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Glenohumeral DJD and Shoulder Replacement

Glenohumeral degenerative joint disease (GDJD), also known as osteoarthritis of the shoulder, is a condition characterized by degeneration or wearing away of the protective cartilage that covers the ends of your bones (articular cartilage). As a result of degeneration of the articular cartilage the ends of the two bones rub together and form bony growths (osteophytes).

The shoulder is a 'ball-and-socket' joint. The shoulder joint is also called as glenohumeral joint, the joint formed by gelnoid and humerus bones. The shoulder joint is formed when a 'ball' at the top of the upper arm bone, humerus, fits neatly into a 'socket', the glenoid, which is part of the shoulder blade.

Glenohumeral DJD is most often seen in people over 50 years. It can also develop after an injury or trauma to the shoulder. The condition may also be hereditary.

A person with glenohumeral DJD is likely to have tenderness and shoulder pain that aggravates during activity. Swelling of the joint may also be seen. You may hear a clicking or creaking sound as you move your shoulder.

To diagnose glenohumeral DJD, your doctor will take a medical history and performs a physical examination of your shoulder. X-rays of an arthritic shoulder may be useful to see osteophytes and loss of joint space.

Treatment for glenohumeral DJD includes both nonsurgical treatment and surgical treatment. Non-surgical treatment includes use of anti-inflammatory medications, applying ice, moist heat to joint, performing range-of-motion exercises and physical therapy, corticosteroid injections, and dietary supplements of glucosamine and chondroitin.

Surgery may be indicated if nonsurgical treatments are not effective. Glenohumeral DJD can be surgically treated with two forms of replacement, hemiarthroplasty and total shoulder arthroplasty. In total shoulder arthroplasty, the entire shoulder joint is replaced with an artificial joint where as in hemiarthroplasty only the head of the upper arm bone is replaced.

Shoulder Replacement

Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial joint parts. Shoulder joint replacement is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, avascular necrosis, and failed former shoulder replacement surgery.

During the surgery, an incision is made over the affected shoulder to expose the shoulder joint. The humerus is separated from the glenoid socket of the scapula. The arthritic part of the humeral head and the socket is removed and prepared so as to take the artificial components. The glenoid component is then pressed into the socket, and the humeral component is cemented into the upper arm bone. The humeral head component made of metal is then placed on the humeral stem. The artificial components are fixed in place. The joint capsule is stitched together. The muscle and tendons are then repaired and the skin is closed.

Possible risks and complications specific to shoulder joint replacement surgery include:

  • Infection around an implanted joint
  • Dislocation or instability of an implanted joint
  • Fracture of the humerus or scapula
  • Damage to nerves or blood vessels
  • Blood clots (deep vein thrombosis)
  • Wound irritation
  • Arm length discrepancies
  • Wearing of the joints
  • Scar formation

AC Joint Arthrosis and Reconstruction

Acromioclavicular (AC) joint arthrosis or osteoarthritis of the acromioclavicular joint is a condition that develops when the cartilage cushioning the AC joint in the shoulder begins to wear out. The shoulder is a 'ball-and-socket' joint. A 'ball' at the top of the upper arm bone, humerus, fits neatly into a 'socket', the glenoid, which is part of the shoulder blade, scapula. The shoulder joint is made up of three bones, the collarbone (clavicle), scapula (shoulder bone), and humerus (arm bone). The AC joint is located where the clavicle meets the end of the shoulder blade, acromion.

The AC joint osteoarthritis occurs as a result of repeated movements of the arm and overhead activities. People who lift heavy weights overhead such as weightlifters and those involved in overhead sports such as basketball are at increased risk for developing osteoarthritis of the AC joint. Another common cause is a previous injury to the AC joint causing AC joint separation.

Osteoarthritis in the AC joint may cause pain and tenderness in front of the shoulder. Moving the affected arm across your chest may compress the AC joint and worsen the pain. Pain also radiates to the shoulder, front of the chest, and the neck. In patients who had previous shoulder injury, bumps appear around the AC joint. You can hear a snap or click when you move your affected shoulder.

Diagnose of AC joint osteoarthritis will be made by collecting medical history and physical examination. During physical examination, your doctor will look for tenderness over the AC joint and pain with compression of the AC joint. To confirm the diagnosis a local anesthesia may be injected into the joint to temporarily reduce the pain. X-rays of the AC joint will be taken to reveal bone spurs around the joint and narrowing of the joint space.

Treatment for AC joint osteoarthritis includes both nonsurgical treatment and surgical treatment. Non-surgical treatment includes rest, use of nonsteroidal anti-inflammatory medications, physical therapy, and injections of corticosteroids. Surgery may be indicated if nonsurgical treatments are not effective. Resection arthroplasty is the surgery of choice for AC joint osteoarthritis. During this surgery, your doctor removes about half-inch of the clavicle bone at the end where it meets the scapula. As the process of healing, scar tissue will fill the space created by removal of a piece of clavicle bone. The scar tissue allows normal movement of the AC joint and avoids rubbing of bone ends. The surgery may be performed using minimally invasive technique or using arthroscope.

AC Joint Reconstruction

Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.

This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.

Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.

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