Clinical Presentation and Evaluation of Glenohumeral Arthritis.
Last updated Thursday, January 27, 2005
Capsulorrhaphy arthropathy
Capsulorrhaphy arthropathy is recognized as a special subset of
secondary degenerative joint disease in which deterioration of the
joint surface related to a previous repair for recurrent dislocations.Common cause of arthritis This is one of the commonest causes of severe arthritis in the
individual under fifty-five years of age. Capsulorrhaphy arthropathy
may be caused by overtightening the anterior capsule, for example in a
Putti Platt repair, limiting external rotation and causing obligate
posterior translation forcing the humeral head out of its normal
concentric relationship with the glenoid fossa (see figures 12 and 13).
The posterior glenoid is typically eroded from this chronic posterior
humeral subluxation; occasionally major posterior bone deficiencies
result (see figure 13). The converse situation may arise when obligate
anterior translation results from excessive posterior capsular
tightening. Lusardi et al (Lusardi, Wirth, Wrutz, et al., 1993)
reported a retrospective study of 20 shoulders in 19 patients who had
been managed for severe loss of external rotation of the glenohumeral
joint after a previous anterior capsulorrhaphy for recurrent
instability. All patients had noted a restricted range of motion, and
17 shoulders had been painful. In 7 shoulders, the humeral head had
been subluxated or dislocated posteriorly, and 16 shoulders had been
affected by mild to severe glenohumeral osteoarthrosis. All 20
shoulders were treated with a reoperation, which consisted of a release
of the anterior soft tissue. In addition, eight shoulders had a total
arthroplasty and one had a hemiarthroplasty. At an average duration of
followup of 48 months, all shoulders had an improvement in the ratings
for pain and range of motion. The average increase in external rotation
was 45 degrees.
Capsulorrhaphy arthropathy may also be related to intraarticular
positioning of metallic internal fixation devices (screws or staples)
or bone graft used in repairs of recurrent instability. (Zuckerman and
Matsen, 1984)
Bigliani et al (Bigliani, Weinstein, Glasgow, et al., 1995) and
Hawkins (Hawkins and Angelo, 1990) reported their results from
reconstruction of shoulders damaged by capsulorrhaphy arthropathy.
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