title: [Operative treatment of the rheumatic shoulder].
abstract: The duration and severity of rheumatic diseases of the shoulder correlate with symptom frequency, structural changes and associated functional limitations. The multifactorial character of the underlying rheumatic disease requires a multimodal therapeutic concept including interaction of surgical and non-surgical disciplines. In addition to basic systemic anti-inflammatory medication, injections targeting the synovial tissue by corticoid instillation and glenohumeral radiosynoviorthesis (with an intact rotator cuff) are further options. Operative interventions on rheumatic shoulders can be characterized as disease-modifying, protective, reconstructive or palliative, depending on the stage. Combining minimally invasive arthroscopic surgical techniques with modern basic therapy has the potential to shift the indications for operative interventions towards an earlier stage of disease without favoring or propagating structural alterations which have already occurred. In cases of severe joint destruction with loss of the rotator cuff, reverse shoulder arthroplasty can be an appropriate option.
authors.affiliation: Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland. g.heers@asklepios.com.
authors.forename: G
authors.initials: G
authors.lastname: Heers
authors.affiliation: Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Grifka
authors.affiliation: Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
authors.forename: H R
authors.initials: HR
authors.lastname: Springorum
authors.affiliation: Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Craiovan
authors.affiliation: Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Anders
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D001182:Arthroscopy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D007270:Injections, Intra-Articular; D010166:Palliative Care / Q000379:methods; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D019651:Plastic Surgery Procedures / Q000379:methods*; D012785:Shoulder Joint / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery*
chemical_list: D018501:Antirheumatic Agents; D019275:Radiopharmaceuticals
keywords: Corticoids; Multimodal therapy concept; Rheumatic diseases; Shoulder arthroplasty; Synovial tissue