Review Question - QID 220056

With severe glenohumeral osteoarthritis (OA) in a 55-year-old without any previous shoulder surgeries, age at the time of shoulder dislocation (30 years old) is the most likely reason for his accelerated arthritis (answer choice 2).

Glenohumeral OA is a degenerative disease of the shoulder joint involving damage to the articular surfaces of the humeral head and/or glenoid. Presentation is normally in patients over 60 years old and is more common in women. Pain is a common complaint with activity and while sleeping. Decreased range of motion, particularly with external rotation, is common due to anterior capsule contraction. Radiographs demonstrate joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts. Treatment typically starts with physical therapy, NSAIDs, and/or steroid injections. Surgical treatment involves the replacement of the joint.

Hovelius et al. conducted a prospective Swedish multicenter study looking at the natural history of shoulder arthropathy secondary to dislocation. They included 257 shoulders in patients 12-40 years old with a first-time anterior shoulder dislocation. 25-year follow-up was obtained in 229 shoulders. They found that moderate to severe arthropathy correlated with age older than 25 years at the time of primary dislocation (p=0.01) and if the primary dislocation was caused by high-energy activity sports (p=0.009).

Vezeridis et al. performed a review article on glenohumeral dislocation arthropathy. They mention the specific etiology remains unclear if it is secondary to the initial trauma of the dislocation, repetitive injury, changes in shoulder biomechanics, or complications associated with instability surgery. They describe the various treatment options and conclude by noting that future studies should help to better predict which patients will suffer from dislocation arthropathy and which ones would benefit from early surgical intervention.

Hovelius et al. described the long-term prognosis in 255 patients with an anterior shoulder dislocation between the ages of 12-40 years old. They noted that early motion or immobilization after the dislocation resulted in the same long-term outcome. They also report around half of all patients with first-time dislocations < 25 years old underwent stabilization surgery, and 67% will develop different stages of arthropathy within 25 years.

Figure A is a true AP (Grashey view) of the right shoulder demonstrating severe osteoarthritis of the glenohumeral joint with a large inferior humeral head osteophyte (goat's beard).

Incorrect answer choices:
Answer choice 1: OA of the glenohumeral joint is more common in those > 60 years old. The patient's current age of 55 years is not the likely reason for his severe OA.
Answer choice 3: Hand dominance has not been associated with an increased risk of severe OA.
Answer choice 4: Uncontrolled diabetes may result in Charcot arthropathy of the shoulder, however, the patient's plain radiographs demonstrate severe OA.
Answer choice 5: Male sex has not been associated with an increased risk of severe OA.