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

What is ?

Anatomy
Glenoid labrum

Lateral view of glenoid

Who gets it ?

Incidence / Epidemiology

Primary osteoarthritis

- rare ( <5% over 65 )

Osteoarthritis 2nd to rotator cuff tear

- more common ( 30% )
Rheumatoid arthritis

- shoulder is commonly
involved

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

1. Dry type
2. Wet type
3. 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

Symptoms

Pain & 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 ?

Medical history of the patient

Drug / Medication history

Family history

History taking

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 ?
Radiography

Shoulder OA:

Investigation
- standard ( two planes )

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 ?

Operative management
Shoulder replacement arthroplasty

Treatment

How do we treat ?

Operative management
Shoulder replacement arthroplasty

Treatment