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167: GLENOHUMERAL JOINT OSTEOARTHRITIS

Eric Shamus, PhD, DPT, PT, CSCS; Reuben Escorpizo, DPT, MSc, PT

CONDITION/DISORDER SYNONYM

  • Glenohumeral joint osteoarthritis (OA)

ICD-9-CM CODES

  • 715 Osteoarthrosis and allied disorders

  • 715.11 Osteoarthrosis localized primary involving shoulder region

  • 715.21 Osteoarthrosis localized secondary involving shoulder region

  • 715.9 Osteoarthrosis unspecified whether generalized or localized

ICD-10-CM CODES

  • M19.019 Primary osteoarthritis, unspecified shoulder

  • M19.219 Secondary osteoarthritis, unspecified shoulder

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders2

  • 4H: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Joint Arthroplasty3

  • 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery4

PATIENT PRESENTATION

A 48-year-old man who formerly played high school and collegiate football presents with chronic right shoulder pain with progressive loss of function. The patient describes the pain as a deep ache. The patient has all shoulder motions limited. He is slightly weaker on the right side. He denies any neck pain and has full cervical spine range of motion (ROM). The patient had an X-ray that showed decreased joint space at the glenohumeral joint.

KEY FEATURES

Description

  • Most common form of arthritis

  • Degenerative joint disease

  • Commonly affects weight-bearing joints

  • Associated with increased age, obesity, previous trauma, previous surgery

  • Associated with abnormal loading of joints

  • Characterized by joint pain

  • Arthrosis

  • Osteoarthrosis

  • Polyarthrosis

FIGURE 167-1

Theoretical model for pathways involved in cartilage destruction during the development of osteoarthritis. Excessive mechanical forces stimulate the chondrocyte directly or indirectly through signals generated by matrix damage including generation of matrix fragments. The resultant activation of signaling pathways, including ROS generation, results in increased production of cytokines, chemokines, and proteolytic enzymes. This catabolic response to injury serves to degrade the damaged matrix. Matrix degradation results in release of growth factors stored in the matrix, which would normally feedback on the cell and shut down the catabolic pathways. But aged chondrocytes have an insufficient response to growth factor stimulation, resulting in continued matrix destruction from unbalanced catabolic and anabolic activity. (Reproduced with permission from Loeser RF. Molecular mechanisms of cartilage destruction: mechanics, inflammatory mediators and aging collide. Arthritis Rheum. 2006;54:1357.)

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Essentials of Diagnosis

  • Radiography is standard method for diagnosis

  • Kellgren and Lawrence (KL) grade ≥2 (definite radiographic OA)5

  • Osteophytes, joint-space narrowing, sclerosis

  • Cartilage lesions, bone marrow lesions, synovitis, effusion, and subchondral bone attrition/sclerosis

  • Erosion of articular cartilage

  • Synovial hyperplasia

  • Fibrosis

  • Inflammatory cell infiltration

  • Conventional radiograph is most commonly used tool in OA6

  • Diagnosis is based on a careful history, physical examination, ...

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