I have pretty bad shoulder arthritis in my left shoulder. Fortunately, I am right-handed, so I can cope. I’d like to keep treating it without surgery for as long as possible. But I don’t want to waste money on things that don’t work. What do you recommend I try?

Conservative (nonoperative) care for shoulder osteoarthritis is often recommended before patients consider surgery. Often a short-course of antiinflammatories, pain relievers, and/or physical therapy provide short-term relief from painful and disabling symptoms.

It’s amazing how a little pain relief can go a long way to improving function and therefore quality of life. But questions have been raised as to how long pain relief lasts with these conservative approaches. Is the money well-spent if the pain comes back and/or disability continues to progress?

Studies to support (or refute) nonoperative care are lacking. In fact, clinical practice guidelines recently published by the American Adademy of Orthopaedic Surgeons (AAOS) couldn’t support the use of any of these nonoperative methods of treatment.

That’s not to say you can’t get relief from your painful symptoms with antiiflammatories or physical therapy. It just means there haven’t been enough studies done to say one way or the other what works best and what doesn’t work at all.

Until we have firm evidence from high-quality studies, it’s up to each patient to discuss the particulars of his or her problem with the physician and chart a course of action. It may take a while to find the right treatment or combination of treatments that work best for you.