Clinical Notes : Orthopedics and Trauma

80. Glenohumeral Arthritis

Glenohumeral Arthritis

Etiology

Diagnosis 

Management

​

- References -

- CPD Quiz -

If the presenting shoulder pain is not referred from the neck then consider :

1. Frozen shoulder

2. Acromioclavicular joint pain

   • AC disruption

   • AC osteoarthritis

3. Rotator cuff pain

   • Impingement

   • Tear

   • Calcific tendonitis

4. Shoulder instability

   • SLAP tear

   • Dislocation

5. Glenohumeral arthritis

Urgent referral if shoulder pain in the presence of :

• History of trauma with acute pain & weakness

  • AC joint tear or displacement

  • Rotator cuff tear

• History of trauma or epileptic fit leading to loss of rotation

  • SLAP tear

• History of instability or subluxation

  • Dislocation

• Mass/swelling/erythema

  • Infective process

Video : True shoulder pain vs referred neck pain (5:01)

How to differentiate between shoulder pain originating from the neck and pain originating from localised shoulder pathology.

Table : Shoulder pain mapping

Visual guide to pain location in the main shoulder pathologies

Video : Complete shoulder exam for the GP (3:39)

The systematic approach to examination of the shoulder

Handout : Rotator Cuff and Shoulder Conditioning Program

AAOS : American Academy of Orthopedic Surgeons

Selected stretching and strengthening exercises, adaptable for individualised management and rehabilitation after shoulder injury or surgery.

Glenohumeral Arthritis

Etiology :

Five major types of arthritis affect the shoulder.

• Osteoarthritis

  • wear and tear arthritis

• Rheumatoid Arthritis

  • autoimmune disease

• Posttraumatic Arthritis

  • after an injury, such as a fracture or dislocation of the shoulder

• Rotator Cuff Tear Arthropathy

  • after a large, long-standing rotator cuff tear

• Avascular Necrosis

  • high dose steroid use

  • heavy alcohol consumption

  • sickle cell disease

  • traumatic injury

  • idiopathic

Diagnosis :

• Limited range of motion (combing hair, reaching high etc.)

• Grinding, clicking or crepitus with movement

• Severe night pain

• Location of pain

  • glenohumeral joint arthritis

    • centered deep in the back of the shoulder

    • may intensify with changes in the weather

  • acromioclavicular (AC) joint

    • focused on the top of the shoulder.

    • can sometimes radiate to the side of the neck

  • rheumatoid arthritis

    • throughout the shoulder if both the glenohumeral and AC joints are affected

​​Video : Differentiating shoulder arthritis from rotatot cuff injury  (1:32)

Imaging

• x-ray to detect arthritis, bone spurs or other bone abnormality

• diagnostic intrarticulat local anesthetic injection (pain relief is diagnostic)

Management :

Refer to secondary care for investigation and management plan

• Non-surgical

  • Rest

  • Activity modification

  • Warm and cold compress

  • NSAIDs

  • Topical analgesics

  • Physical therapy

  • Steroid injections

  • Hyaluronic acid injections

• Surgical

  • Arthroscopy

    • to remove loose pieces of damaged cartilage

  • Osteotomy

    • to shave off osteophytes and reduce friction between bones

  • Hemiarthroplasty or arthroplasty

​​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.

Access

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.

Access

CPD Quiz and Certificate

This activity attracts 1,0 CPD point