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Glenohumeral Osteoarthritis: Imaging
• XRAY • Loss of Glenohumeral joint
space
• Osteophytes
• “Beard Osteophyte”
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Glenohumeral Osteoarthritis: Treatment
• Non-operative • Analgesics
• Modification of Activities
• Corticosteroid Injections
• Operative • Shoulder Replacement
• Half
• Total
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Cuff Tear Arthropathy of the Shoulder
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Unbalanced CUFF TEARS: Massive Rotator Cuff Tears
Normal Massive tear: Proximal Humeral Migration
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Consequences of a Massive Unbalanced Cuff Tear à Cuff Tear Arthropathy
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Cuff Tear Arthropathy: Clinical Features
• Chronic Shoulder pain • Anterior / lateral
• Worse with activity
• Examination • Reduced Active Motion
• Variable passive motion
• XRAY is diagnostic
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“Normal” Osteoarthritis
XRAY Clues for Cuff Tear Arthropathy: “Proximal Migration of Humeral Head
Cuff Tear Arthropathy
- Acromiohumeral distance - Humeroscapular curve
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XRAY Clues for Cuff Tear Arthropathy: “Shoulder becomes a Hip Joint”
“Normal” Osteoarthritis Cuff Tear Arthropathy
Femoralisation of Humeral Head Acetabularisation of Acromion / Glenoid
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Cuff Tear Arthropathy: Non-Operative Management
• Analgesics
• Modification of Activities
• Corticosteroid Injections
• Physiotherapy: • Anterior Deltoid
Strengthening Exercises
!
!
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Cuff Tear Arthropathy: Surgical Management
• Reverse Total Shoulder Replacement
• Good for improving pain AND active motion
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What is a REVERSE Shoulder Replacement? Ball and Socket Reversed.
Normal Shoulder Standard Shoulder Replacement Reverse Shoulder
Replacement
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Can’t do “Standard” Shoulder Replacement: Glenoid loosens
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Reverse TSR: Works by Lever Mechanism
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Acromioclavicular Joint: Anatomy
• Small Fibrocartilaginous Joint
• Stabilized mainly by Coracoclavicular Ligaments
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Acromioclavicular Joint: Degenerative Arthritis
• Present on Xrays in almost all individuals >50 years
BUT
• Usually not symptomatic
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Acromioclavicular Joint: Degenerative Arthritis
• Pain • Superior, directly over AC
joint
• Worse with activitiy
• Examination • Tenderness directly over AC
joint
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Acromioclavicular Joint OA: Exam
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Acromioclavicular Joint OA: Imaging
• Xray • Narrowing of AC Joint
• Osteophytes from AC joint
• MRI • AC jt degeneration
• Oedema in lateral end of clavicle
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Acromioclavicular Joint Osteoarthritis: Treatment
• Non-operative • Analgesics,
• Corticosteroid injections
• Modification of Activities
• Operative • Excisions of lateral end of
clavicle
• Open
• Arthroscopic
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Long Head of Biceps: Anatomy
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Evolutionary Anatomy
• Quadrupeds (e.g horse) • Biceps only has one head proximally
• Important for elevating limb after stance, and locking limb in stance phase
• the biceps tendon fits over the humeral head
and locks the forelimb forming the passive stay apparatus in stance.
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From 4 legs to 2: The INvolution of the Long Head of Biceps
4 legs --------------------------à 2 legs
Anatomical Changes indicate that the role of the biceps tendon in the shoulder is lessening
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Long Head of Biceps Tendon
• Tendinitis
• Instability
• Longitudinal Tears / Splits
• Tendinopathy
• Rupture (Popeye)
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Biceps Tendon Problems: History
• Pain • Anterior
• Radiates down the front of the arm
• Worse with activity
• Clicking • With biceps instability
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Biceps Tendon Problems: Examination
• Tenderness • Over Biceps Tendon
anteriorly
• Pain with resisted forward elevation
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Biceps Tendon Problems: Investigation
• XRAY (screening test)
• MRI
• Ultrasound: dynamic
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Biceps Tendon Problems: Treatment
• Non-operative • Analgesics,
• Corticosteroid injections
• Modification of Activities
• Operative • Tenotomy
• Just cut it and let it drop
• Tenodesis
• Attach it to the humerus
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Key Points
• Increase in life expectancy is coincident with the mechanical failure of the rotator cuff.
• Tendonosis and Cuff Tears are mostly a wear and tear phenomenon of the shoulder.
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Thank You
Lake Louise, Alberta, Canada