/CORR.0000000000001803
38. Macías-Hernández SI, Morones-Alba JD, Miranda-Duarte A, et al. Glenohumeral osteoarthritis: overview, therapy, and rehabilitation. Disabil Rehabil. 2017;39(16):1674-1682. doi:10.1080/09638288.2016.1207206
39. Guo JJ, Wu K, Guan H, et al. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients. Orthopedics. 2016;39(4):e634-e641. doi:10.3928/01477447-20160606-02
40. Onishi K, Utturkar A, Chang E, Panush R, Hata J, Perret-Karimi D. Osteoarthritis: A Critical Review. Crit Rev Phys Rehabil Med. 2012;24(3-4):251-264. doi:10.1615/CRITREVPHYSREHABILMED.2013007630
41. Menge TJ, Boykin RE, Byram IR, Bushnell BD. A comprehensive approach to glenohumeral arthritis. South Med J. 2014;107(9):567-573. doi:10.14423/SMJ.0000000000000166
42. Manca A, Dragone D, Dvir Z, Deriu F. Cross-education of muscular strength following unilateral resistance training: a meta-analysis. Eur J Appl Physiol. 2017;117(11):2335-2354. doi:10.1007/S00421-017-3720-Z
43. Crowell MS, Tragord BS. Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report. J Orthop Sports Phys Ther. 2015;45(6):453-461. doi:10.2519/JOSPT.2015.5887
44. MacHado GC, Abdel-Shaheed C, Underwood M, Day RO. Non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain. BMJ. 2021;372. doi:10.1136/BMJ.N104
45. Gordo AC, Walker C, Armada B, Zhou D. Efficacy of celecoxib versus ibuprofen for the treatment of patients with osteoarthritis of the knee: A randomized double-blind, non-inferiority trial. J Int Med Res. 2017;45(1):59-74. doi:10.1177/0300060516673707
46. Wenham CYJ, Hensor EMA, Grainger AJ, et al. A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis. Rheumatology (Oxford). 2012;51(12):2286-2294. doi:10.1093/RHEUMATOLOGY/KES219
47. da Costa BR, Reichenbach S, Keller N, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2017;390(10090):e21-e33. doi:10.1016/S0140-6736(17)31744-0
48. Zeng C, Wei J, Persson MSM, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med. 2018;52(10):642-650. doi:10.1136/BJSPORTS-2017-098043
49. Malik, A. T., Bishop, J. Y., Neviaser, A., Jain, N., & Khan, S. N. What are the costs of glenohumeral osteoarthritis in the year prior to a total shoulder arthroplasty (TSA)? Physician and Sportsmedicine. 2020; 48(1), 86–97. https://doi.org/10.1080/00913847.2019.1632159