Clinical Notes : Orthopedics and Trauma
80. Glenohumeral Arthritis

If the presenting shoulder pain is not referred from the neck then consider :
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Frozen shoulder
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Acromioclavicular joint pain
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AC disruption
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AC osteoarthritis
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Rotator cuff pain
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Impingement
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Tear
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Calcific tendonitis
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Shoulder instability
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Glenohumeral arthritis
Urgent referral if shoulder pain in the presence of :
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History of trauma with acute pain & weakness
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AC joint tear or displacement
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Rotator cuff tear
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History of trauma or epileptic fit leading to loss of rotation
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SLAP tear
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History of instability or subluxation
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Dislocation
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Mass/swelling/erythema
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Infective process
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Handout : Rotator Cuff and Shoulder Conditioning Program
Glenohumeral Arthritis
Etiology :
Five major types of arthritis affect the shoulder.
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Osteoarthritis
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wear and tear arthritis
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Rheumatoid Arthritis
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autoimmune disease
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Posttraumatic Arthritis
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after an injury, such as a fracture or dislocation of the shoulder
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Rotator Cuff Tear Arthropathy
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after a large, long-standing rotator cuff tear
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Avascular Necrosis
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high dose steroid use
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heavy alcohol consumption
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sickle cell disease
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traumatic injury
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idiopathic
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Diagnosis :
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Limited range of motion (combing hair, reaching high etc.)
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Grinding, clicking or crepitus with movement
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Severe night pain
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Location of pain
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glenohumeral joint arthritis
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centered deep in the back of the shoulder
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may intensify with changes in the weather
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acromioclavicular (AC) joint
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focused on the top of the shoulder.
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can sometimes radiate to the side of the neck
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rheumatoid arthritis
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throughout the shoulder if both the glenohumeral and AC joints are affected
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Video : Differentiating shoulder arthritis from rotatot cuff injury (1:32)
Imaging
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x-ray to detect arthritis, bone spurs or other bone abnormality
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diagnostic intrarticulat local anesthetic injection (pain relief is diagnostic)

Management :
Refer to secondary care for investigation and management plan
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Non-surgical
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Rest
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Activity modification
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Warm and cold compress
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NSAIDs
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Topical analgesics
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Physical therapy
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Steroid injections
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Hyaluronic acid injections
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Surgical
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Arthroscopy
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to remove loose pieces of damaged cartilage
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Osteotomy
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to shave off osteophytes and reduce friction between bones
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Hemiarthroplasty or arthroplasty
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Video : Shoulder Arthritis Stretches & Exercises (7:24)

Glenohumeral arthritis and its management.
Parsons IM, Weldon EJ, Titelman RM, Smith KL.
Phys Med Rehabil Clin N Am. 2004 May;15(2):447-74.
Management of glenohumeral arthritis in the young adult.
Denard PJ, Wirth MA, Orfaly RM.
J Bone Joint Surg Am. 2011 May 4;93(9):885-92.

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