Glenohumeral Osteoarthritis

Shoulder pain is one of the commoner complaints seen by GPs. The shoulder girdle consists of five separate joints: the joints of the sternoclavicular, acromioclavicular, subacromial, glenohumeral and scapulothoracic. Problems in one of these can cause shoulder pain.

Patients may also suffer from shoulder pain referred from remote areas such as the cervical spine, thoracic inlet, mediastinum and lungs, diaphragm, and even problems in the diaphragm, such as liver problems. Thus, the clinician should keep an open mind as to the cause of shoulder symptoms, but here will focus on problems within the shoulder girdle.

The sternoclavicular joint
It is a synovial joint with a small meniscus, and lies between the manubrium of the sternum and medial end of clavicle. Problems with this joint are rare, which is just as well because the solutions to the sternoclavicular pain tends not to be effective. degenerative changes in this county is generally post-traumatic and can be treated in general by a series of three injections of hydrocortisone in the sternoclavicular joint. Excision arthroplasty of the joint can be done in severe cases. Sternoclavicular dislocations are rare and are usually treated conservatively with patients are managed symptomatically.

If the patient continues to have pain and instability of a dislocation or subluxation long sternoclavicular surgical options include either stabilizing or dislocated joint excision arthroplasty, but only about half the patients improved significant.

Problems affecting the glenohumeral joint
The glenohumeral joint is the main town of the shoulder girdle and may be involved in a number of problems.

Glenohumeral osteoarthritis
This is a painful, stiff shoulder and is confirmed radiologically with the expected signs of loss of joint space, subchondral sclerosis, cysts and osteophyte formation. Management is usually conservative with analgesics, NSAIDs and intra-articular injections of steroids. Joint replacement is rarely necessary.

Adhesive capsulitis
This is a poorly understood disease, presenting with spontaneous emergence of increasing pain and stiffness of the shoulder girdle. The condition affects the lining normally lax glenohumeral joint.

Marked inflammation of the lining of the town led to the joint capsule, which tend to stick together, producing a markedly restricted range of motion at the glenohumeral joint. Patients have limited internal and external rotation compared to the healthy side, with a low degree of elevation restricted.

The natural history is usually eight months of pain, followed by eight months of pain and stiffness, followed by eight months of the stiffness before the resolution. Therefore, after 24 months, the majority of patients with this condition to resolve. The diagnosis is made from history, examination and radiographs were normal.

Management is to educate the patient about the natural history of disease, and symptoms are managed according to their severity. Some patients are so disabled by the condition that they need a manipulation under anesthesia and intra-articular steroids.

glenohumeral instability
The extreme mobility of the glenohumeral joint is achieved because the socket is only one third of the surface of the ball of the humeral head. This architectural arrangement allows great mobility at the expense of stability. shoulder instability is therefore a common problem.

In 90-95 percent of cases, there is anteroinferior dislocation. Patients with three or more dislocations, which have become recurrent dislocators, should be referred to the consideration of Surgic.