Clinical Presentation and Evaluation of Glenohumeral Arthritis.
Last updated Thursday, January 27, 2005
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Other types of arthritis
Types
Neurotrophic arthropathy arises in association with syringomyelia,
diabetes, or other causes of joint denervation. The joint and
subchondral bone are destroyed because of the loss of the trophic and
protective effects of its nerve supply. It has been suggested that the
injection of corticosteroids may contribute to the development of this
condition. (Parikh, Houpt, Jacobs, et al., 1993) The Charcot joint
presents with functional limitation and pain (in spite of the
denervation). Cervical spine trauma may have occurred in the past,
(Rhoades, Neff, Rengachary, et al., 1983) or unrecognized syringomyelia
may exist.(Mau and Nebinger, 1986; Tully and Latteri, 1978) There is
usually significant bone destruction and with osseous debris about the
joint area. This condition may resemble infectious arthritis.
(Louthrenoo, Ostrov, Park, et al., 1990)
Radiation therapy, especially for the treatment of breast cancer,
may cause a number of shoulder problems: brachial plexopathies,
osteonecrosis, malignant bone tumors, and fibrous replacement of many
tissues. Glenohumeral cartilage and subchondral bone are on occasion
affected by these changes and may require treatment by prosthetic
arthroplasty or other alternative methods.
Septic arthritis of the shoulder is uncommon, but when it occurs, it
is often in a person debilitated from a generalized disease (Baker,
Oddis, Medsger, 1987; Burdge, Reid, Reeve, et al., 1988), in a person
on immunosupressive medications, or in a person who has an underlying
shoulder disease process such as rotator cuff tearing (Armbuster,
Slivka, Resnick, et al., 1977) or rheumatoid arthritis. (Kraft, Panush
and Longley, 1985) In this latter setting, there appears to be an
exacerbation of the underlying shoulder disease, and in the absence of
fever or an elevated white blood count, diagnosis will depend on a high
level of suspicion, jointaspiration, and bacteriological testing.
Leslie et al (Leslie, Harris and Driscoll, 1989) reviewed 18 cases of
shoulder sepsis, of which 11 had Staph aureus. Some were initially
confused with non-septic arthritis and treated with anti-inflammatory
agents. The results of treatment were poor, but somewhat better with
arthrotomy than repeated aspiration.
Neoplasia present insidiously; it is often characterized by non
mechanical pain. The tumor may incite a synovial response, mimicking an
arthritic condition. (Benjamin, Hirschowitz, Arden, et al., 1982;
Medsger, Dixon, Garwood, 1982) The pain may be more intense than the
usual arthritic pain and decidedly unresponsive to rest. Diagnosis will
depend on accessing the patient's general health, high quality plain
x-rays, and additional imaging modes including tomography, computerized
tomographic scanning, bone scanning, or magnetic resonance imaging.
Identification of the primary lesion in metastatic disease is
desirable, but sometimes biopsy of the shoulder lesion is the most
direct route to diagnosis.
Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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