Osteoarthritis

EpidemiologyShoulder OA

 

Usually 50-60 years old

 

Aetiology

 

1° uncommon

 

2° most common

- AVN

- trauma

- cuff arthropathy (Neer)

- instability

 

Pathology

 

Cuff & biceps intact as rule

- rare to have OA and rotator cuff pathology

 

Inferior osteophytes 

- beard

 

Retroversion of glenoid 

- posterior wear

 

Posterior subluxation not uncommon

 

Shoulder OA Posterior Subluxation

 

Tight anterior capsule & subscapularis

- limitation of ER

 

Post traumatic

- always soft tissue contracture

- limitation of ER

- CH ligament and rotator interval contracted

- malunion of tuberosities leads to impingement and offset of normal cuff action

- non-union results in extensive shortening of cuff

- scarring about axillary nerve

 

Signs

 

Global painful restriction of range of movement 

- due to incongruity of joint surfaces

- crepitus

- limitation of ER

 

DDx Limitation ER

 

Frozen Shoulder

Chronic posterior dislocation

Arthrodesis = Lack of ER

Post septic arthritis

 

X-ray

 

Shoulder OAShoulder OA Xray

 

Typical changes of OA

1. Teardrop osteophytes on inferior head & glenoid

2. Osteochondral loose bodies

 

Shoulder Loose Body

 

DDx

- cuff arthopathy - proximal migration of head & subacromial sclerosis

 

Arthroscopy

 

Shoulder OA GlenoidShoulder OA Debridement

 

Management

 

Non-operative

 

Education & Reassurance

- Analgesia

- NSAID

- Physio

ROM

Strengthening

 

Operative

 

1.  Arthroscopic Debridement

 

Concept

- if patient has acromial spur and acromioclavicular pathology

- may benefit from debridement

- concept of limited goals

 

Technique

 

A.  Glenohumeral joint

- deal with biceps tendon pathology if present (tenotomy / tenodesis)

- synovectomy

 

Shoulder OA Synovitis

 

B.  Subacromial space

- acromioplasty

- CA ligament left intact

- ACJ resection

 

C.  Removal beard osteophyte

- additional option

- may improve ROM

- risk of axillary nerve injury

 

2.  Arthrodesis

 

Indication

- may be considered in young active patient

 

Issues

- good pain relief but limitation movement

- difficult to perform

- rarely done in the modern age

 

3.  Excision Arthroplasty

 

Issue

- good pain relief but main problem is flail arm

 

4.  Arthroplasty

 

Options

- hemiarthroplasty (young patient or insufficient glenoid bone stock)

- TSR