Thursday, January 23, 2014

comprehensive arthroscopic management for shoulder arthritis: how does it hold up?

Comprehensive Arthroscopic Management (CAM) Procedure:Clinical Results of a Joint-Preserving Arthroscopic Treatment forYoung, Active Patients With Advanced Shoulder Osteoarthritis

These authors reviewed the outcomes of 30 shoulders having an arthroscopic procedure that included glenohumeral chondroplasty (4/30); removal of loose bodies (9/30), humeral osteoplasty and osteophyte resection (14/30), synovectomy (20/30) capsular release (30/30); subacromial decompression (10/30); axillary nerve neurolysis (7/30); and biceps tenodesis (8/30). Patient age averaged 52 years (range 33-68 years). The axillary nerved decompression was justified by an observation of posterior pain and teres minor atrophy (although we recognize that these findings are nonspecific). The authors noted no complications. After 1.9 years 6 of the 30 (20%) required revision to an arthroplasty an annualized revision rate of just over 10% per year. Patients with less than 2 mm of radiographic joint space were more likely to need revision to a shoulder arthroplasty. Patients who were not revised and who were available for followup demonstrated improved range of motion, comfort and outcome scores.

In considering this article we need to recall the NEJM paper: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee in which the authors randomly assigned 180 patients with knee arthritis to receive arthroscopic débridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated débridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment-group assignment. They found that at no point did either of the intervention groups report less pain or better function than the placebo group. The authors concluded that in this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.

Arthroscopic management may have a role in the treatment of early shoulder arthritis. What type of arthroscopic surgery benefits which patients by how much will need to be determined by further studies, ideally studies comparing other methods of treatment.

To learn more about shoulder arthritis and what can be done about it, see the Shoulder Arthritis Book.

To learn more about the rotator cuff, see the Rotator Cuff Book

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