Glenohumeral Arthritis in Athletes

  • Peter A. D’AlessandroEmail author
  • Andrew L. Wallace


Chondral damage leading to arthritis in the glenohumeral joint is an uncommon but potentially career ending condition in both the professional and recreational athlete. Secondary arthritis related to previous instability is most common in this group of patients. Appropriate assessment of subtle signs and symptoms is the key to effective diagnosis and treatment of the condition, whilst adequate education and management of expectations is an important role of the treating team. Management options are determined by the stage of the disease, level of symptoms and are grouped relative to the impact on the athlete’s career. Career-maintaining, career-salvage and career-ending treatment options are presented, with their respective indications, evidence base and outcome.


Glenohumeral arthritis Chondral damage Athlete Arthroscopy Non-arthroplasty Career 


  1. 1.
    Reineck JR, Krishnan SG, Burkhead W. Early glenohumeral arthritis in the competing athlete. Clin Sports Med. 2008;27(4):803–19.PubMedCrossRefGoogle Scholar
  2. 2.
    McCarty LP, Cole BJ. Nonarthroplasty treatment of glenohumeral cartilage lesions. Arthroscopy. 2005;21(9):1131–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Outerbridge R. The etiology of chondromalacia patellae. J Bone Joint Surg. 1961;43(4):752–7.CrossRefGoogle Scholar
  4. 4.
    Gartsman GM, Brinker MR, Khan M, Karahan M. Self-assessment of general health status in patients with five common shoulder conditions. J Shoulder Elb Surg. 1998;7(3):228–37.CrossRefGoogle Scholar
  5. 5.
    Bhatia S, Hsu A, Lin EC, Chalmers P, Ellman M, Cole BJ, et al. Surgical treatment options for the young and active middle-aged patient with glenohumeral arthritis. Adv Orthop. 2012;2012:846843.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Provencher MT, Barker JU, Strauss EJ, Frank RM, Romeo AA, Ill FAM. Glenohumeral arthritis in the young adult. Instr Course Lect. 2011;60:137–53.PubMedGoogle Scholar
  7. 7.
    Sayegh ET, Mascarenhas R, Chalmers PN, Cole BJ, Romeo AA, Verma NN. Surgical treatment options for glenohumeral arthritis in young patients: a systematic review and meta-analysis. Arthroscopy. 2015;31(6):1156–66.PubMedCrossRefGoogle Scholar
  8. 8.
    Boselli KJ, Ahmad CS, Levine WN. Treatment of glenohumeral arthrosis. Am J Sports Med. 2010;38(12):2558–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Cole BJ, Yanke A, Provencher MT. Nonarthroplasty alternatives for the treatment of glenohumeral arthritis. J Shoulder Elb Surg. 2007;16(5):S231–S40.CrossRefGoogle Scholar
  10. 10.
    Wallace A. Management of glenohumeral osteoarthritis in the young adult. Should Elb. 2010;2(1):1–8.CrossRefGoogle Scholar
  11. 11.
    Walch G, Boulahia A, Badet R, Riand N, Kempf J. Primary gleno-humeral osteoarthritis: clinical and radiographic classification. Shoulder Arthroplast. 1999;64(Suppl 2):46–52.Google Scholar
  12. 12.
    Buscayret F, Edwards TB, Szabo I, Adeleine P, Coudane H, Walch G. Glenohumeral arthrosis in anterior instability before and after surgical treatment incidence and contributing factors. Am J Sports Med. 2004;32(5):1165–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Hovelius L, Saeboe M. Neer award 2008: arthropathy after primary anterior shoulder dislocation–223 shoulders prospectively followed up for twenty-five years. J Shoulder Elb Surg. 2009;18(3):339–47.CrossRefGoogle Scholar
  14. 14.
    Marx RG, McCarty EC, Montemurno TD, Altchek DW, Craig EV, Warren RF. Development of arthrosis following dislocation of the shoulder: a case-control study. J Shoulder Elb Surg. 2002;11(1):1–5.CrossRefGoogle Scholar
  15. 15.
    Maquirriain J, Ghisi J, Amato S. Is tennis a predisposing factor for degenerative shoulder disease? A controlled study in former elite players. Br J Sports Med. 2006;40(5):447–50.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS. Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 2000;16(1):35–40.CrossRefGoogle Scholar
  17. 17.
    Levy JC, Virani NA, Frankle MA, Cuff D, Pupello DR, Hamelin JA. Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty. J Shoulder Elb Surg. 2008;17(3):380–8.CrossRefGoogle Scholar
  18. 18.
    Hansen BP, Beck CL, Beck EP, Townsley RW. Postarthroscopic glenohumeral chondrolysis. Am J Sports Med. 2007;35(10):1628–34.PubMedCrossRefGoogle Scholar
  19. 19.
    McNickle AG, L’Heureux DR, Provencher MT, Romeo AA, Cole BJ. Postsurgical glenohumeral arthritis in young adults. Am J Sports Med. 2009;37(9):1784–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Scheffel PT, Clinton J, Lynch JR, Warme WJ, Bertelsen AL, Matsen FA. Glenohumeral chondrolysis: a systematic review of 100 cases from the English language literature. J Shoulder Elb Surg. 2010;19(6):944–9.CrossRefGoogle Scholar
