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Glenohumeral Arthritis in Athletes

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Abstract

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.

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Author information

Authors and Affiliations

  1. Orthopaedic Research Foundation of Western Australia, Claremont, WA, Australia

    Peter A. D’Alessandro

  2. University of Western Australia, Crawley, WA, Australia

    Peter A. D’Alessandro

  3. Fortius Clinic, London, UK

    Andrew L. Wallace

Authors
  1. Peter A. D’Alessandro
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  2. Andrew L. Wallace
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Corresponding author

Correspondence to Peter A. D’Alessandro .

Editor information

Editors and Affiliations

  1. Wrightington Hospital, Wigan, UK

    Lennard Funk

  2. Wrightington Hospital, Wigan, UK

    Mike Walton

  3. Wrightington Hospital, Materials, University of Manchester, Wigan, UK

    Adam Watts

  4. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Michael Hayton

  5. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Chye Yew Ng

Q&A

Q&A

  1. (1)

    What are the important and sometimes subtle signs of early arthritis on examination?

    Understated symptoms include subtle episodes of instability or a slightly reduced ability to undertake previously performed tasks or activities. Night pain is common, with a deep ache associated with an inability to sleep on the affected side. Clicking, grinding and transient locking with sudden pain that limits activity are also frequently reported.

  2. (2)

    What is the gold standard tool for diagnosis of chondral damage?

    Due to the limitations of imaging modalities in accurately diagnosing chondral damage, diagnostic arthroscopy remains the gold standard for diagnosis, particularly in joints such as the shoulder with thinner layers of articular cartilage.

  3. (3)

    How should intra-articular steroid injections be utilised relative to game day?

    Regular injections should not be used as short-term solutions to ‘get an athlete through a game.’ This approach can have devastating consequences and accelerate chondral degeneration due to the loss of the protective mechanism of pain.

  4. (4)

    What are the possible adjunctive procedures in arthroscopy performed for glenohumeral arthritis?

    The adjunctive procedures at time of arthroscopy in patients with earlier stage disease can include debridement, lavage and removal of loose bodies. Management of all possible pain generators should be considered as part of arthroscopic management including chondroplasty, subacromial decompression, AC joint excision, biceps tenodesis, humeral osteoplasty, capsular release and axillary nerve decompression.

  5. (5)

    Is glenohumeral arthroplasty indicated in the competing athlete?

    For the professional or high-level recreational athlete, prosthetic arthroplasty is only an option following the end of a career, as a prosthesis cannot tolerate the high forces and loads required by the vast majority of athletic pursuits involving the upper limbs.

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D’Alessandro, P.A., Wallace, A.L. (2020). Glenohumeral Arthritis in Athletes. In: Funk, L., Walton, M., Watts, A., Hayton, M., Ng, C. (eds) Sports Injuries of the Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-23029-6_11

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  • DOI: https://doi.org/10.1007/978-3-030-23029-6_11

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