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Glenohumeral Arthritis

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Other Names

  • Shoulder Arthritis
  • Shoulder OA
  • Glenohumeral OA
  • Shoulder Osteoarthritis
  • Shoulder Arthropathy
  • Rotator Cuff Arthropathy

Background

Epidemiology

  • Incidence increases with age (need citation)
  • Women > men (need citation)
  • Chondral injuries (early OA) seen in 4-17% of patients undergoing routine arthroscopy[1]
  • Third most common joint replaced after hip and knee[2]

Pathophysiology

Primary Osteoarthritis

  • Only 25-30% of the humeral head articulates with the glenoid fossa at any given time[3]
    • This facilitates increased range of motion at a cost of decreased stability
  • Irreversible loss of articular cartilage, hypertrophic subchondral bone
  • The humeral head undergoes flattening, ostephyte and subchondral cyst formation, posterior subluxation
  • Glenoid is also worn down with subchondral cyst formation

Secondary Osteoarthritis

  • Rheumatoid Arthritis
    • Chronic synovial inflammation, degeneration of joint, medialization of humeral head
    • Occurs in up to 90% of patients with RA (need citation)
    • Can also occur with Gout, Pseudogout
  • Post-traumatic
    • Commonly seen following proximal humerus fractures and shoulder dislocations
  • Septic Arthritis
  • Neuropathic
  • Osteonecrosis or Avascular Necrosis
    • Loss of blood supply with subsequent collapse of subchondral bone and joint degeneration
  • Rotator cuff arthropathy
    • Rotator cuff tears lead to abnormal glenohumeral articulation

Associated Conditions

Pathoanatomy


Risk Factors


Differential Diagnosis


Clinical Features

  • General: Physical Exam Shoulder
  • History
    • Patients endorse pain, decreased function, and/or loss of motion
    • Pain often is vague and nonspecific
    • Most often patients will endorse chronic, progress symptoms
    • There may be a history of remote trauma or surgery
    • Pain often worse at night or with activity
    • Patients may also endorse catching, locking, or popping
  • Physical
    • May be relatively normal in the setting of mild or moderate symptoms
    • Patients may experience loss of range of motion
    • Mechanical signs include grinding, popping
    • Atrophy of rotator cuff muscles may be observed
  • Special Tests

Evaluation

Shoulder XR - AP view showing glenohumeral osteoarthritis and high riding humeral head
Shoulder XR - Severe glenohumeral osteoarthritis

Radiographs

  • Standard Radiographs Shoulder
  • Arthritis findings: Joint space narrowing, osteophytes, subchondral sclerosis, Cyst
  • High riding humeral head suggests cuff arthropathy

CT

  • Study of choice to evaluate osseous anatomy
  • Consider arthrogram

MRI

  • Better for evaluating soft tissue structures
  • May demonstrate subchomdral edema in OA
  • Helpful for surgical planning and decision making, especially integrity of rotator cuff

Diagnostic Injection

  • See: Glenohumeral Joint Injection
  • Diagnostic injection can help clarify etiology of shoulder pain
  • This can be done as a separate procedure OR during arthrogram for CT/MRI
  • This should be performed under fluoroscopy or ultrasound guidance

Classification

Walch Classification of Glenoid Wear

  • Type A[5]
    • Concentric wear, no subluxation of HH, well centered
    • A1: no or minor central erosion
    • A2: deeper central erosion, line connects anterior/posterior glenoid rims and transects humeral head (HH)
  • Type B
    • Biconcave glenoid, asymmetric glenoid wear and head subluxated posteriorly
    • B0: pre-osteoarthritic posterior subluxation of HH
    • B1: posterior joint narrowing (no posterior bone loss), osteophytes, subchondral sclerosis
    • B2: posterior rim erosion, retroverted glenoid
    • B3: monoconcave, posterior wear, at least HH subluxation >70% OR retroversion >15%
  • Type C
    • C1: Glenoid retroversion >25 degrees, regardless of erosion
    • C2: Biconcave, posterior bone loss, posterior translation of HH
  • Type D
    • Glenoid anteversion or anterior HH subluxation (HH subluxation <40%)

Management

Nonoperative

Operative

  • Indications
    • Failure of nonoperative management
  • Technique
    • Total shoulder arthroplasty (TSA) if rotator cuff intact
    • Hemiarthroplasty
    • Reverse shoulder arthroplasty (RSA) if large or irreparable rotator cuff tear
    • Arthroscopy
    • Arthrodesis

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Needs to be updated

Complications

  • Chronic Pain
  • Loss of ADLS, function

See Also


References


  1. Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS: Arthroscopic findings in the overhand throwing athlete: Evidence for posterior internal impingement of the rotator cuff. Arthroscopy 2000;16(1):35-40.
  2. Gross, Christopher E., Geoffrey S. Van Thiel, and MBA Nikhil N. Verma. "Epidemiology and Etiologies of Glenohumeral Arthritis." (2012).
  3. Murray IR, Goudie EB, Petrigliano FA, et al. Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 2013;32:607Y624.
  4. Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability. J Shoulder Elbow Surg. 1998;7(1):43–52.
  5. https://www.orthobullets.com/shoulder-and-elbow/3058/glenohumeral-arthritis
Created by:
John Kiel on 4 July 2019 08:28:19
Authors:
Last edited:
10 July 2022 15:11:55
Categories: