Clinical Presentation and Evaluation of Glenohumeral Arthritis.

Disease characteristics

Establishing criteria

Clinical evaluation, management and effectiveness measurement is facilitated by establishing necessary and sufficient criteria which enable us to standardize the assignment of each diagnosis. Six of the more common types of glenohumeral joint destruction include: primary degenerative joint disease, secondary degenerative joint disease, rheumatoid arthritis, cuff tear arthropathy, capsulorrhaphy arthropathy, and avascular necrosis.

In an extension of a recent study on self-assessment of patients with glenohumeral osteoarthritis (Matsen, Ziegler and DeBartolo, 1995), patients presenting with these conditions assessed their shoulder function using the 12 questions of the Simple Shoulder Test. (Matsen, Lippitt, Sidles, et al., 1994) These individuals with glenohumeral arthritis had greatest difficulty with overhand throwing, sleeping comfortably on the affected side, washing the back of the opposite shoulder, and placing eight pounds on a shelf. Interestingly, the degree of functional compromise at the time of presentation for evaluation was comparable for the different diagnoses. Apparently, it is this level of functional impairment, irrespective of the diagnosis, that brings the patient in for evaluation.

These individuals also assessed their health status using the SF 36 (see footnote 1). The self-assessed overall health status of individuals with glenohumeral arthritis is most compromised in the domains of physical role function and overall comfort. For patients with primary and secondary degenerative joint disease and cuff tear arthropathy the other SF 36 parameters, such as vitality and overall health, were relatively close to population-based age and sex matched controls. The health status of patients with rheumatoid arthritis, capsulorrhaphy arthropathy and avascular necrosis was poorer than controls of the same age and sex.

Footnotes

Footnote 1: The SF 36 is a general health status self-assessment used in many fields of medicine.(Radosevich, Wetzler and Wilson, 1994; Ware, Snow, Kosinski, et al., 1993) It is very useful in orthopedics for documenting the general health deficits of patients before and after reconstructive surgery. The overall comfort and physical role function scales are most commonly affected by arthritic conditions of the shoulder. Other SF 36 scores are useful in documenting the patients' vitality, mental health, general health and social, emotional, and physical function.

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