Surgical management includes comprehensive arthroscopic management (cam procedure) 12 and different options of shoulder arthroplasty from anatomic total shoulder arthroplasty over shoulder resurfacing arthroplasty or hemiarthroplasty to reverse total shoulder arthroplasty 3,6,7. Intra-articular injections of steroids and hyaluronic acid are other options 3,4,7. Non-operative management includes patient education, lifestyle and activity modifications and physical therapy as well as pain management with acetaminophen and nonsteroidal anti-inflammatory drugs. The main objectivities are pain control and functional maintenance or restoration. Management strategies include conservative non-surgical measures as well as surgical modalities and should be individualized to the patient’s fitness and functional requirements 3,4,7. rotator cuff pathology, in particular, massive and full-thickness rotator cuff tears and subscapularis tears.subchondral bone marrow edema like signal.In addition to the above-mentioned features the MRI report should include the description of the following: subchondral fractures, signs of osteonecrosis presence of subchondral cysts and/or bone erosion. presence and the location of osteophyte formation.joint space narrowing and joint space width.The radiological report should include a description of the following: In exchange, it provides valuable information in the evaluation of the rotator cuff, which forms an integral part of surgical planning. The capacity in the detection of cartilage injury is however limited if compared to other joints (e.g. It allows the assessment of a variety of tissue abnormalities including cartilage, labrum and the glenohumeral ligaments. In addition to the visualization of glenoid and humeral head morphology, MRI can help in the detection of underlying etiology. CTĬomputed tomography provides information on glenoid and proximal humeral anatomy and is invaluable for surgical planning in the assessment of the amount of bone stock. Ultrasound can be used in the evaluation and workup of shoulder pain in particular shoulder impingement and rotator cuff tears, which represent an important differential diagnosis and critical criterium in surgical management. It utilizes the size of inferior humeral osteophytes 4,5: Specifically for the glenohumeral joint, a classification scheme originally suggested by Samilson and Prieto for glenohumeral osteoarthritis in the setting of glenohumeral instability 11 has been used for grading due to its simplicity and reproducibility. bony erosions/subchondral cyst formationĪ radiological classification system generally used for the assessment of osteoarthritis is the Kellgren and Lawrence score which can also be used for the glenohumeral joint 10.Principal signs of osteoarthritis are the following: Plain radiographĪnteroposterior and lateral views of the shoulder are the main modality for the diagnosis and assessment. Subchondral cyst formation and remodeling of the articular surfaces or deformity are seen in more advanced stages. General features are osteophyte formation, joint space narrowing and sclerosis of the subchondral bone plate. Similar to other joints glenohumeral osteoarthritis of the shoulder can be classified into primary and secondary, depending on whether it is due to a known predisposing factor or not.Īn important classification scheme in the workup of glenohumeral osteoarthritis with regard to the management is the Walch classification of glenoid morphology which was later modified by Bercik et al. iatrogenic, e.g. multiple intra-articular steroid injections.EtiologyĬauses for the development of glenohumeral osteoarthritis include the following 3-6: Soft tissue changes associated with the condition are capsular thickening and contraction potentially leading to an internal rotation deficit and further eccentric posterior glenoid erosion 3. Like in other diarthrodial joints glenohumeral osteoarthritis is associated with thickening of the subchondral bone plate and marginal osteophyte formation, which usually can be seen at the posterior glenoid rim and the central part of the humeral head first. These alterations are thought to arise from an imbalance between destruction and repair of the affected tissues 3,5. Generally, osteoarthritis is characterized by progressive joint alteration, due to a combination of mechanical, inflammatory and metabolical factors not only affect the hyaline cartilage but also the surrounding tissues, including the subchondral bone, the joint capsule and the synovium as well as the ligaments and in case of the shoulder the rotator cuff.
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