Osteoarthritis, glenohumeral joint

• Glenohumeral joint osteoarthritis (OA)

• 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

• M19.019 Primary osteoarthritis, unspecified shoulder
• M19.219 Secondary osteoarthritis, unspecified shoulder

• 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

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

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 based on careful history, physical examination, imaging studies, laboratory examination, exclusion of other possible diseases

General Considerations

• Low bone-mineral density (BMD)
• Repetitive joint use or loading
• Joint alignment
• Bone or joint morphology
• Calcification of the biceps tendon
• Bone formation, cyst formation
• Thickening of subchondral bone plate, osteosclerosis
• Overall joint dysfunction
• Joint swelling and inflammation (in certain, severe cases)
• Joint pain
• Morning stiffness
• Long-term disease
• Secondary problems
  • Muscle atrophy and weakness
  • Bony protrusion or prominence
  • Joint deformity
  • Difficulty with ADLs

Demographics

• More common in middle- to older-aged populations
• Women more commonly affected than men
• More common African American and Caucasian than other ethnicities
• May affect approximately 12% of the population in U.S. and other developed countries7

Signs and Symptoms

• Joint pain, aching
• Joint stiffness
• Muscle weakness
• Muscle atrophy
• Crepitus
• Bony enlargement
• Limited range of motion (ROM) in joint
• Joint-line tenderness
• Joint deformity in severe cases
• Activity limitation

Functional Implications

• Limited mobility
• Household and work-related activity limitations/restrictions
• Decreased overall activity and participation

Possible Contributing Causes

• Chronic factors affecting the joint (obesity, BMD, LLD)
• Ageing
• Chronic and vigorous joint-loading
• Previous chronic joint injury (e.g., accident, trauma); secondary OA

Differential Diagnosis

• Rheumatoid arthritis
• Gout
• Rotator cuff tear
• Bursitis
• Biceps tendinitis
• Adhesive capsulitis
• Fibromyalgia syndrome
• Spondyloarthropathy

Laboratory Tests

• Synovial fluid examination (optional, not required)
• Other ...