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 TreatmentWhat 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 typeSeverity
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.binHow do we treat ? Treatment
Operative management
Shoulder replacement arthroplasty
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