Glenohumeral (shoulder) degenerative joint disease is defined by damage to the articular (joint) surface of the humeral head and/or glenoid. Arthritis etiology is primary or secondary (due to another cause).
Secondary osteoarthritis may be due to:
- Chronic or repeated dislocations
- Inflammatory arthritis
- Rotator cuff arthropathy
- Crystalline arthritis
- Charcot Arthropathy
Shoulder arthritis is more likely to occur in those over the age of sixty and is more common in women.
Signs and Symptoms
Pain is generally worse with activity, whereas rest improves symptoms. Sleep is often difficult. Motion may be limited, particularly with external rotation.
Physical Examination and Work-up
On examination, patients often limitations in active and passive range of motion, as well as grinding/crepitus during motion. There may or may not be associated weakness of the rotator cuff musculature, and careful examination is essential.
X-rays are utilized to make the diagnosis of osteoarthritis presence of joint space narrowing, osteophytes, subchondral sclerosis and posterior glenoid wear. MRI is not needed to make a diagnosis of osteoarthritis but may be used for pre-operative planning to evaluate the integrity of the rotator cuff. CT scans evaluate morphology of the glenoid and allow for pre-operative templating.
Management of Rotator Cuff Arthropathy
Physical therapy, activity modification, NSAIDs and injection are the mainstays of first line treatment. If non-operative treatment fails, total shoulder arthroplasty (TSA) is considered. TSA requires a well-functioning rotator cuff and good bone stock. Post-operative rehabilitation is closely monitored and guided with criterion-based advancement based on regular exercise testing intervals at the COSMO Fit Lab.