Artrite do Ombro
Patients › Shoulder
Shoulder arthritis causes pain, stiffness, and reduced range of motion — diagnosis and treatment options explored.
O que você está sentindo
A artrite do ombro é uma condição comum. Ela causa danos por desgaste nas superfícies articulares. Você pode notar que o aumento da idade traz mais dor e alterações visíveis nos raios X. A dor geralmente começa de forma lenta. Em alguns casos, torna-se destrutiva rapidamente, especialmente em mulheres mais velhas.
Você provavelmente sentirá dor profunda no ombro. Essa dor frequentemente piora à noite. Ela também pode se agravar após o uso do braço ou ao acordar pela primeira vez. Tarefas diárias simples tornam-se difíceis. Você pode ter dificuldade em alcançar as costas para fechar um sutiã. Enfiar a camisa pode parecer desconfortável ou doloroso. Levantar objetos acima da cabeça pode desencadear desconforto agudo.
Seu cirurgião verificará padrões específicos de desgaste articular. Por exemplo, a cabeça do seu úmero pode se deslocar para trás na cavidade. Isso é chamado de subluxação posterior. Com o tempo, esse deslocamento pode alterar a forma como a articulação se desgasta. Cerca de 20% dos ombros com esse padrão desenvolvem um padrão de desgaste excêntrico ao longo de uma década. Seu cirurgião procura por esses sinais para entender sua situação específica.
Você pode se perguntar se uma infecção está causando sua dor. Seu cirurgião pode usar imagens avançadas, como uma tomografia computadorizada por emissão de pósitrons (PET/CT) especial, para diferenciar infecção de artrite comum. Isso ajuda a garantir que você receba o tratamento adequado.
Embora as estratégias de manejo continuem a evoluir, especialmente para pacientes mais jovens, a longevidade do implante permanece uma preocupação se você for muito ativo. Seu cirurgião discutirá as melhores opções para você. A artroplastia total anatômica do ombro é frequentemente a escolha padrão se os tendões do manguito rotador estiverem saudáveis. A artroplastia total reversa do ombro é outra opção, particularmente se o manguito estiver danificado ou em casos complexos. Ambas as abordagens visam reduzir a dor e melhorar a função.
Se os sinais de sua artrite forem leves nos raios X, você tem cerca de sete vezes mais chances de não sentir melhora significativa após a artroplastia total anatômica do ombro em comparação com pacientes com artrite grave. Este é um contexto importante para sua tomada de decisão. Seu cirurgião o ajudará a ponderar esses fatores em relação às suas necessidades diárias e níveis de atividade.
O que realmente está acontecendo
A artrite do ombro é uma condição comum de desgaste onde o revestimento liso nas extremidades dos ossos se degrada. Esse revestimento, chamado de cartilagem, atua como um amortecedor de impacto. Quando ela se torna mais fina ou desaparece, os ossos esfregam uns contra os outros. Isso causa dor e rigidez. A cápsula articular, a bainha ao redor do ombro, também pode se contrair.
Em muitos casos, os tendões do manguito rotador ainda estão intactos. Esses tendões funcionam como cordas que ajudam a levantar o braço. Quando funcionam bem, o cirurgião pode realizar uma artroplastia total do ombro anatômica. Esse procedimento substitui as superfícies ósseas desgastadas por componentes artificiais que imitam a forma natural da sua articulação. É o tratamento padrão quando o manguito rotador está saudável.
Às vezes, o manguito rotador está rompido ou enfraquecido. Sem esses tendões, a cabeça da articulação (a "bola") escorrega para fora do lugar. O cirurgião pode então recomendar uma artroplastia total do ombro reversa. Essa cirurgia inverte a posição da cabeça e da cavidade articular. Ela utiliza o músculo deltoide para levantar o braço em vez dos tendões rompidos. Esse design ajuda a recuperar o movimento mesmo quando o manguito rotador está danificado.
