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Glenohumeral joint arthritis

Glenohumeral (shoulder) arthritis is a common source of pain and disability that affects up to 20% of the older population. Damage to the cartilage surfaces of the glenohumeral joint (the shoulder’s “ball-and-socket” structure) is the primary cause of shoulder arthritis.

What does the inside of the shoulder look like?

The shoulder is the most mobile joint in the human body with a complex arrangement of structures working together to provide the movement necessary for daily life. Unfortunately, this great mobility comes at the expense of stability. Several bones and a network of soft tissue (ligaments, tendons, and muscles), work together to produce shoulder movement. They interact to keep the joint in place while it moves through extreme ranges of motion. Each of these structures makes an important contribution to shoulder movement and stability. Certain work or sports activities can put great demands upon the shoulder, and injury can occur when the limits of movement are exceeded and/or the individual structures are overloaded. Click here to read more about shoulder structure.


What is glenohumeral joint arthritis?

Glenohumeral joint arthritis is caused by the destruction of the cartilage layer covering the bones in the glenohumeral joint. Friction between the humerus and the glenoid increases, so the shoulder no longer moves smoothly or comfortably. As osteophytes develop, motion is gradually lost. A number of conditions can lead to the breakdown of cartilage surfaces:

  • Wear and tear over time
  • Trauma (such as a fracture or dislocation)
  • Infection
  • chronic (long-standing) inflammatory condition (such as rheumatoid arthritis)
  • Osteonecrosis (bone death caused by loss of blood supply)
  • Chronic rotator cuff tears in which the head of the humerus (the upper bone in the arm) loses its proper position in the middle of the glenoid (socket)
  • Rare congenital and metabolic conditions
  • Post-surgical changes that can be a result of over-tightening during instability surgery


What are the signs and symptoms of glenohumeral arthritis?

Pain from bone-on-bone rubbing within the joint is the most common symptom of glenohumeral arthritis

  • At first the pain may come and go, but it tends to increase with time, usually over several years.
  • Movement usually adds to the discomfort.
  • The pain is commonly present at night, and interferes with sleep.
  • There may or may not be pain at rest.

Loss of motion is another common symptom. Possible causes of motion loss include:

  • Osteophytes that block joint motion
  • Constriction of the joint capsule due to chronic inflammation, pain, and disuse
  • Fractures or previous surgeries that may have changed joint structure and interfered with motion
  • Weakness of the supporting muscles following a rotator cuff tear

Other symptoms may be:

  • Atrophy (wasting away) of shoulder muscles due to disuse
  • Swelling in the shoulder due to inflammation
  • Crepitus (clicking or crunching sound) during shoulder motion
  • Tenderness with palpation (touch) affecting the entire shoulder region or specific areas


How is glenohumeral arthritis diagnosed?

The doctor will first obtain a history of the patient’s symptoms and health over the past several years. Those who suffer from shoulder arthritis typically report an increase in pain over several years. Patient has any conditions that may be the underlying cause of osteoarthritis such as:

  • Previous trauma or surgery to the shoulder
  • An infection in the shoulder
  • A previous rotator cuff tear
  • Osteoarthritis or rheumatoid arthritis in other joints

Next, the doctor will do a physical examination of the shoulder to evaluate the symptoms and reveal other conditions that may exist.

X-ray imaging of the shoulder can confirm a diagnosis of glenohumeral arthritis. With x-ray, the doctor can see structural changes that indicate arthritis, such as:

  • Irregularity of the joint surface
  • Osteophytes, typically located on the lower part of the joint
  • Bone erosion on the humeral head, glenoid, or both.
  • Glenoid bone loss is often visible on the backside of the joint.

Other imaging techniques used to make the diagnosis include:

  • CT-Scan (Computer Tomography) – This test shows the extent of glenoid bone loss and any anatomic abnormalities that may affect treatment.
  • Arthrogram – This technique is useful in the evaluation of rotator cuff tears
  • MRI (Magnetic Resonance Image) – Although not as commonly used to diagnose arthritis as other imaging studies, an MRI can provide detailed information about the soft tissue structures of the joint.


What is the prognosis of Glenohumeral Joint Arthritis?

There is no cure for glenohumeral joint arthritis. Medications, physical therapy, and other treatment options help slow the progression of the disease and relieve symptoms. Surgery may be needed if the condition does not respond to available nonsurgical treatments.


What are the treatments of Glenohumeral Joint Arthritis?

The doctor may recommend the following:

  • Resting and applying ice and heat alternatively over the shoulder
  • Over-the-counter pain medications like naproxen. If these don’t relieve pain, he may recommend prescription pain medications.
  • Disease-modifying anti-rheumatic drugs (DMARDs) in case of rheumatoid arthritis
  • A hyaluronic injection to provide for artificial lubrication
  • Strengthening and stretching exercises that help reduce pain and increase range of motion. A physical therapist can help devise an individualized exercise plan.


What are interventional managements?

There are many non-surgical interventional managements before going for surgery. These are:

  1. Intraarticular steroid injection is the simplest one. It relieve pain and improve the symptoms.
  2. Platelet rich plasma injection helps in regeration of joint when joint is degenerated.
  3. Radiofrequency or cryoablation helps in reducing pain when other options has failed and the pationt is not willing for operation.
  • Surgery is the last resort. Various surgeries are performed to either replace the total shoulder joint, replace the humeral head, or cut a part of the collar bone.