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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:
1 October 2022 19:06:53
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