A maneira como o ombro se move muda após a cirurgia. A escápula, ou omoplata, trabalha mais para mover o braço. Isso é normal e esperado. O novo design da articulação permite uma amplitude completa de movimento, embora os padrões de movimento difiram de um ombro saudável.
Os designs dos implantes melhoraram significativamente. As próteses modernas se encaixam com mais precisão e se movem de forma mais natural. No entanto, a longevidade desses implantes continua sendo uma preocupação para pacientes ativos. Indivíduos mais jovens ou mais ativos podem desgastar as partes artificiais mais rapidamente. O cirurgião escolherá a melhor opção com base no dano articular específico e no nível de atividade do paciente.
O que podemos fazer a respeito
Sempre começamos com opções não cirúrgicas, especialmente se a sua artrite por desgaste for moderada ou leve. Seu cirurgião provavelmente recomendará inicialmente um programa de automaneio e fisioterapia. Esta abordagem concentra-se em manter o ombro em movimento e fortalecer os músculos ao redor dele para aliviar a pressão sobre a articulação. Você pode esperar dar uma chance adequada a este tratamento conservador antes de considerar etapas mais invasivas. Esta é a primeira linha de defesa padrão para ajudá-lo a controlar a dor e manter a função sem recorrer à cirurgia.
Se movimentos suaves e exercícios não forem suficientes, avaliamos o manejo clínico para controlar seus sintomas. Isso geralmente envolve medicamentos para dor e anti-inflamatórios para reduzir o inchaço e o desconforto. Seu cirurgião também pode discutir injeções. Injeções de cortisona podem proporcionar alívio significativo da dor por um período limitado, ajudando-o a retomar as atividades diárias. Outras opções, como injeções de ácido hialurônico ou plasma rico em plaquetas (PRP), são às vezes usadas para lubrificar a articulação ou promover a cicatrização, embora sua duração de efeito varie. Estes tratamentos não curam a artrite, mas podem ganhar tempo e melhorar sua qualidade de vida enquanto você gerencia a condição.
A cirurgia é considerada apenas quando o tratamento conservador atingiu seu limite e sua dor permanece severa. Neste estágio, seu cirurgião pode recomendar uma substituição do ombro, também conhecida como artroplastia. Este procedimento substitui as partes danificadas da sua articulação por componentes artificiais para restaurar o movimento suave e aliviar a dor. O tipo específico de substituição depende da saúde do manguito rotador e da extensão dos danos ósseos. Por exemplo, uma artroplastia total anatômica do ombro é o padrão-ouro se o seu manguito rotador estiver íntegro, enquanto uma artroplastia total reversa do ombro é frequentemente utilizada em casos mais complexos envolvendo lesão do manguito. Estes tratamentos cirúrgicos são considerados eficazes para casos graves e podem oferecer melhorias significativas e sustentadas na sua capacidade de usar o braço.
O que esperar
A artrite do ombro é uma condição comum que causa desgaste das superfícies articulares. Sem tratamento, os sintomas frequentemente persistem e podem piorar ao longo do tempo. Muitos pacientes experimentam dor e rigidez contínuas que limitam as atividades diárias. Se você tiver sinais leves de artrite nas imagens, tem cerca de sete vezes mais probabilidade de sentir que a cirurgia não ajudou o suficiente em comparação com aqueles que têm artrite grave. Isso destaca por que seu cirurgião combina cuidadosamente o tratamento com o estágio da sua doença.
Quando bem gerenciada, as opções cirúrgicas, como a substituição articular, podem proporcionar um alívio significativo. A maioria dos pacientes observa melhorias substanciais na dor e na função. Para aqueles com o manguito rotador intacto, tanto as substituições articulares anatômicas quanto as reversas oferecem bons resultados. A substituição reversa, em particular, apresenta baixas taxas de complicações a curto prazo para este grupo. Mesmo que seu cirurgião precise mudar para uma substituição reversa durante a cirurgia, seus resultados provavelmente serão comparáveis aos de quem planejou isso desde o início.