  21. 21.
    Chu CR, Coyle CH, Chu CT, Szczodry M, Seshadri V, Karpie JC, et al. In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage. J Bone Joint Surg. 2010;92(3):599–608.PubMedCrossRefGoogle Scholar
  22. 22.
    Webb S, Ghosh S. Intra-articular bupivacaine: potentially chondrotoxic? Br J Anaesth. 2009;102(4):439–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Ellman H, Harris E, Kay SP. Early degenerative joint disease simulating impingement syndrome: arthroscopic findings. Arthroscopy. 1992;8(4):482–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Brox J, Lereim P, Merckoll E, Finnanger AM. Radiographic classification of glenohumeral arthrosis. Acta Orthop. 2003;74(2):186–9.CrossRefGoogle Scholar
  25. 25.
    Samilson R, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg. 1983;65(4):456–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Yeh L, Kwak S, Kim Y-S, Chou DS, Muhle C, Skaf A, et al. Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers. Skelet Radiol. 1998;27(9):500–4.CrossRefGoogle Scholar
  28. 28.
    Guntern DV, Pfirrmann CW, Schmid MR, Zanetti M, Binkert CA, Schneeberger AG, et al. Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome 1. Radiology. 2003;226(1):165–70.PubMedCrossRefGoogle Scholar
  29. 29.
    Smith TO, Drew BT, Toms AP, Donell ST, Hing CB. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2367–79.PubMedCrossRefGoogle Scholar
  30. 30.
    Moskowitz RW, Blaine TA. An overview of treatment options for persistent shoulder pain. Am J Orthop. 2005;34(12 Suppl):10–5.PubMedGoogle Scholar
  31. 31.
    Vangsness CT, Spiker W, Erickson J. A review of evidence-based medicine for glucosamine and chondroitin sulfate use in knee osteoarthritis. Arthroscopy. 2009;25(1):86–94.PubMedCrossRefGoogle Scholar
  32. 32.
    Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357(9252):251–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795–808.PubMedCrossRefGoogle Scholar
  34. 34.
    Buchbinder R, Green S, Youd J. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;1:CD004016.Google Scholar
  35. 35.
    Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014;43(5):593–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Brzusek D, Petron D. Treating knee osteoarthritis with intra-articular hyaluronans. Curr Med Res Opin. 2008;24(12):3307–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. J Bone Joint Surg. 2008;90(5):970–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Kwon YW, Eisenberg G, Zuckerman JD. Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial. J Shoulder Elb Surg. 2013;22(5):584–94.CrossRefGoogle Scholar
  39. 39.
    Cameron BD, Galatz LM, Ramsey ML, Williams GR, Iannotti JP. Non-prosthetic management of grade IV osteochondral lesions of the glenohumeral joint. J Shoulder Elb Surg. 2002;11(1):25–32.CrossRefGoogle Scholar
  40. 40.
    Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive arthroscopic management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Arthroscopy. 2013;29(3):440–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Cole BJ, Mellano C. Is there a role for arthroscopy in the treatment of glenohumeral arthritis. Am J Orthop. 2014;43(2):1–3.Google Scholar
  42. 42.
    Elser F, Braun S, Dewing CB, Millett PJ. Glenohumeral joint preservation: current options for managing articular cartilage lesions in young, active patients. Arthroscopy. 2010;26(5):685–96.PubMedCrossRefGoogle Scholar
  43. 43.
    Frank RM, Van Thiel GS, Slabaugh MA, Romeo AA, Cole BJ, Verma NN. Clinical outcomes after microfracture of the glenohumeral joint. Am J Sports Med. 2010;38(4):772–81.PubMedCrossRefGoogle Scholar
  44. 44.
    Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR, et al. Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res. 2003;407:215–27.CrossRefGoogle Scholar
  45. 45.
    Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;391:S362–S9.CrossRefGoogle Scholar
  46. 46.
    Millett PJ, Huffard BH, Horan MP, Hawkins RJ, Steadman JR. Outcomes of full-thickness articular cartilage injuries of the shoulder treated with microfracture. Arthroscopy. 2009;25(8):856–63.PubMedCrossRefGoogle Scholar
  47. 47.
    Kircher J, Patzer T, Magosch P, Lichtenberg S, Habermeyer P. Osteochondral autologous transplantation for the treatment of full-thickness cartilage defects of the shoulder: results at nine years. J Bone Joint Surg. 2009;91B(4):499–503.CrossRefGoogle Scholar
  48. 48.
