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Dr MARC BEAUCHAMP MD FRCSC
Private orthopedic surgery clinic, Montreal, Canada Shoulder and elbow surgery, arthroscopy
Private orthopedic surgery Montreal, Canada
Shoulder anatomyCommon shoulder and elbow problemsBursitis tendinitis and shoulder impingement syndromeRotator cuff tearRecurrent shoulder dislocationSuperior labrum tear: SLAP lesionTendinitis of the long head of the bicepsAcromioclavicular joint disordersAdhesive capsulitisOsteoarthritis and arthritis of the shoulder
Elbow anatomy
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Osteoarthritis and arthritis of the shoulder

Like most of the main joints in the body, the shoulder is subject to degenerative changes and the development of osteoarthritis. It may be due to aging alone (usually after 60 years of age) but can also result from an old injury or chronic rotator cuff deficiency.

The term "arthritis", reserved for inflammatory diseases (e.g., rheumatoid arthritis, psoriatic arthritis) often affects several joints at once. These conditions are usually followed and treated by family doctors and rheumatologists.

Nonsurgical treatment for recurrent shoulder dislocation

Osteoarthritis of the shoulder is generally better tolerated than osteoarthritis of the hip or knee. It can cause a certain amount of pain or a slight loss of range of motion. Nonsurgical treatment is therefore the treatment of choice: preventive restriction of activities, oral anti-inflammatories, physiotherapy, steroid or viscosupplement injection, etc. Despite numerous studies on the subject (in particular on glucosamine sulfate), as yet there is unfortunately no nutrient with scientifically demonstrated effectiveness in treating osteoarthritis.

When should surgery for osteoarthritis of the shoulder (glenohumeral joint) be considered?

Surgery may be necessary if the problems related to the pain can no longer be managed by the nonsurgical measures mentioned above. Arthroscopic debridement surgery may be considered in some cases if the osteoarthritis is mild or if the main problem is synovitis. In advanced osteoarthritis where there is cartilage destruction or a bone deformity, the best surgical treatment is artificial joint replacement. In some cases, replacement of the humeral head by resurfacing is sufficient and the glenoid-scapula component does not have to be replaced. In other cases, total shoulder joint replacement (humeral component and glenoid component) is indicated. This surgery has been performed for around twenty years: pain control and improved function are seen in 90% of cases. It is a major intervention with risks and complications (fracture, infection, neurological lesion, vascular lesion, shoulder instability, permanent stiffness, etc.) and a long convalescence (6 to 12 months). It is also important to know that following total shoulder joint replacement, the prosthesis itself has a life of around 15 to 20 years. It should also be noted that the main benefit of successful surgery is pain relief and not the complete restoration of range of motion (which is rarely achieved).

New types of "nonanatomical" or reverse prostheses (i.e., a ball is attached to the scapula while the humerus is cup shaped) are now available. They are mainly used when osteoarthritis is associated with irreparable rotator cuff deficiency. This intervention carries a high risk of complications and is available only in very specialized hospitals.

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