Glenohumeral Arthritis - Arthritis of the Shoulder

What Is Glenohumeral Arthritis?

Glenohumeral arthritis is an inflammatory disease of the glenohumeral joint, which is the ball and socket joint of the shoulder that causes pain, rigidity, and loss of functional movement in the shoulder. It is a degenerative type of arthritis affecting the joint cartilage, bone, ligaments, muscles, and the synovial membrane.

What Is the Cause of Glenohumeral Arthritis?

Glenohumeral arthritis occurs due to degeneration of the articular cartilage layer that covers the bones of the shoulder joint, which leads to wear and tear of the cartilage, making it ragged and rough, thereby reducing the shielding effect between the bones. This leads to bone-to-bone contact during the movement of the joint. The friction created by rubbing the bone's glenoid and humerus against each other favors the synthesis of bone spurs called osteophytes. As the number of osteophytes increases, the movement of the shoulder joint is restricted, causing a gradual loss of motion. The glenohumeral joint can be affected by five different types of arthritis, which mainly include:

• Osteoarthritis - This type of arthritis causes wear and tear of the joint's cartilage, leading to loss of the articular cartilage resulting in joint degeneration.

• Inflammatory Arthritis - A chronic inflammatory type of arthritis leads to damage to the soft tissues like ligaments and muscles around the glenohumeral joint. An example of such arthritis is rheumatoid arthritis.

• Post-traumatic Arthritis - This type of arthritis may occur due to some shoulder injury or in cases of fracture or dislocation of the shoulder joint.

• Osteonecrosis - Also known as avascular necrosis, it occurs due to the loss of vascular supply to the humerus bone. This necrosis occurs due to bone cell death due to impaired blood supply.

• Chronic Rotator Cuff Arthropathy- This occurs due to chronic wear and tear in the rotator cuff that causes the humerus bone to lose its proper alignment from the glenoid fossa, which results in degeneration and destruction of the joint.

Other Predisposing Factors Include

• Certain genetic disorders.

• Few metabolic conditions.

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• Post-surgical complications after shoulder surgery.

• The cartilage loss followed by sclerosis of the subchondral bone is more prominent in the two-thirds portion of the upper head of the humerus bone.

What Is the Epidemiology of Glenohumeral Arthritis?

The glenohumeral joint is the third-largest joint after the hip and knee joint, which is commonly affected by osteoarthritis. Usually, the condition is more prevalent in older people above 50 years of age. Females are more commonly affected than males. Obesity, chronic infections, and post-traumatic injury are some risk factors associated with the disease. The condition is more prevalent among the Caucasian race.

What Are the Signs and Symptoms of Glenohumeral Arthritis?

The main presenting symptom of the inflammatory disease is chronic, long-lasting, sharp, stabbing pain that exacerbates doing any sort of physical activity. The pain is deeply localized in the posterior part of the joint and worsens at night. There is uneasiness and discomfort while resting also. There are episodic attacks of pain that aggravate with time. There is tenderness on palpation of the affected joint area.

Other Clinical Signs:

• Locking of the joint.

• Crepitus (a creaking sound) which further affects the functioning of the joint, is also observed during shoulder movement.

• There is a restricted range of movement, typically during the joint's rotation.

• Atrophy of the muscle is also seen in many cases.

• The fluid sign or the geyser sign is especially observed in the cases of the tear of the rotator cuff due to fluid collection around the shoulder girdle. This fluid is accumulated due to the escape of the glenohumeral joint's synovial fluid into the larger subacromial and subdeltoid joint.

• Swelling or edema in the shoulder is observed.

• Periarticular cysts (cysts that occur in the ankle, wrist, and knee joints) may also be present.

• Narrowing of the joint space.

What Are the Diagnostic Tests for Glenohumeral Arthritis?

The clinical examination done by your doctor will help to identify the condition. The patient’s past medical history of chronic, exacerbating pain over several years is characteristic of this condition. The diagnostic tests include:

1. X-Rays - The X-ray can be done for the affected joint to establish the confirmed diagnosis of glenohumeral arthritis. The following changes will be observed on X-ray imaging:

• Joint surface irregularity.

• An increase in the number of bone spurs called osteophytes present on the lower aspect of the joint.

• Erosion of the bone surfaces was observed both on the head of the arm bones and the glenoid bone.

• Loss of bone is usually exhibited on the posterior aspect of the glenoid bone (the bony part of the shoulder).

2. Computed Tomography (CT Scan) - This imaging technique is used to observe any defects or abnormalities present anatomically in the joint and to demonstrate the amount of bone loss in the glenoid bone.

3. Arthrogram - This imaging technique is beneficial to evaluate rotator cuff tear arthropathy (a type of wear and tear of the shoulder degenerative joint disease).

4. Magnetic Resonance Imaging (MRI) - This imaging procedure can be used to evaluate the soft tissue involvement of the affected joint in a detailed manner.

What Is the Treatment of Glenohumeral Arthritis?

The therapeutic approach to managing the condition includes conservative and surgical approaches.

1. Mild Cases - Mild cases of glenohumeral arthritis can be managed by a conservative non-operative treatment method which includes:

• Take proper rest.

• Use of nonsteroidal anti-inflammatory drugs to relieve the pain.

• Physical exercises improve joint movement and increase muscular strength.

2. Moderate and Severe Cases - Moderate to severe cases of glenohumeral arthritis can be effectively treated by combining these methods:

3. Drug Therapy - Corticosteroid therapy should be recommended for individuals who fail to respond to NSAIDs (non-steroidal anti-inflammatory drugs).

4. Biologic Supplements - The destructive enzymes in joint arthritis can be neutralized using supplements like glucosamine or chondroitin (cartilage's structural components that help cushion the joints). These supplements help in the biogenesis of new cartilage formation.

5. Hyaluronic Acid Injections - They can be injected into the affected joint to improve lubrication of the bony surfaces.

6. Surgery - If non-operative procedures cannot manage severe cases of glenohumeral arthritis, surgery is recommended. Shoulder replacement surgery can be done in advanced cases of the condition.

Conclusion

Glenohumeral arthritis worsens with increasing age. The etiology of the condition is not properly understood. Therefore, more research should be done to identify the causative agents and diagnostic techniques more comprehensively to enable healthcare professionals to diagnose the disease and identify the various treatment modalities more precisely for the affected individual.