Shoulder Osteoarthritis

• Glenohumeral degenerative joint disease characterized by damage to the articular surfaces of the humeral head and/or glenoid.

• Can be primary (degenerative), or secondary (post traumatic, neuropathic, rotator cuff arthropathy, osteonecrosis…).

• Anatomical changes

  • Articular cartilage :irreversible progressive loss of articular cartilage with hypertrophic reaction of the subchondral bone

  • Humeral head: thinning/absence of cartilage, flattening, osteophyte and subchondral cyst formation, posterior humeral subluxation

  • Glenoid: posterior wear (see: Walch glenoid classification), subchondral cyst formation

We should distinguish between concentric and eccentric shoulder osteoarthritis.

In rotator cuff tear, the humeral head will be displaced superiorly and thus, osteoarthritis will be eccentric.

Hamada classification

Hamada et al, CORR, 254: 92-96, 1990

Clinical symptoms

• pain (worse with activities)

• decreased range of motion, especially limited external rotation

• crepitus

Imaging

• Xray AP + axillary lateral

• CT scan to evaluate glenoid wear and type

• MRI /Arthroscan to evaluate rotator cuff if needed

Treatment

• Medical treatment: NSAIDs, physical therapy as a first line, injections as a second line (steroids, hyaluronic acid ? PRP ?)

• Surgical Treatment: arthroplasty

  • anatomical total shoulder arthroplasty: concentric osteoarthritis, with functionning rotator cuff, and no gleoid abnormalities

  • reverse total shoulder arthroplasty: eccentric osteoarthritis, rotator cuff tear, Walch B3 and C (B2 is controversial)

• For young patients, we can propose arthroscopy for debridement, capsular release, biceps tenodesis, synovectomy…