A perspectiva a longo prazo varia. Embora muitos desfrutem de uma melhora sustentada, a longevidade do implante continua sendo uma preocupação, especialmente se você for ativo. Alguns pacientes continuam a ter dor ou experimentam erosão óssea mais de 10 anos após certos tipos de substituição. Além disso, cerca de 16% dos pacientes desenvolvem artrite na articulação acromioclavicular (a protuberância no topo do ombro) dentro de 12 anos após a substituição anatômica. A força na parte frontal do ombro pode não retornar totalmente ao normal por dois anos, embora você provavelmente veja uma melhora em relação ao ponto de partida.
A recuperação é um processo, não um evento único. Você deve esperar um progresso gradual ao longo de semanas e meses. Embora a dor geralmente diminua, a força total leva tempo para ser reconstruída. Seu cirurgião irá guiá-lo por essa jornada, mas entender que algumas limitações ou desconfortos podem persistir ajuda a estabelecer expectativas realistas. O objetivo é restaurar a função e reduzir a dor, permitindo que você retome as atividades que mais importam para você.
Quando procurar ajuda
A artrite do ombro é comum e frequentemente piora com a idade. Consulte o seu médico de família se tiver dor persistente que não melhora com o repouso. Procure uma avaliação especializada se sentir fraqueza, instabilidade ou se o seu ombro bloquear ou ceder. Estes sintomas podem interferir com o sono ou o trabalho. A piora súbita da dor requer atenção. Isto é especialmente verdadeiro para mulheres idosas com dor no ombro de início insidioso, que pode indicar uma artrose destrutiva rápida. O seu cirurgião pode utilizar imagens para distinguir entre infeção e artrite por desgaste. A avaliação precoce ajuda a gerir os sintomas e a planear o tratamento, incluindo a possível substituição da articulação.
Evidence & references
Overview
- Standardization of outcome assessment following treatment of shoulder arthritis is needed [1].
- Shoulder arthritis is common [2].
- Management strategies for shoulder arthritis, especially in young patients, continue to evolve [2].
- Significant improvements in implant design have occurred for shoulder arthritis management [2].
- Implant longevity remains a concern in more active patients with shoulder arthritis [2].
- Anatomic total shoulder arthroplasty (ATSA) is the benchmark for surgical treatment of glenohumeral arthritis with an intact cuff [19].
- Reverse total shoulder arthroplasty (RTSA) has gained popularity for rotator cuff arthropathy and other complex indications [19].
- Knowledge of the array of shoulder prostheses currently available and their indications can lead to optimized patient outcomes [11].
- Use of treatment algorithms can lead to optimized patient outcomes in shoulder arthroplasty [11].
- Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of patient-reported pain, function, or adverse effects [24].
- The evidence comparing total shoulder arthroplasty to hemiarthroplasty is of low quality [24].
- Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty [3].
- Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].
- Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
- The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [7].
- A clear standardized set of shoulder arthroplasty complication definitions is lacking [8].
- Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis [26].
Anatomy & Pathophysiology
- Pathoanatomic metrics with identified threshold values can discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
- Measurement of humeral subluxation in the glenoid hull plane may be more accurate than measurement in the scapular plane [27].
- Scapular kinematics in patients with shoulder arthroplasty are influenced by the implementation of external loads, but not by the type of load [34].
- Scaption kinematics in reverse shoulder arthroplasty do not change after the sixth postoperative month [35].
- Elliptical and spherical humeral heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty [37].
- Geometric analysis of the prosthetic shoulder is precise [38].
- Reverse total shoulder arthroplasty (RTSA) shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but exhibit much greater intersubject variation and larger moment-arm magnitudes [41].
- In RTSA, although the teres minor external rotation moment arm is higher than in a normal shoulder, decreased length could impair force generation [42].
- Reverse total shoulder arthroplasty alters humerothoracic, scapulothoracic, and glenohumeral motion during weighted scaption [43].
- Custom, non-spherical prosthetic heads more accurately replicate head shape, rotational range of motion, and glenohumeral joint kinematics compared with commercially available spherical prosthetic heads when compared to the native humeral head [44].