    Ebert JR, Robertson WB, Woodhouse J, Fallon M, Zheng MH, Ackland T, et al. Clinical and magnetic resonance imaging–based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med. 2011;39(4):753–63.PubMedCrossRefGoogle Scholar
  49. 49.
    Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37(1):33–41.PubMedCrossRefGoogle Scholar
  50. 50.
    Gross CE, Chalmers PN, Chahal J, Van Thiel G, Bach BR Jr, Cole BJ, et al. Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy. 2012;28(12):1889–901.PubMedCrossRefGoogle Scholar
  51. 51.
    Buchmann S, Salzmann GM, Glanzmann MC, Wörtler K, Vogt S, Imhoff AB. Early clinical and structural results after autologous chondrocyte transplantation at the glenohumeral joint. J Shoulder Elb Surg. 2012;21(9):1213–21.CrossRefGoogle Scholar
  52. 52.
    Romeo AA, Cole BJ, Mazzocca AD, Fox JA, Freeman KB, Joy E. Autologous chondrocyte repair of an articular defect in the humeral head. Arthroscopy. 2002;18(8):925–9.PubMedCrossRefGoogle Scholar
  53. 53.
    De Beer J, Bhatia D, van Rooyen K, Du Toit D. Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1767–73.PubMedCrossRefGoogle Scholar
  54. 54.
    Savoie FH, Brislin KJ, Argo D. Arthroscopic glenoid resurfacing as a surgical treatment for glenohumeral arthritis in the young patient: midterm results. Arthroscopy. 2009;25(8):864–71.PubMedCrossRefGoogle Scholar
  55. 55.
    Williams G, Font-Rodriguez D, Baghlan S. Soft-tissue interposition without hemiarthroplasty as an alternative for degenerative shoulder arthritis in young, active patients. In: Proceedings of the American Shoulder and Elbow Surgeons; 2002.Google Scholar
  56. 56.
    Strauss EJ, Verma NN, Salata MJ, McGill KC, Klifto C, Nicholson GP, et al. The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis. J Shoulder Elb Surg. 2014;23(3):409–19.CrossRefGoogle Scholar
  57. 57.
    Denard PJ, Wirth MA, Orfaly RM. Management of glenohumeral arthritis in the young adult. J Bone Joint Surg. 2011;93(9):885–92.PubMedCrossRefGoogle Scholar
  58. 58.
    Boileau P, Sinnerton RJ, Chuinard C, Walch G. Arthroplasty of the shoulder. J Bone Joint Surg. 2006;88B(5):562–75.CrossRefGoogle Scholar
  59. 59.
    Johnson MH, Paxton ES, Green A. Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts. J Shoulder Elb Surg. 2015;24(2):317–25.CrossRefGoogle Scholar
  60. 60.
    Burgess DL, McGrath MS, Bonutti PM, Marker DR, Delanois RE, Mont MA. Shoulder resurfacing. J Bone Joint Surg. 2009;91(5):1228–38.PubMedCrossRefGoogle Scholar
  61. 61.
    Bailie DS, Llinas PJ, Ellenbecker TS. Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age. J Bone Joint Surg Am. 2008;90(1):110–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Iagulli ND, Field LD, Hobgood ER, Hurt JA, Charles R, O’Brien MJ, et al. Surface replacement arthroplasty of the humeral head in young, active patients: midterm results. Orthop J Sports Med. 2014;2(1):2325967113519407.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Levy O, Tsvieli O, Merchant J, Young L, Trimarchi A, Dattani R, et al. Surface replacement arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years: results after a minimum ten-year follow-up. J Shoulder Elb Surg. 2015;24(7):1049–60.CrossRefGoogle Scholar
  64. 64.
    Radnay CS, Setter KJ, Chambers L, Levine WN, Bigliani LU, Ahmad CS. Total shoulder replacement compared with humeral head replacement for the treatment of primary glenohumeral osteoarthritis: a systematic review. J Shoulder Elb Surg. 2007;16(4):396–402.CrossRefGoogle Scholar
  65. 65.
    Sperling JW, Cofield RH, Rowland CM. Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger. J Shoulder Elb Surg. 2004;13(6):604–13.CrossRefGoogle Scholar
  66. 66.
    Sperling JW, Antuna SA, Sanchez-Sotelo J, Schleck C, Cofield RH. Shoulder arthroplasty for arthritis after instability surgery. J Bone Joint Surg. 2002;84(10):1775–81.PubMedCrossRefGoogle Scholar
  67. 67.
    Raiss P, Aldinger P, Kasten P, Rickert M, Loew M. Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis. J Bone Joint Surg. 2008;90(6):764–9.CrossRefGoogle Scholar
  68. 68.
    Adams JE, Sperling JW, Hoskin TL, Melton LJ, Cofield RH. Shoulder arthroplasty in Olmsted County, Minnesota, 1976-2000: a population-based study. J Shoulder Elb Surg. 2006;15(1):50–5.CrossRefGoogle Scholar
  69. 69.
    Bülhoff M, Sattler P, Bruckner T, Loew M, Zeifang F, Raiss P. Do patients return to sports and work after total shoulder replacement surgery? Am J Sports Med. 2015;43(2):423–7.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Orthopaedic Research Foundation of Western AustraliaClaremontAustralia
  2. 2.University of Western AustraliaCrawleyAustralia
  3. 3.Fortius ClinicLondonUK

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