Thursday, November 13, 2014

Shoulder arthritis, why not just clean it up with an arthroscope?

Arthroscopic Debridement and Capsular Release for the Treatment of Shoulder Osteoarthritis

These authors performed a retrospective review of 33 patients having arthroscopic debridement and capsular release for shoulder osteoarthritis.

Their technique included debridement of loose cartilage, frayed labrum, and other degenerative tissues as well as complete release of the rotator interval, middle, and inferior glenohumeral ligaments.

A patient-directed home exercise program was initiated immediately for stretching and range of motion therapy.

While there appeared to be an initial improvement in range of motion and pain scores, patients returned to preoperative status 4 months after debridement and capsular release. Twenty patients (61%) reported dissatisfaction with the outcome of the procedure. Over 40% of the shoulders had total shoulders at an average of 9 months.

Comment: This information is useful. We often find patient's asking, 'can't you just clean up my shoulder arthritis without a joint replacement?' It is a good question and comes to the complexity of glenohumeral degenerative joint disease, which, as the picture below suggests, may include loss of cartilage, loss of the roundness of the joint surfaces, bone spurs (osteophytes), instability, capsular tightness, and muscle imbalance - features that are difficult to manage without arthroplasty.
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