- The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with reverse total shoulder arthroplasty compared with a healthy shoulder [47].
- Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss [51].
- Anatomic total shoulder arthroplasty results in tendon-metal contact and higher tendon contact pressures compared to the native shoulder [52].
- The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction [55].
- Glenosphere configuration can be modified to increase range of movement in reverse shoulder arthroplasty [56].
Classification
- Pathoanatomic metrics with identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
- Anatomic patterns of glenoid bone loss exist for different classes of glenohumeral arthritis [14].
- Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed over a decade [18].
- Concentric arthritis developed an eccentric pattern 20% of the time over a decade [18].
- Measurement of humeral subluxation in the glenoid hull plane may be more accurate than in the scapular plane [27].
- A 3-dimensional classification system using combined humeroscapular alignment and glenoid erosion can be applied to describe degenerative glenohumeral arthritis comprehensively [36].
- A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology [40].
- Osteoarthritic humeral head morphology varies significantly from normal, characterized by larger spherical diameters [58].
- Osteoarthritic humeral head morphology does not vary as a function of the Walch classification between symmetric and asymmetric glenoids [58].
Clinical Presentation
- Shoulder arthritis is a common condition [2].
- Management strategies for shoulder arthritis, particularly in young patients, continue to evolve with significant improvements in implant design, although longevity remains a concern in more active patients [2].
- Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
- Pathoanatomic metrics with identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
- Rapidly destructive arthrosis of the shoulder joints should be considered in the differential diagnosis of elderly women with insidious shoulder pain [10].
- Increased age is the main determinant of radiological changes in shoulder osteoarthritis, as well as pain [12].
- Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed, while concentric arthritis developed an eccentric pattern 20% of the time over a decade [18].
- Arthritic B2 glenoids are common, and their maximal erosion is usually posteroinferior [48].
- F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis [22].
Investigations
- Standardization of outcome assessment is needed following treatment of shoulder arthritis [1].
- Pathoanatomic metrics with identified threshold values can discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis [6].
- Rapidly destructive arthrosis should be considered in the differential diagnosis of elderly women with insidious shoulder pain [10].
- Increased age is the main determinant of radiological changes in shoulder osteoarthritis [12].
- Increased age is the main determinant of pain in shoulder osteoarthritis [12].
- Anatomic patterns of glenoid bone loss exist for different classes of glenohumeral arthritis [14].
- F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis [22].
- In healthy/nonosteoarthritic shoulders, increased glenoid retroversion is associated with decreased anterior glenoid offset [31].
- Additional research is required to document the clinical value of new technologies to patients with glenohumeral arthritis [32].
- MRI offers a more precise method of determining glenoid version compared with x-ray imaging for preoperative osseous imaging in total shoulder arthroplasty [57].
- The critical shoulder angle is an effective radiographic parameter associated with rotator cuff tears and osteoarthritis [63].
- Three-dimensional CT reconstruction allows for reliable evaluation of the scapulohumeral relationship [64].
- Three-dimensional CT reconstruction reveals significant posterior translation of the humeral head in osteoarthritic shoulders compared to nonpathologic controls [64].
- Significant posterior translation of the humeral head in osteoarthritic shoulders supports the pathomechanism of glenoid component loosening [64].
- A quantitative method for determining medial migration of the humeral head on plain radiographs is inexpensive, practical, and reproducible after shoulder arthroplasty [67].
- Cystic disease in the glenoid did not affect functional outcome after total shoulder arthroplasty with minimum 5-year follow-up [68].
- Cystic disease in the glenoid did not affect the presence of radiographic glenoid loosening after total shoulder arthroplasty with minimum 5-year follow-up [68].
- Three significantly differently oriented posterior erosion patterns (posterior-superior, posterior-central, and posterior-inferior) were distinguished in shoulders demonstrating posterior wear on axillary imaging [69].
Treatment
Non-Operative Management
- Nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild shoulder osteoarthritis [17].
