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Arthritis of glenohumeral joint — Clinical Guidelines

Overview

Glenohumeral arthritis involves degenerative changes in the shoulder joint, leading to pain, stiffness, and functional impairment. Management varies based on patient age, severity, and associated rotator cuff status 1 2 7.

Diagnosis

Clinical Presentation: Pain, crepitus, weakness, and reduced range of motion 7.

Imaging: Radiographs showing osteophyte formation, sclerosis, superior humeral head migration, and bony erosion 7.

Advanced Imaging: MRI or ultrasound to assess rotator cuff integrity, tear size, and fatty infiltration 3 7.

Management

Nonoperative: Physical therapy, corticosteroid injections, and NSAIDs for pain management 7.

Surgical Options:

- Total Shoulder Arthroplasty (TSA): Preferred for intact rotator cuffs 2. - Hemiarthroplasty: Suitable for severe rotator cuff deficiency 9. - Reverse Shoulder Prosthesis: Effective for irreparable rotator cuff tears 6 8.

Biologic Resurfacing: Emerging option for younger patients with glenohumeral arthritis 4.

Special Populations

Elderly Patients: Reverse shoulder arthroplasty shows promising short-term outcomes for severe rotator cuff deficiency 6 8.

Rotator Cuff Deficiency: Hemiarthroplasty and reverse shoulder prosthesis are key interventions 9 7.

Key Recommendations

Assess Rotator Cuff Integrity: Use advanced imaging (MRI, ultrasound) preoperatively to guide prosthesis choice (TSA vs. RSA) 3. (Evidence: Moderate)

Consider Reverse Shoulder Prosthesis: For patients with severe rotator cuff deficiency, reverse shoulder arthroplasty offers effective pain relief and functional improvement 6 8. (Evidence: Moderate)

Evaluate Patient Age and Arthritis Severity: Younger patients may benefit from biologic resurfacing, while older patients with severe arthritis may require prosthetic replacement 4. (Evidence: Expert opinion)

References

1 Colasanti CA, Lin CC, Simovitch RW, Virk MS, Zuckerman JD. International consensus statement on the management of glenohumeral arthritis in patients ≤ 50 years old. Journal of shoulder and elbow surgery 2023. link 2 Singh Jagdev B, McGrath J, Cole A, Gomaa AR, Chong HH, Singh HP. Total shoulder arthroplasty vs. hemiarthroplasty in patients with primary glenohumeral arthritis with intact rotator cuff: meta-analysis using the ratio of means. Journal of shoulder and elbow surgery 2022. link 3 Levin JM, Wickman J, Lazarides AL, Cunningham DJ, Goltz DE, Mather RC et al.. Is Advanced Imaging to Assess Rotator Cuff Integrity Before Shoulder Arthroplasty Cost-effective? A Decision Modeling Study. Clinical orthopaedics and related research 2022. link 4 Burkhead WZ, Krishnan SG, Lin KC. Biologic resurfacing of the arthritic glenohumeral joint: Historical review and current applications. Journal of shoulder and elbow surgery 2007. link 5 Gutiérrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. Journal of shoulder and elbow surgery 2007. link 6 Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M et al.. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. The Journal of bone and joint surgery. American volume 2006. link 7 Laudicina L, D'Ambrosia R. Management of irreparable rotator cuff tears and glenohumeral arthritis. Orthopedics 2005. link 8 Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. The Journal of bone and joint surgery. American volume 2005. link 9 Sanchez-Sotelo J, Cofield RH, Rowland CM. Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. The Journal of bone and joint surgery. American volume 2001. link

Arthritis of glenohumeral joint