Clinical Notes : Orthopedics and Trauma

80. Glenohumeral Arthritis

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

  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

 

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

 

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