Surgical Management: General Principles and Indications
- Anatomic total shoulder arthroplasty (ATSA) is the benchmark for surgical treatment of glenohumeral arthritis with an intact rotator cuff [19].
- Reverse total shoulder arthroplasty (RTSA) has gained popularity for rotator cuff arthropathy and other complex indications [19].
- Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [17].
- Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes [11].
- Shoulder arthritis is common, and management strategies, especially in young patients, continue to evolve with significant improvements in implant design [2].
- Longevity of implants remains a concern in more active patients with shoulder arthritis [2].
Surgical Management: Anatomic Total Shoulder Arthroplasty (ATSA)
- Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis [5].
- Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis [26].
- There was no clinically or statistically significant difference in the Oxford Shoulder Score results between groups with and without glenoid cementation in total shoulder arthroplasty for degenerative arthritis of the shoulder [28].
- Total shoulder arthroplasty (TSA) is superior to hemiarthroplasty for treating end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old, resulting in greater cost savings, fewer revision procedures, and greater quality-adjusted life years (QALYs) gained [65].
Surgical Management: Reverse Total Shoulder Arthroplasty (RTSA)
- Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty [3].
- Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].
Surgical Management: Surface Replacement Arthroplasty
- Cemented surface replacement arthroplasty (CSRA) provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients [9].
- Patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected [50].
Surgical Management: Arthroscopic and Other Procedures
- The authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis known as the Comprehensive Arthroscopic Management (CAM) procedure [16].
- Scapulothoracic fusion resulted in improvements in functional outcomes scores, with most patients meeting or exceeding the minimum clinically important difference for recalcitrant scapular winging [53].
Outcome Assessment and Registry Data
- The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [7].
- The PROMIS Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after total shoulder arthroplasty [33].
- A study of 1,270 individual patients from eleven centers demonstrated significant improvement in patient-reported outcomes at 1 and 2 years post-surgery for a polyethylene glenoid with a fluted peg, establishing a benchmark for early clinical value [54].
Standardization and Complications
- There is a need for standardization of outcome assessment following treatment of shoulder arthritis [1].
- A clear standardized set of shoulder arthroplasty complication definitions is lacking [8].
Complications
- Standardized definitions for shoulder arthroplasty complications are lacking [8].
- Standardization of outcome assessment following treatment of shoulder arthritis is needed [1].
- Longevity of implants remains a concern in more active patients with shoulder arthritis [2].
- Total shoulder arthroplasty is associated with high mid-term complication rates due to instability and loosening in B2 glenoids [45].
- Symptomatic acromioclavicular joint osteoarthritis occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years [15].
- No case of glenoid loosening occurred at 3 years' follow-up in revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders [21].
- Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of adverse effects, although the evidence was of low quality [24].
Recovery
- Standardization of outcome assessment is needed following treatment of shoulder arthritis [1].
- Implant longevity remains a concern in more active patients with shoulder arthritis [2].
- Patients with glenohumeral osteoarthritis converted intraoperatively to reverse shoulder arthroplasty (RSA) had outcomes comparable to those who underwent total shoulder arthroplasty (TSA) [3].
- Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [4].
- Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [23].
- Surgeons may consider using reverse arthroplasty in cases of primary shoulder arthritis with a critical shoulder angle of 35 degrees or greater [29].
- The PROMIS Global-10 has limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA [33].
- Subscapularis strength returned to normal in only a minority of patients at 2 years after shoulder arthroplasty, although significant strength improvement from baseline was observed [60].
- There is a substantive subgroup with continuing pain and a high rate of glenoid bone erosion after 10 years following humeral head replacement for osteoarthritis [70].
