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Glenohumeral Arthritis
From WikiSM
Contents
Other Names
- Shoulder Arthritis
- Shoulder OA
- Glenohumeral OA
- Shoulder Osteoarthritis
- Shoulder Arthropathy
- Rotator Cuff Arthropathy
Background
- This page describes osteoarthritis of the Glenohumeral Joint
- Defined as degeneration of the articular surfaces of the humeral head and glenoid
- Also includes discussion of Rheumatoid Arthritis affecting the glenohumeral joint
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
- Static Stabilizers
- Negative intra-articular pressure[4]
- The bony geometry of the glenoid surface of the Scapula and Humeral Head
- Glenoid Labrum
- Glenohumeral Joint Capsule
- Glenohumeral Ligament Complex
- Coracohumeral Ligament
- Dynamic Stabilizers
Risk Factors
- Rotator Cuff Tear
- 5-10% of cases of OA and 25-50% of cases of RA (need citation)
- Older age
- Shoulder Dislocation
Differential Diagnosis
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Separations
- Arthropathies
- Muscle & Tendon Injuries
- Rotator Cuff
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
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
- Passive Compression Test: Apply axial compression while passively internally and externally rotating
Evaluation
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
- Generally considered first line management
- Treatment options
- Relative rest
- Activity modification
- Physical Therapy
- Medications including NSAIDS, Acetaminophen
- Intra-articular Corticosteroid Injection under ultrasound or fluoroscopy guidance
- Viscosupplementation is an off-label option
- Regenerative Medicine has mixed and limited evidence
- Heat
- Ice
- Supplements: Glucosamine, Chondroitin
- Acute arthritis "flare" can consider
- Brief period of immobilization in Shoulder Sling
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
- Internal
- External
- Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/
- https://www.sportsmedreview.com/blog/treatment-glenohumeral-osteoarthritis/
References
- ↑ 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.
- ↑ Gross, Christopher E., Geoffrey S. Van Thiel, and MBA Nikhil N. Verma. "Epidemiology and Etiologies of Glenohumeral Arthritis." (2012).
- ↑ Murray IR, Goudie EB, Petrigliano FA, et al. Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 2013;32:607Y624.
- ↑ Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability. J Shoulder Elbow Surg. 1998;7(1):43–52.
- ↑ https://www.orthobullets.com/shoulder-and-elbow/3058/glenohumeral-arthritis
Created by:
John Kiel on 4 July 2019 08:28:19
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Last edited:
1 October 2022 19:06:53
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