Degenerative and rheumatoid arthritis of glenohumeral joint

Learning Objectives

What is?Who gets?What types?How does manifest ?How do we investigate ?How do we treat? Definition / Anatomy Incidence Acute / Chronic Hystory / Physical exam Investigation Treatment

What is ? Definition

Impairment of the integrity of the glenohumeral joint has the most significant effect on overall capacity of the shoulder

What is ? Anatomy

Bony structures

Anterior view

Bony architecture accounts for its tendency to dislocate

It is a ball and socket articulation with glenoid covering 1/3 of the humeral articular surface

What is ? Anatomy

Glenoid labrum

Lateral view of glenoid

Who gets it ? Incidence / Epidemiology

Primary osteoarthritis - rare (

What types? Osteoarthritis

Pathology

Subchondral sclerosis

Subchondral cysts

Osteophytes humeral head ( inferiorly & posteriorly )

Glenoid flattened

Osteohcondral loose bodies in the joint

What types? Rheumatoid arthritis

Pathology

Dry type Wet type Resorptive type

Severity

Mild

Moderate

Severe

What types? Arthritis 2nd to trauma

Recurrent dislocations

Fracture dislocation

Fractures of humeral head

Non-union / Mal-union of proximal humeral fractures

What types? Cuff tear arthropathy

Longstanding presence of massive rotator cuff tear

Loss of integrity of the joint space

Mechanical factors

&

Nutritional factors ( leakage of synovial fluid )

How does manifest ? Clinical evaluation

SymptomsPain & Functional Impairment

History - gradual onset

- pain aggravated by activity

- pain exacerbated at night

sleep in the chair

- limitations in daily activities

( getting dressed, brushing hair, writing )

How does manifest ? History taking

Medical history of the patient

Drug / Medication history

Family history

How does manifest ? Physical Examination

Look

Muscle wasting - generalized

Surgical / traumatic scars

Distorted contour of shoulder ( flattened, squared-shoulder )

Swelling soft tissue lump ( synovial fluid )

Look at other joints ( ? Rheumatoid arthritis )

How does manifest ? Physical Examination

Feel

Painful at palpation joint line of shoulder

Collection of synovial fluid

Crepitation

Squeaking noise severe

How does manifest ? Physical Examination

Move

Limitation of shoulder movement - restricted to scapulo-thoracic

Internal & External rotation limited the most

How do we investigate ? Investigation

Radiography - standard ( two planes )

Shoulder OA: reduction of joint space, bone sclerosis

inferior ostophyte

How do we investigate ? Investigation

Radiography - standard ( two planes )

Shoulder RA: diffuse osteopenia & erosion of humeral head

How do we investigate ? Investigation

Other Investigations

CT - useful in assessment of severely damaged shoulders

Standard Lab tests - ? Inflammatory arthritis

? Haemathologic conditions

? Metabolic disease

Local anesthetic injections AC joint to localize the pain

How do we treat? Treatment

Non operative treatment

Painkillers & NSAIDs

Physiotherapy

Intra-articular / Intra-bursal steroid injection

Specific treatment of the condition ( RA )

How do we treat ? Treatment

Operative management

Synovectomy

Open / Arthroscopic procedure - excision of subacromial bursa

- removal of synovial membrane

Debridement

Open / Arthroscopic - results could be disappointing

- young / middle aged patients

How do we treat ? Treatment

Operative management

Shoulder replacement arthroplasty

1.bin

How do we treat ? Treatment

Operative management

Shoulder replacement arthroplasty

3.bin