Key Evidence
- [L1] The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. (10.1177/1758573215622385)
- [L5] Shoulder arthritis is common, and management strategies, especially in young patients, continue to evolve with significant improvements in implant design, though longevity remains a concern in more active patients. (10.1016/j.csm.2018.07.001)
- [L3] Patients with glenohumeral osteoarthritis converted intraoperatively to RSA had outcomes comparable to those who underwent total shoulder arthroplasty. (10.1016/j.jse.2015.01.005)
- [L4] Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff. (10.1016/j.jse.2021.06.010)
- [Paper] Patients with mild radiographic signs of arthritis have about sevenfold higher odds of failing to achieve the minimum clinically important difference (MCID) after anatomic total shoulder replacement compared to patients with severe arthritis. (10.1097/corr.0000000000002747)
- [L4] Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with primary glenohumeral osteoarthritis. (10.1016/j.jse.2021.03.140)
- [L4] The authors recommend the continued use of WOOS in shoulder arthroplasty registries and observational studies. (10.1186/s12891-023-06578-5)
- [L1] A clear standardised set of shoulder arthroplasty complication definitions is lacking. (10.1007/s00402-017-2635-9)
- [L4] CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. (10.1016/j.jse.2014.11.035)
- [L4] This condition should be considered in the differential diagnosis of elderly women with insidious shoulder pain. (10.1016/j.jse.2014.10.020)
- [L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. (10.5435/00124635-200907000-00002)
- [L3] This study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. (10.1186/s13018-022-03137-x)
- [L4] These data demonstrate an anatomic pattern of glenoid bone loss for different classes of glenohumeral arthritis. (10.1007/s12306-016-0406-3)
- [L4] Symptomatic ACJ OA occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years. (10.1177/17585732221114796)
- [L4] The authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. (10.1016/j.arthro.2022.01.033)
- [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. (10.1155/2013/370231)
- [L4] Shoulders presenting with posterior subluxation (B types) remained posteriorly subluxed, while concentric arthritis developed an eccentric pattern 20% of the time. (10.1016/j.jse.2020.05.021)
- [L4] At 3 years' follow-up, pain and clinical scores improved significantly and no case of glenoid loosening occurred. (10.1016/j.jse.2013.05.004)
- [L3] F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis. (10.1016/j.jse.2025.01.047)
- [L3] At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. (10.5435/jaaos-d-22-00014)
- [L1] Total shoulder arthroplasty did not provide a clinically important advantage over hemiarthroplasty in terms of patient-reported pain, function, nor adverse effects; however, the evidence on this topic was of low quality. (10.1097/corr.0000000000001523)
- [L3] Both augmented and standard anatomic total shoulder arthroplasty can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis. (10.1016/j.jse.2021.12.016)
- [L4] Measurement in the glenoid hull plane may be more accurate than in the scapular plane. (10.1016/j.jse.2017.01.027)
- [L3] There was no clinically or statistically significant difference in the Oxford Shoulder Score results between the two groups. (10.1016/j.jse.2013.08.022)
- [L3] These data suggest that surgeons may consider using reverse arthroplasty in cases of primary shoulder arthritis with a critical shoulder angle of 35 degrees or greater. (10.1016/j.jse.2021.08.003)
- [L4] In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset. (10.1016/j.jse.2023.09.031)
- [L4] Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. (10.2106/jbjs.20.01853)
- [L3] The Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA. (10.1016/j.jse.2020.10.021)
- [L4] Scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. (10.1016/j.clinbiomech.2012.04.009)
- [L4] Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month. (10.1016/j.clinbiomech.2018.07.005)
- [L3] The 3D classification system using combined humeroscapular alignment and glenoid erosion can be applied to describe the disease comprehensively. (10.1177/23259671221110512)
- [L5] A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. (10.1186/s12891-023-06273-5)
- [L2] Geometric analysis of the prosthetic shoulder is precise. (10.1007/s00402-012-1580-x)
- [L3] A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology. (10.1016/j.jse.2021.01.018)
- [L5] RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. (10.1016/j.jse.2015.09.015)
