title: Extra-glenohumeral joint shoulder surgery in rheumatoid arthritis: The role of bursectomy, acromioplasty, and distal clavicle excision.
abstract: Twenty-four painful shoulders in patients with rheumatoid arthritis have been studied before and after extra-glenohumeral joint surgery. Preoperative local anesthetic injections were used to localize sites of pain and served as a basis for the surgical procedure performed. Radiographs were graded with the Larsen classification; 17 shoulders had radiographic evidence of advanced glenohumeral disease. Surgery included subacromial bursectomy, anterior acromioplasty, and excision of the outer end of the clavicle. At an average follow-up of 30 months (range 18 to 50 months) for 22 of the shoulders, 19 had minimal pain. Average motions improved in flexion from 68° to 121° and in external rotation from 23° to 52°. Two experienced infections, one superficial and one deep. One further operation has been necessary to treat the shoulder arthritis. Extra-glenohumeral joint surgery, planned according to the results of preoperative injection testing, has a useful role in management of the shoulder in rheumatoid arthritis, even when the glenohumeral joint is involved radiographically.
authors.affiliation: From the Orthopaedic Department of the Royal Infirmary, Glasgow, Scotland.
authors.forename: N S
authors.initials: NS
authors.lastname: Simpson
authors.forename: I G
authors.initials: IG
authors.lastname: Kelly