Clinical Presentation and Evaluation of Glenohumeral Arthritis.

Last updated Thursday, January 27, 2005

Figure 1

Figure 2

Figure 3

Radiographic evaluation

Standard views

Standard views include an anteroposterior view in the plane of the scapula and a true axillary view (see figure 1). These views indicate the thickness of the cartilage space between the humerus and glenoid, the relative positions of the humeral head and glenoid, the presence of osteophytes, the degree of osteopenia, and the extent of bony deformity and erosion. Superior displacement of the humeral head relative to the scapula suggests major cuff deficiency and argues against the use of a glenoid prosthesis (see figure 2). If a humeral arthroplasty is being considered, a templating AP view of the humerus in 35 degrees of external rotation relative to the x-ray beam with a magnification marker is obtained (see figure 3). This view places the humeral neck in maximal profile, allowing comparison of the proximal humeral anatomy to that of various humeral prostheses. If this view is taken with the arm in 45 degrees of abduction, placing the middle of the humeral articular surface in the middle of the glenoid fossa, it can reveal thinning of the central aspect of the humeral articular cartilage typical of degenerative joint disease (the "Friar Tuck" pattern), whereas radiographs with the arm in other positions may suggest the presence of a thicker layer of cartilage at the periphery of the head.

CT scans are obtained if there is question about the amount or quality of bone available for reconstruction. Most often these questions can be answered from plain radiographs alone. Friedman et al (Friedman, Hawthorne and Genez, 1992) and Mullaji et al (Mullaji, Beddow and Lamb, 1994) have used CT to characterize the changes in version in a group of patients with degenerative and inflammatory arthritis. The most important conclusion from these two studies is that glenoid version varies through a range of 30 degrees in these populations! Mallon et al (Mallon, Brown, Vogler, et al., 1992) have also conducted detailed studies of the articular surface of the glenoid and related this shape to the anatomy of the scapula.

Imaging of the rotator cuff by arthrography, MRI or ultrasound is carried out if it will affect management of the patient. Usually the status of the rotator cuff can be understood from evaluation of the history, the physical examination, and the plain radiographs.

Green and Norris (Green and Norris, 1994a) and Slawson et al (Slawson, Everson and Craig, 1995) have recently provided a review of imaging techniques for glenohumeral arthritis and for glenohumeral arthroplasty.

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