Glenohumeral arthritis and its management.
Glenohumeral arthritis has many different etiologies, including osteo-arthritis, secondary degenerative joint disease, rheumatoid arthritis,avascular necrosis, cuff tear arthropathy, and capsulorrhaphy arthropathy. Each of these diagnoses may have different underlying pathoanatomy and pathomechanics. The treating physician must recognize how these characteristics impair shoulder function so that the prescribed course of treatment addresses the root causes of shoulder dysfunction. The patient's age. level of physical activity, and comorbidities should be taken into account, and the intended management should be weighed against how these factors may interfere with treatment efficacy over the long-term. The goal of treatment is to restore comfort, motion, strength, and stability to the shoulder in a safe and reliable manner. Conservative treatments should aim to optimize shoulder flexibility, maintain muscle function, and reduce inflammation. Activity modification is crucial but often unreasonable to the active patient. Temporary surgical approaches include arthroscopic debridement and synovectomy. These approaches may be appropriate for a younger patient with some remaining joint space and a functional rotator cuff. Definitive surgical treatment typically involves either a proximal humerus replace mentor a total shoulder replacement. The decision to resurface the glenoid should be based on the patient's age, diagnosis, available bone stock, and physical demands. The surgeon must be familiar with the options provided by the given implant system so that the proper balance of motion and stability can be restored with a close approximation of the native anatomy. Inexperienced hands, good-to-excellent results can be achieved in greater than 90% of properly selected patients. Glenoid component failure is one of the most common complications of shoulder arthroplasty, highlighting the need to select carefully patients in whom glenoid resurfacing is warranted.
Parsons
I M
IM
Seacoast Orthopaedics and Sports Medicine, 237 Route 108, Suite 205, Somersworth, NH 03878, USA.
Weldon
Edward J
EJ
Titelman
Robert M
RM
Smith
Kevin L
KL
D001168:Arthritis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001178:Arthroplasty; D001182:Arthroscopy; D003646:Debridement; D006801:Humans; D011859:Radiography; D012785:Shoulder Joint