Glenohumeral Arthritis: Causes, Symptoms, Treatment, Prognosis, Pathophysiology, Epidemiology

Glenohumeral arthritis is also known as glenohumeral degenerative joint disease or the osteoarthritis of the shoulder. In this condition, the cartilage called the articular cartilage, which forms a protective covering at the ends of the bones on the shoulder joint gets degenerated resulting in rubbing of bones against each other and formation of osteophytes along with swelling and severe shoulder pain.

The structure of the shoulder joint is in the form of a ball and socket and is called glenohumeral joint. It is made up by the articulation of humerus and glenoid bones, in which the head of the humerus in the upper arm forms the ball whereas the glenoid in the shoulder blade constitutes the socket in which the head of the humerus fits. For the proper functioning of the joint, there is another set of soft tissues which comprises of muscles, tendons and ligaments that provide stability, support and mobility to the joint.

In case of glenohumeral arthritis, the cartilage present between the bones of the shoulder joint gets damaged which exposes the bones to each other, thereby encouraging friction in between the bones and leading to development of bony growth or osteophytes which hampers the movement of the shoulder with aggravated pain and swelling. This condition may even result in loss of movement in the shoulder with progression.

The symptoms that arise as a result of glenohumeral arthritis are:

• Pain due to rubbing of bones in the shoulder joint.
• Progressive increase in the pain.
• Discomfort and difficulty in movement.
• Inability to sleep due to persistence of pain especially at night.
• Loss of the motion in the shoulder joint.
• Blockage in the movement of shoulder joint owing to the presence of osteophytes.
• Weakness in the rotator cuff.
• Presence of shoulder muscle atrophy.
• Inflammation and tenderness in the shoulder can be a symptom of glenohumeral arthritis.
• Motion in the shoulder joint produces clicking sound can be a symptom of glenohumeral arthritis.

Glenohumeral arthritis is known to be the third major type of degenerative joint disease; yet, it is the least frequent type of arthritis. It accounts for only three percent of the reported osteoarthritis cases. Most of the cases of glenohumeral arthritis are diagnosed at a later stage. The routine treatment opted for over fifteen percent cases is shoulder arthroscopy.

The outlook for glenohumeral arthritis is good if diagnosed in time and simultaneous opting of a physical therapy exercises to restore the optimal range of motion. For the cases with severe degeneration, surgical measures are taken up to reinstate the shoulder movement.

The primary causes behind glenohumeral arthritis are:

• Glenohumeral Arthritis Caused Due to Osteoarthritis: It is the most common type of arthritis in which the cartilage protecting the shoulder bone degenerates over time.
• Glenohumeral Arthritis Caused Due to Rheumatoid Arthritis: It is a severe and serious form of arthritis which causes bone erosion and deformity of the joints due to damage in the lining of joints thereby resulting in severe pain and swelling.
• Post-Traumatic Arthritis as a Reason for Glenohumeral Arthritis: Recurrence of traumatic incidences like fracture or shoulder dislocation, affects the articulating cartilage in the shoulder leading to progressive damage to the joint.
• Avascular Necrosis: This occurs when the blood supply to the humerus reduces or gets obstructed due to fracture, dislocation or medicinal complications, leading to arthritis.
• Rotator Cuff Tear Arthopathy Causing Glenohumeral Arthritis: The severe wear and tear in the rotator cuff results in the inability to hold and support the joint which simultaneously causes damage to the bone surface and arthritis. This condition is known as rotator cuff tear arthopathy and can contribute towards the onset of Glenohumeral arthritis.

The presence of osteoarthritis marks the decreased levels of glycosaminoglycans, chondroitin sulfate, hyaluronic acid, and keratin sulfate. This results in diffusion of water into the cartilage and enhancement in the activity of matrix metalloproteinases or MMPs which causes the erosion of the extracellular matrix of the cartilage. As a consequence of the cartilage surface erosion, there occurs bone to bone contact which causes friction and severe pain.

The predominant risk factors in case of glenohumeral arthritis are sports like weight lifting, baseball, soft ball, tennis, squash and badminton. Apart from the sports, presence of a prior condition like fracture, dislocation, age and post-surgical trauma also increase the danger of glenohumeral arthritis.

The complications in case of glenohumeral arthritis usually arise post-surgery. These are:

• Loss of blood
• Nerve injuries which can be permanent as well as temporary.
• Failure of glenoid component owing to the shoulder surgery.

The diagnosis for the glenohumeral arthritis involves the below mentioned diagnostic measures:

Physical Examination to Diagnose Glenohumeral Arthritis: It involves analysis of the symptoms, pain, swelling and movement of the joint due to the condition.

• X-Ray: It is used to confirm the presence of the condition by identifying the presence of osteophytes and bone loss at the shoulder joint.
• Arthrogram: This technique is used to diagnose the presence of injury and tears on the rotator cuff.
• CT scan: The CT scan is used to identify the glenoid bone loss and presence of abnormalities in the joint.
• MRI: Though it is not used frequently for the diagnosis of the glenohumeral arthritis, but in certain cases it does help in providing the detailed information about the underlying soft tissue structures.

The measures opted for the treatment of glenohumeral arthritis can be non-operative as well as surgical depending on the severity of the condition.

• Non-Operative Treatments for Glenohumeral Arthritis: These treatments are opted in the case of mild and manageable condition of glenohumeral arthritis. It includes:
  • NSAIDs Medication: The medications like Ibuprofen and Naproxen are given to control the inflammation.
  • Corticosteroid Shots: The corticosteroid injections are given when the NSAIDs fail to provide the required relief. These are anti-inflammatory injection that help in relieving the pain temporarily but do not help in curing the condition.
  • Viscosupplementation: This treatment involves injecting of hyaluronic acid into the joint so as to improve the cushioning and lubrication in between the joints as well as reduction of friction during movement.
  • Non-Prescription Supplements: These are glucosamine and chondroitin supplements which reduce the activity of enzymes that contribute to osteoarthritis. It also helps in the formation of new cartilage.
• Surgical Procedures for Treating Glenohumeral Arthritis: Surgical measures are selected when pain cannot be managed by medications. These measures prove to be effective in reducing the pain and re-establishing the motion within the joint.
  • Arthroscopy: This surgery is done for less severe cases of glenohumeral arthritis. The surgery is conducted by inserting an arthroscope into the shoulder joint by creating a small incision. The arthroscope is a small camera that helps in directing surgery using micro surgical instruments.
  • Arthroplasty: It is also known as the shoulder joint replacement surgery in which prosthetics are used to replace the damaged parts of the shoulder.

Though difficult to avoid, the condition can definitely be prevented to a certain extent by following simple measures, which are:

• Abstaining from sedentary lifestyle.
• Ensure proper and continuous movement of joints.
• Regular stretching in order to avoid stiffness in the joint.
• Following strengthening exercises to increase the stress endurance of the muscles.
• Escaping and proper protection from heavy stress activities.

The extent of recovery and coping regarding the condition depends on the intensity of pain, amount of activity, extent of injury and complexity of the surgical procedure. Recovery post the surgery entirely depends on the will power and dedication of the individual towards lifestyle modification and following of prescribed exercise routine.

The glenohumeral arthritis is the arthritis ailing the shoulder region in which the protective cartilage present over the shoulder region erodes thereby causing friction and rubbing in between the bone. This results in severe pain, swelling and discomfort in the shoulder region. The condition can be treated effectively with medications and lifestyle modifications if treatment is taken during the mild stages. In cases when the condition is severe, surgery is opted to restore the proper activity and motion within the shoulder.

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