- Bruce C Anderson, MD
Bruce C Anderson, MD
- Associate Professor of Medicine
- Oregon Health Sciences University
Osteoarthritis of the glenohumeral joint, a wear-and-tear of the articular cartilage of the glenoid labrum and humeral head, is a relatively uncommon cause of shoulder complaints [1,2]. Trauma precedes the condition in most cases, although the injury may have occurred years earlier. Injuries that are associated with the development of osteoarthritis include previous dislocation, humeral head or neck fracture, and large rotator cuff tendon tears (cuff tear arthropathy) and may also include detachments of the superior glenoid labrum from anterior to posterior (SLAP lesions) . Primary glenohumeral osteoarthritis is more common in women and in patients over the age of 60.
Glenohumeral osteoarthritis must be distinguished from rheumatoid arthritis (RA) affecting the glenohumeral joint. Shoulder involvement is common in RA, although typically fairly late in the course of disease. In one study, 55 percent of 74 patients with RA had developed radiographic evidence of erosive glenohumeral joint disease at 15 years . The symptoms of glenohumeral osteoarthritis and RA affecting the glenohumeral joint are identical; single joint involvement in an older patient suggests the former, while multiple joint involvement tends to occur in the latter. (See "Clinical manifestations of rheumatoid arthritis".)
The clinical examination in patients with glenohumeral osteoarthritis is identical to that of patients with frozen shoulder, and presenting symptoms may be similar (see "Frozen shoulder (adhesive capsulitis)"). X-rays are diagnostic in the former.
The clinical presentation, evaluation, diagnosis, and treatment of glenohumeral osteoarthritis are reviewed here. The clinical evaluation and use of imaging in patients with shoulder complaints are discussed separately. (See "Evaluation of the patient with shoulder complaints" and "Physical examination of the shoulder" and "Radiologic evaluation of the painful shoulder".)
Patients with glenohumeral osteoarthritis complain of the gradual development of anterior shoulder pain and stiffness over a period of months to years. The patient may rub the front of the shoulder while describing the symptoms. The pain generally is aggravated by activity and is relieved by rest, although patients may complain of night pain.
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- Anderson BC. Office Orthopedics for Primary Care: Diagnosis, Third Edition, Elsevier Saunders Company, Philadelphia 2006.
- Patzer T, Lichtenberg S, Kircher J, et al. Influence of SLAP lesions on chondral lesions of the glenohumeral joint. Knee Surg Sports Traumatol Arthrosc 2010; 18:982.
- Lehtinen JT, Kaarela K, Belt EA, et al. Incidence of glenohumeral joint involvement in seropositive rheumatoid arthritis. A 15 year endpoint study. J Rheumatol 2000; 27:347.
- Green A, Norris TR. Imaging techniques for glenohumeral arthritis and glenohumeral arthroplasty. Clin Orthop Relat Res 1994; :7.
- Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am 2008; 90:970.
- Hammond LC, Lin EC, Harwood DP, et al. Clinical outcomes of hemiarthroplasty and biological resurfacing in patients aged younger than 50 years. J Shoulder Elbow Surg 2013; 22:1345.
- Cole BJ, Yanke A, Provencher MT. Nonarthroplasty alternatives for the treatment of glenohumeral arthritis. J Shoulder Elbow Surg 2007; 16:S231.
- Boyd AD Jr, Thornhill TS. Surgical treatment of osteoarthritis of the shoulder. Rheum Dis Clin North Am 1988; 14:591.
- Gartsman GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am 2000; 82:26.
- Rispoli DM, Sperling JW, Athwal GS, et al. Humeral head replacement for the treatment of osteoarthritis. J Bone Joint Surg Am 2006; 88:2637.
- Bryant D, Litchfield R, Sandow M, et al. A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87:1947.
- Singh JA, Sperling J, Buchbinder R, McMaken K. Surgery for shoulder osteoarthritis. Cochrane Database Syst Rev 2010; :CD008089.
- Frankle M, Siegal S, Pupello D, 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. J Bone Joint Surg Am 2005; 87:1697.
- Physical examination
- - Joint line tenderness
- - Restricted range of motion
- - Crepitation
- Acute period
- Persistent symptoms
- - Intraarticular injections
- Glucocorticoid injections
- Intraarticular sodium hyaluronate injections
- Referral and surgery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS