Osteoarthritis Of Glenohumeral Joint Research Articles

Cooled Radiofrequency Ablation of the Glenohumeral Joint in lateral Position: A Case Report

Background: Shoulder pain due to adhesive capsulitis is a prevalent musculoskeletal condition, necessitating innovative treatments. Radiofrequency ablation (RFA) offers an effective approach to alleviate chronic shoulder pain. This case report focuses on Cooled Radiofrequency ablation of articular branches of the glenohumeral joint, performed with hybrid technique using fluoroscopy and ultrasonography, while the patient remains in a lateral position. Case Presentation: A 56-year-old female presented with chronic right shoulder pain and restricted motion diagnosed with right shoulder adhesive capsulitis. Diagnostic blocks of sensory articular nerves provided significant pain relief, leading to Glenohumeral joint sensory articular nerve denervation via Cooled Radiofrequency Ablation. The procedure was performed with the patient in a lateral position, as lying prone was intolerable due to pain. The patient showed substantial pain relief and improved range of motion post-procedure. Discussion: Cooled radiofrequency ablation (CRFA) has shown promise in treating Adhesive Capsulitis and Glenohumeral joint osteoarthritis. While the traditional approach involves changing the patient's position from prone to supine, this case report introduces a novel lateral position technique. Benefits include improved patient comfort, strict asepsis maintenance, reduced procedure time, and decreased radiation exposure. However, challenges in C-arm positioning were encountered. Additionally, hydrodilatation of the glenohumeral joint was performed, resulting in further pain reduction and range of motion improvement. Conclusion: This case report demonstrates the efficacy and safety of Cooled Radiofrequency Ablation for the Glenohumeral joint, utilizing a lateral position approach. The findings support its potential advantages over traditional methods, offering a valuable addition to the management of chronic shoulder pain. Further research and clinical experience will refine its role in addressing this common and debilitating condition.

Glenohumeral joint osteoarthritis is not associated with clavicle fractures in a large arthroplasty cohort

IntroductionA recent study based on a large osteological collection reported an association between clavicle fractures and osteoarthritis of the glenohumeral joint. No clinical study has yet addressed this potential association. Other radiographic parameters such as the critical shoulder angle have been associated with the risk of glenohumeral joint osteoarthritis. The primary outcome of this study was to determine if there is an association between glenohumeral joint arthritis and clavicle fractures. The secondary outcome was to determine the association between critical shoulder angle and glenohumeral joint arthritis in our patient cohort. MethodsWe retrospectively analysed 572 consecutive shoulder arthroplasty surgeries. Osteoarthritis was the indication for 343 shoulder arthroplasties. 229 shoulder arthroplasties were performed due to another diagnosis such as trauma or fracture, cuff arthropathy, or revision surgery. Three fellowship trained consultant shoulder surgeons assessed the pre- and post-operative radiographs of all patients. ResultsA clavicle fracture was suspected in 5/343 (1.5 %) shoulder arthroplasties performed due to osteoarthritis and 5/229 (2.1 %) shoulder arthroplasties performed for another diagnosis. Interobserver variability was assessed using a Fisher Exact test and showed no significant relationship between osteoarthritis and a fracture of the clavicle (p = 0.531). Critical shoulder angle results correlated with the previously published literature regarding critical shoulder angle and osteoarthritis and rotator cuff arthropathy. ConclusionClavicle fractures were not associated with glenohumeral osteoarthritis in our patient cohort of shoulder arthroplasty patients. Critical shoulder angle results were consistent with published literature. Further research in the form of prospective long term studies are needed to establish if any association exists between clavicle fractures and osteoarthritis of the glenohumeral joint. Level of evidenceLevel III. Retrospective analysis.

Medium-Term Clinical Outcomes of the Global Icon Stemless Shoulder System: Results of a 2-Year Follow-Up.

The primary aim of this study was to assess the medium-term outcomes of the Global Icon stemless shoulder replacement in patients who have undergone primary total shoulder arthroplasty (TSA) for glenohumeral joint osteoarthritis. A retrospective review of patients who had undergone a TSA using the Global Icon stemless shoulder system was performed. The Western Ontario Osteoarthritis Shoulder (WOOS) Index and Oxford Shoulder Score (OSS) were evaluated pre-operatively and at 12 to 24 months post-operatively. Radiological outcomes, operation time, and post-operative complications were reported. Primary analysis for the WOOS Index and OSS focused on detecting within-group treatment effects at 24 months using a repeated measures ANOVA. Thirty patients were included in the study. Post-surgery, there was a significant improvement at 24 months on the OSS (ES = 0.932, CI: 41.7 to 47.7, p < 0.001) and the WOOS Index (ES = 0.906, CI: 71.9 to 99.8, p < 0.001). Radiographs revealed that no component loosened, migrated, or subsided. The median operative time was 75.5 (IQR: 12.25, range: 18 to 105) min. No implant-related complications were reported. The Global Icon stemless replacements have excellent clinical outcomes in this cohort at 12- and 24-month follow-up with no implant-related complications.

Efficacy of intra-articular injections of hyaluronic acid in patients with glenohumeral joint osteoarthritis: A systematic review and meta-analysis.

Symptomatic primary glenohumeral (GH) joint osteoarthritis (OA) can be challenging to treat. Hyaluronic acid (HA) has emerged as a promising treatment for the nonsurgical management of GH-OA. In this systematic review with meta-analysis, we aimed to evaluate the current evidence regarding the efficacy of intra-articular HA on pain relief in patients suffering from GH-OA. A total of 15 studies (only randomized controlled trials providing data at the end of the intervention) were included. The relevant studies were selected based on the following PICO model: P: patients with diagnosis of shoulder OA; I: HA infiltrations as therapeutic intervention administered; C: no restriction for comparators assessed; O: pain, in terms of visual analog scale (VAS) or numeric rating scale. The risk of bias among the included studies was estimated using the PEDro scale. A total of 1023 subjects were analyzed. Comparing HA injections combined with physical therapy (PT) compared to PT alone resulted in superior scores, showing an overall effect size (ES) of 4.43 (p = 0.00006). Moreover, pooled analysis of VAS pain scores demonstrated a significant improvement in the ES of the HA in comparison with corticosteroid injections (p = 0.002). On average, we reported a PEDro score of 7.2. A total of 46.7% of studies showed probable signs of a randomization bias. The findings of this systematic review and meta-analysis showed that IA injections of HA might be effective on pain relief with significant improvements compared to baseline and compared to corticosteroid injections in patients affected by GH-OA.

Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association.

A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for physical therapist management of glenohumeral joint osteoarthritis. This clinical practice guideline is available in Spanish; see Supplementary Appendix 8.

Diagnostic sensitivity of ultrasound of the supraspinatus tendon when compared to magnetic resonance imaging prior to arthroscopy: A retrospective study

AbstractIntroductionUltrasound (USS) and magnetic resonance imaging (MRI) have been used as screening tools for rotator cuff tears with MRI reported as superior. When comparing USS and MRI for supraspinatus tears, less data is available.AimCompare the diagnostic sensitivity of USS and MRI in the pre‐operative diagnosis of partial thickness tears (PTT) and full thickness tears (FTT) of supraspinatus tendons compared to gold‐standard shoulder arthroscopy to assess if differences in detection rates exist.MethodRetrospective study of deidentified electronic medical records including post‐operative surgical notes and pre‐operative imaging USS and MRI results.ResultsN = 103 participants, male: female ratio of 63:40, mean age 64 years. FTT were diagnosed by arthroscopy in 63/103 (61.2%), PTT &lt;5 mm in 18/103 (17.5%), PTT &gt;5 mm in 22/103 (21.4%). USS and MRI sensitivity were both 95.2% for FTT. PTT &lt;5 mm sensitivity for USS and MRI were 83.3% and 77.7%, and PTT &gt;5 mm sensitivity were 73.3% and 86.4% respectively. Overall supraspinatus tears USS sensitivity was 88.4% and MRI 90.3%.DiscussionComparable sensitivity was demonstrated for FTT for USS and MRI. USS had better sensitivity than MRI for PTT &lt;5 mm, MRI performed better for PTT &gt;5 mm. Pre‐operative evaluation of suspected supraspinatus tears could include USS as a first line imaging modality, due to its low cost and easier availability.ConclusionUSS has high diagnostic accuracy for diagnosing supraspinatus FTT and PTT. MRI may be used where significant glenohumeral joint osteoarthritis needs to be assessed. Further studies with larger numbers are needed to verify these results.

Rotator cuff muscle degeneration in a mouse model of glenohumeral osteoarthritis induced by monoiodoacetic acid.

Osteoarthritis (OA) is a disease of joint degeneration and impaired function. Muscle atrophy, fatty infiltration (FI), and fibrosis are degenerative features of muscle injury and predict poor outcomes in some degenerative and exercise-related injuries. Patients with glenohumeral joint OA are usually accompanied by rotator cuff muscle degeneration, even though the rotator cuff is intact. However, the mechanism and correlation between OA and degeneration of muscles around joints are still unknown. Forty-five 12-month-old C57BL/6J mice received a single injection of monoiodoacetic acid(MIA)into the right glenohumeral joint. The sham group was injected with saline on the same day in the right glenohumeral joint. 3 and 6 weeks after the operation, gait analysis was conducted to evaluate the function of the forelimb. Then, the shoulder joint and supraspinatus muscle (SS) were collected for histological staining, RT-qPCR, and biomechanics test. Correlations between fat area fraction in muscle, percentage wet muscle weight change or OARSI score and gait analysis,/muscle mechanics tests were assessed using Pearson's correlation coefficient or Spearman's correlation coefficient. Compared with the sham group, the MIA group developed significant glenohumeral joint OA, and the SS developed significant FI and muscle atrophy. Shoulder function correlated with glenohumeral joint OA/rotator cuff muscle severity, weight loss, and FI. In mice, glenohumeral joint OA can lead to rotator cuff degeneration and inferior limb function. The small animal model could be a powerful tool to further study the potential mechanisms between glenohumeral OA and rotator cuff muscle degeneration. Basic Science Study; In-Vivo Animal Model.

Good clinical and radiological outcomes of anatomic total shoulder arthroplasty with a novel convertible all polyethylene glenoid with hybrid fixation: minimum 2-year follow-up

BackgroundThe ideal glenoid implant for anatomic total shoulder arthroplasty (aTSA) is one that provides sound fixation and allows ease of conversion to a reverse shoulder arthroplasty should the clinical need arise. This study is the first to report a consecutive series of patients treated with a novel convertible all polyethylene glenoid with hybrid fixation. The aim of the study was to evaluate the clinical, functional, and radiological outcomes of aTSA, for treatment of primary glenohumeral joint osteoarthritis using the SMR TT Hybrid Glenoid. MethodsThis is a prospective study including consecutive patients from two centers in New Zealand and Sweden. Between August 29, 2017 and April 22, 2020, 103 patients received an aTSA for osteoarthritis with the SMR TT Hybrid Glenoid implant (LimaCorporate, San Daniele del Friuli, Italy). Ninety-seven patients had a minimum follow-up of 24 months and were therefore included in this study. There were 45 female and 52 male patients. The average age at the time of surgery was 68.2 years (range 49-81 years). Preoperative and postoperative clinical evaluations were performed using the American Shoulder and Elbow Surgeons score and the Oxford Shoulder Score. Preoperative and postoperative range of motion measures were conducted using a goniometer. Standardized Grashey and axillary lateral radiographs were utilized to assess for evidence of glenoid and humeral component failure and loosening. ResultsThe mean follow-up duration was 2.3 years (range 2.0-4.6 years). The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 29.0 ± 12.4 and 90.3 ± 14.5, respectively (P < .001). The mean preoperative and postoperative Oxford Shoulder Scores were 21.0 ± 6.7 and 45.3 ± 4.4, respectively (P < .001). We found significant improvements in the range of motion, with mean forward flexion increasing from 87° to 155° and abduction 73° to 149°, respectively. Radiologically, there was no evidence of glenoid or humeral component failure or loosening. Six patients had evidence of reduced bone density around the humeral component. Two patients had repair of traumatic rupture of subscapularis tendon in the early postoperative period. None of the patients had revision of the glenoid or humeral components. ConclusionsPatients treated with an aTSA with the SMR TT Hybrid Glenoid, a novel glenoid implant that has the potential to simplify the process of revision, achieved promising clinical and radiologic results at a minimum of two years.

Relationship Between Preoperative Shoulder Osteoarthritis Severity Score and Postoperative PROMIS-UE Score After Rotator Cuff Repair

Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established. To apply the magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) scores. Case-control study; Level of evidence, 3. Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction. The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score (r = -0.24; P = .040). Both cartilage wear (r = -0.33; P = .0045) and acromioclavicular joint degeneration (r = -0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score. In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis.

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 2

AbstractAnatomic total shoulder arthroplasty is a widely used definitive surgical solution for end-stage glenohumeral joint osteoarthritis and is associated with good clinical outcomes. Anatomic total shoulder arthroplasty has a role for patients under 50 years of age who have exhausted nonoperative management and for patients over 80 years of age with an intact rotator cuff. Patients younger than 50 place greater demands on their replaced shoulders, raising concerns about implant survivorship and in particular the failure of the glenoid component. There are limited data on the long-term survivorship of anatomic total shoulder arthroplasty in patients under the age of 50 years in the literature. Modern bone-preserving designs utilizing newer materials may contribute to improved outcomes and survivorship. Achieving comparable functional outcomes in patients over 80 years of age remains a challenge with concerns related to rotator cuff failure. However, in appropriately selected patients over the age of 80 years, an anatomic total shoulder arthroplasty provides better pain relief and function than a reverse total shoulder arthroplasty.

Outcomes Between Stemmed and Stemless Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Both stemmed and stemless designs for total shoulder arthroplasty (TSA) have demonstrated efficacious outcomes for the surgical treatment of primary glenohumeral joint osteoarthritis. The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of stemmed versus stemless TSA in randomized controlled trials. We hypothesized that there would be no differences in Constant Score (CS), range of motion, or adverse events, such as periprosthetic fracture and/or revision surgery. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature was done using MEDLINE, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Registry of Controlled Trials, Embase, and Web of Science databases. Outcomes of interest included CS, range of motion, and adverse events (periprosthetic fracture and revision). Summary effect estimates of the mean difference between stemmed and stemless TSA for each outcome were estimated in random effects models. The search yielded 301 articles with 4 appropriate for qualitative analysis, including the results of 229 stemmed and 358 stemless TSAs. No significant difference was observed in postoperative CS (P = 0.36), forward flexion (P = 0.93), abduction (P = 0.30), or external rotation (P = 0.34) between stemmed and stemless TSA. No significant difference was observed in change in CS (P = 0.27), forward flexion (P = 0.25), or external rotation (P = 0.74). A change in abduction was significantly different between stemmed and stemless TSA (standardized mean difference = -0.64; 95% confidence interval, -1.20 to -0.08) in favor of stemmed TSA (P = 0.02), attributed to preoperative differences. No significant difference was observed in periprosthetic fractures (P = 0.07) or revision (P = 0.90). TSA with stemless versus stemmed humeral components was not associated with notable differences in functional and clinical outcomes. No difference was observed between stemmed and stemless designs in postoperative forward flexion, abduction, or external rotation. Similarly, there was no difference in change in forward flexion or external rotation. A markedly greater improvement in abduction was observed with stemmed TSA, likely due to the lower preoperative motion in the stemmed cohort in one of the studies. No differences were observed between stemmed and stemless designs in the rate of humeral fracture or risk of revision. Level II; systematic review and meta-analysis of prospective randomized controlled trials.

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 1

AbstractAnatomic total shoulder arthroplasty is a widely used definitive surgical solution for end-stage glenohumeral joint osteoarthritis and is associated with good clinical outcomes. Anatomic total shoulder arthroplasty has a role for patients under 50 years of age who have exhausted nonoperative management and for patients over 80 years of age with an intact rotator cuff. Patients younger than 50 place greater demands on their replaced shoulders, raising concerns about implant survivorship and in particular the failure of the glenoid component. There are limited data on the long-term survivorship of anatomic total shoulder arthroplasty in patients under the age of 50 years in the literature. Modern bone-preserving designs utilizing newer materials may contribute to improved outcomes and survivorship. Achieving comparable functional outcomes in patients over 80 years of age remains a challenge with concerns related to rotator cuff failure. However, in appropriately selected patients over the age of 80 years, an anatomic total shoulder arthroplasty provides better pain relief and function than a reverse total shoulder arthroplasty.

Rationalizing routine postoperative blood testing following elective shoulder arthroplasty

