Review Question - QID 7650

The patient has classic "arthritis of dislocation." Procedures done years ago were designed to enhance shoulder stability by limiting external rotation. However, it is now understood that limiting external rotation results in significant alteration of joint mechanics and kinematics, thus leading to the development of osteoarthritis. The average age of patients who develop `arthritis of dislocation` is 45 years old. Despite the young age of these patients, total shoulder arthroplasty offers the most predictable improvement in pain and function. However, the patient must be made aware of the need to protect the arm from excessive loads to protect the glenoid implant. Because there is complete loss of articular cartilage and incongruent joint surfaces, there is no role for arthroscopic debridement and capsular release. Injections offer little, if any, chance of improvement with the prior history of nonresponse. Physical therapy predictably makes patients worse because loading the arthritic joint generates more pain. Reverse shoulder arthroplasty is reserved for elderly patients with severe rotator cuff deficiency. A humeral head arthroplasty, while potentially more ideal than a total shoulder arthroplasty because of glenoid concerns, would likely not offer pain relief in the face of the significant glenoid involvement and incongruity.