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Anterior
10%
232/2307
Posterior
65%
1499/2307
Superior
6%
147/2307
Inferior
7%
171/2307
Central
11%
252/2307
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The exam and radiograph is consistent with glenohumeral osteoarthritis. The most common pattern of glenoid wear is central or posterior. In patients with posterior wear and subluxation, the posterior capsule becomes stretched, osteophytes form, and the anterior capsule and subscapularis shorten and contract. This leads to significant loss of external rotation, as is seen in this patient. An axillary XR or CT scan would be needed to assess the degree of posterior glenoid wear. In addition, when considering TSA, patients with less than 40-45° of external rotation with exam under anesthesia should be considered for subscapularis lengthening and anterior capsule release. Walch et al developed a classification system to describe the morphology of an arthritic glenoid and is relevant when considering performing total shoulder arthroplasty. There are 3 types of glenoids described in this classification: Class A: well centered humeral head with balanced strength and central erosion of the glenoid (59%) Class B: Posteriorly subluxated humeral head, with asymmetric load distribution and either narrowing of the posterior joint space, subchondral sclerosis and osteophytes (B1, 17%) or a posterior cupula, leading to a biconcave glenoid (B2, 15%). Class C: Dysmorphic glenoid, with retroversion of >25° (9%).
2.9
(37)
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