BackgroundImprovements in perioperative care have decreased complication rates following arthroplasty surgery and enabled outpatient surgery. Although studies have suggested selective routine postoperative blood tests for lower limb arthroplasty, there is currently a paucity of research into its utility for shoulder arthroplasty. Our aim was to define an algorithm based on Charlson Comorbidity Index (CCI) value as part of a predictive algorithm to identify low-risk patients undergoing elective anatomic and reverse shoulder arthroplasty that can safely do without routine postoperative blood tests. MethodsElectronic medical records were retrospectively reviewed for patients who underwent elective primary shoulder arthroplasty at our institution, both anatomic and reverse, between January 2009 and October 2020. Inclusion criteria included patients who underwent reverse or anatomic shoulder arthroplasty for glenohumeral joint osteoarthritis or rotator cuff arthropathy and had documented preoperative and postoperative blood tests including full blood count and serum electrolytes. Exclusion criteria included patients who had revision and trauma indications for surgery because of the increased complication rates associated with these indications. Variables recorded included age, gender, body mass index, indication for surgery, comorbidities, American Society of Anesthesiologists score, CCI score, preoperative blood test values from preadmission assessment, postoperative day one blood test values, and interventions required based on blood results. ResultsA total of 140 patients were included in the study. Eighteen patients (12.85%) required intervention based on postoperative blood tests, the most common indications being anemia and hyponatremia. Patients that required intervention had higher CCI (P = .001) and lower preoperative hemoglobin (P = .014). With the application of cutoff values of hemoglobin of ≥106 g/L, and CCI score of less than 4, only one patient in our study required intervention. ConclusionRoutine postoperative blood test following primary elective shoulder arthroplasty is not required in low-risk patients, defined as those with a CCI score of <4 and a preoperative hemoglobin of >106 g/L.

Retear After Arthroscopic Rotator Cuff Repair Results in Functional Outcome Deterioration Over Time

This study aimed to evaluate the effect of retear on long-term functional outcomes and glenohumeral joint osteoarthritis (OA) progression after arthroscopic rotator cuff repair (ASRCR). We retrospectively reviewed 201 patients who underwent ASRCR and were followed up for at least 5 years. Rotator cuff tendon structural integrity was evaluated using magnetic resonance imaging and/or ultrasonography. Pain, active range of motion, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were evaluated for functional outcomes. To evaluate deterioration over time, the minimal clinically important difference value of pain and ASES were used. The mean follow-up period was 8.6 ± 2.2 years and overall retear rate was 21.4%. OA progression was strongly associated with retear (odds ratio 5.1, P < .001). Functional outcomes at the 2-year postoperative follow-up significantly improved compared to the preoperative status (all P < .017), regardless of retear. However, the retear group presented worse functional outcomes at the final follow-up (pain: 3.1 ± 2.6; ASES: 72.0 ± 17.4) than at the 2-year postoperative follow-up (pain: 1.2 ± 2.3, P= .014; ASES: 91.1 ± 9.9, P= .015) than the healed tendon group at final follow-up (pain:.6± 1.7; P < .001; ASES 95.5 ± 11.8; P < .001). The time for deterioration of pain (healed group vs. retear group: 5.5 ± 0.5 vs. 10.6 ± 0.4 years; P < .001) and ASES (healed group vs. retear group: 7.5 ± 0.5 vs. 12.8 ± 0.2 years; P< .001) decreased in the retear group. The functional status improved after ASRCR in short- and long-term follow-up, regardless of retear. However, retear was strongly associated with OA progression, and long-term functional outcomes deteriorated over time in retear cases, which was not observed during short-term follow-up. III, retrospective cohort study.

Non-Operative Treatment Options in Primary Glenohumeral Osteoarthritis: A Comprehensive Review

Primary glenohumeral joint osteoarthritis is a growing pathology with multifactorial aethiology that affects younger and older population. Treatment must be focused on reducing pain, regaining functionality, and slowing the course of the disease. Surgery and non-operative methods are available for treating it and are a frequent source of controversy, the latter being applied to patients with factors that may relatively contraindicate surgery. Practitioners must be acquainted with the therapeutic choices and the current status of the evidence. Given that nonsurgical therapy may be beneficial in relieving symptoms, it should be considered first-line treatment, particularly in low-demand individuals with symptoms that have shown themselves sub acutely. Literature is lacking of high quality evidence on this matter, and up to date, there have not been any high quality studies comparing different options. Optimal treatment of primary glenohumeral osteoarthritis depends on specifically patient´s needs, therefore a combination of all the resources available could represent the best option and result in better outcomes.

The prevalence of glenohumeral joint osteoarthritis in a primary care shoulder pain population referred for radiographs

Dear Editor, Glenohumeral joint (GHJ) OA is characterized by pain, restricted movement and radiographic loss of articular cartilage, subchondral bone changes and loss of joint space. It may be primary or secondary to rotator cuff tears (RC arthropathy). It has a significant impact on quality of life, with significant negative effects on lifestyle and emotional health [1]. It also poses a significant economic burden: the number of UK shoulder replacements has increased by almost 300% in 5 years, with 7294 shoulder replacements in 2019 [2]. In the USA, from 2007 to 2015, procedures for GHJ OA have increased by up to 322% and 66 185 patients were discharged from hospital with a diagnosis of GHJ OA in 2016 [3]. In Australia, a recent population-level analysis has found the lifetime risk of shoulder arthroplasty from 2008 to 2017 has increased by 128% in men...