- [L5] Even if TM external rotation moment arm is higher in RTSA than in a normal shoulder, the decreased length could impair its force generation. (10.1016/j.jse.2014.08.019)
- [L5] This commentary highlights that reverse total shoulder arthroplasty alters humerothoracic, scapulothoracic, and glenohumeral motion during weighted scaption, emphasizing the need to integrate biomechanical studies, computer modeling, and dynamic clinical evaluations to develop a roadmap for precision rTSA. (10.1097/corr.0000000000002383)
- [L5] The custom, non-spherical prosthetic head more accurately replicated the head shape, rotational range of motion, and glenohumeral joint kinematics than the commercially available, spherical prosthetic head compared with the native humeral head. (10.1016/j.jse.2013.01.002)
- [L5] Total shoulder arthroplasty may have reasonable short-term results but is associated with high mid-term complication rates due to instability and loosening in B2 glenoids. (10.1016/j.jse.2013.06.017)
- [L4] The ST contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder. (10.1016/j.jse.2024.12.018)
- [L4] Arthritic B2 glenoids are common, and their maximal erosion is usually posteroinferior. (10.1016/j.jse.2015.01.007)
- [L4] Patients undergoing total shoulder arthroplasty with an asymmetric glenoid component for osteoarthritis achieve satisfactory mid-term pain relief and improvement in function; however, instability is not always corrected. (10.1007/s11999-007-0104-4)
- [L5] Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. (10.1177/0363546518768276)
- [L5] Anatomic total shoulder arthroplasty results in tendon-metal contact and higher tendon contact pressures compared to the native shoulder. (10.1016/j.jse.2018.04.017)
- [L4] Scapulothoracic fusion resulted in improvements in functional outcomes scores, with most patients meeting or exceeding the minimum clinically important difference. (10.1097/corr.0000000000002673)
- [L4] The study establishes a benchmark for early clinical value of new glenoid components by demonstrating significant improvement in patient-reported outcomes at 1 and 2 years post-surgery across a large multicenter cohort. (10.1007/s00264-018-4213-3)
- [L4] The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. (10.1016/j.jse.2022.10.009)
- [L5] Glenosphere configuration can be modified to increase range of movement in reverse shoulder arthroplasty. (10.1302/0301-620x.100b9.bjj-2018-0264.r1)
- [L3] MRI is useful for preoperative osseous imaging for total shoulder arthroplasty because it offers a more precise method of determining glenoid version compared with x-ray imaging. (10.1016/j.jse.2012.10.036)
- [L4] Osteoarthritic humeral head morphology varies significantly from normal, with larger spherical diameters, but does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. (10.1016/j.jse.2015.08.047)
- [L4] Although significant strength improvement from baseline was observed at 2 years after shoulder arthroplasty, subscapularis strength returned to normal in only a minority of patients. (10.1016/j.jse.2014.06.042)
- [L4] The CSA is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis. (10.1136/jisakos-2018-000255)
- [L4] The study demonstrates that 3D CT reconstruction allows for reliable evaluation of the scapulohumeral relationship, revealing significant posterior translation of the humeral head in osteoarthritic shoulders compared to nonpathologic controls, which supports the pathomechanism of glenoid component loosening. (10.1016/j.jse.2016.02.035)
- [L2] Treatment of end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old in the United States with TSA, instead of hemiarthroplasty, would result in greater cost savings, avoid a substantial number of revision procedures, and result in greater years of satisfactory or excellent patient outcomes and greater QALYs gained. (10.1007/s11999-016-4991-0)
- [L3] This is an inexpensive, practical, and reproducible method that can be used to determine the rate of medial migration of the humeral head on plain radiographs after shoulder arthroplasty. (10.1016/j.jse.2010.03.010)
- [L3] Cystic disease did not affect functional outcome or the presence of radiographic glenoid loosening. (10.1016/j.jse.2017.10.035)
- [L4] Three significantly differently oriented wear patterns (posterior-superior, posterior-central, and posterior-inferior) were distinguished in shoulders demonstrating posterior wear on axillary imaging. (10.1016/j.jse.2021.04.028)
- [L4] However, there is a substantive subgroup with continuing pain and a high rate of glenoid bone erosion after 10 years. (10.1016/j.jse.2017.10.017)
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