Interpretation of 2020 American Academy of Orthopaedic Surgeons (AAOS) on the Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline

Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.

A Matlab toolbox for scaled-generic modeling of shoulder and elbow

There still remains a barrier ahead of widespread clinical applications of upper extremity musculoskeletal models. This study is a step toward lifting this barrier for a shoulder musculoskeletal model by enhancing its realism and facilitating its applications. To this end, two main improvements are considered. First, the elbow and the muscle groups spanning the elbow are included in the model. Second, scaling routines are developed that scale model’s bone segment inertial properties, skeletal morphologies, and muscles architectures according to a specific subject. The model is also presented as a Matlab toolbox with a graphical user interface to exempt its users from further programming. We evaluated effects of anthropometric parameters, including subject’s gender, height, weight, glenoid inclination, and degenerations of rotator cuff muscles on the glenohumeral joint reaction force (JRF) predictions. An arm abduction motion in the scapula plane is simulated while each of the parameters is independently varied. The results indeed illustrate the effect of anthropometric parameters and provide JRF predictions with less than 13% difference compared to in vivo studies. The developed Matlab toolbox could be populated with pre/post operative patients of total shoulder arthroplasty to answer clinical questions regarding treatments of glenohumeral joint osteoarthritis.

Interpretation of 2020 American Academy of Orthopaedic Surgeons (AAOS) on the Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline

The 2020 Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline which was prepared by the American Academy of Orthopaedic Surgeons (AAOS) were publicated on October 2020. The guideline involves the following 8 chapters: drug therapy and injectable biologics, physical therapy and non-surgical treatments, radiographs, prognostic factors, surgical treatments, intraoperative hemostasis measure (tranexamic acid), management of supraspinatus tears, multimodal pain management and discharge. In this paper, the guideline is interpreted to provide cutting-edge information for domestic glenohumeral joint osteoarthritis researchers.

Injection of Bone Marrow Aspirate for Glenohumeral Joint Osteoarthritis: A Pilot Randomized Control Trial

PurposeTo compare the efficacy of a single, intra-articular, nonconcentrated bone marrow aspirate (BMA) injection in comparison to cortisone for the treatment of glenohumeral joint osteoarthritis (GHJ OA).MethodsInclusion criteria were patients between the ages of 18 and 75 with a diagnosis of GHJ OA on radiograph. Patients were randomized to receive an ultrasound-guided, intra-articular cortisone injection or BMA injection (without concentration). The primary outcome measure was the Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 12 months. Secondary outcome measures were the QuickDASH, EuroQOL 5-dimensions 5-level questionnaire (EQ-5D-5L) and visual analogue scale.ResultsThe study included 25 shoulders of 22 patients who completed baseline and 12 months’ patient-reported outcome measures (12 shoulders received cortisone, 13 shoulders received BMA) after the study was terminated early by changes in Health Canada regulations. Baseline characteristics demonstrated a significant difference in the ages of the 2 groups, with the BMA group being older (61.6 vs 53.8 mean years, P = 0.021). For the BMA group, a significant improvement was seen in the WOOS index (P = 0.002), the QuickDASH (P < 0.001), and the EQ-5D-5L pain dimension (P = 0.004) between baseline and 12 months. No significant difference was seen for any outcome in the cortisone group between baseline and 12 months. No significant difference was demonstrated between changes in the WOOS scores from baseline to 12 months when compared between groups (P = 0.07). However, a significant difference in changes in scores was seen in the QuickDASH (P = 0.006) and the EQ-5D-5L pain scores (P = 0.003) and the EQ-5D-5L health scores (P = 0.032) in favor of BMA.ConclusionsThe results of this study demonstrate that patients with GHJ OA treated with BMA have superior changes in the QuickDASH and EQ-5D-5L pain and health scores but not in the WOOS outcomes measures at 12 months post injection when compared to patients treated with cortisone. However, because of the limited number of patients as a result of the early termination of the study, larger randomized studies are required to confirm these findings.Level of EvidenceLevel II, randomized controlled trial.