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Osteoarthritis pp 43–60Cite as

Shoulder and Elbow Osteoarthritis

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Key Points

Shoulder

  • Shoulder osteoarthritis (OA) is common.

  • Primary shoulder OA is the most common form.

  • The most common type of secondary shoulder OA is rotator cuff arthropathy and is believed to be related to a decoupling of forces about the humeral head.

  • Typical presentation is activity-related shoulder pain and loss of shoulder range of motion.

  • Physical exam should include an assessment of the rotator cuff and axillary nerve.

  • Standard radiographs are often sufficient to make diagnosis, but cross-sectional imaging may be indicated to identify bone loss (CT) or soft tissue deficiencies (MRI/ultrasound).

  • Nonoperative care can include physical therapy, pharmacotherapy, and intra-articular injections (cortisone and hyaluronic acid), but evidence for or against these treatments is limited.

  • Surgical management of end-stage shoulder OA includes arthroscopic debridement, interposition arthroplasty (glenoid resurfacing), humeral head resurfacing, hemiarthroplasty, anatomic total shoulder arthroplasty, and, in low demand patients with a deficient rotator cuff, reverse total shoulder arthroplasty.

  • In young patients with end-stage shoulder OA, arthroplasty has high failure rates secondary to either glenoid erosion (hemiarthroplasty) or glenoid component loosening (anatomic total shoulder arthroplasty).

  • For older patients with end-stage shoulder OA and an intact rotator cuff, anatomic total shoulder arthroplasty is recommended.

Elbow

  • Symptomatic elbow OA is rare.

  • Secondary elbow OA is the most common form.

  • Following elbow trauma, radiographic changes consistent with elbow OA are common, but symptoms infrequent.

  • Typical presentation of patients with symptomatic elbow OA includes complaints of motion loss and impingement.

  • Physical exam should include an assessment of the collateral ligaments and ulnar nerve.

  • In addition to standard elbow radiographs, cross-sectional imaging (CT) is often useful to determine osteophyte distribution and presence of loose bodies.

  • Nonoperative management of elbow OA should include activity modification, while the utility of pharmacotherapy, physiotherapy, bracing, and intra-articular injections (cortisone and hyaluronic acid) has not been fully elucidated.

  • The mainstay of surgical management is elbow debridement, performed either open or arthroscopically.

  • Total elbow arthroplasty should be reserved for older patients with minimal physical demands.

  • For patients with OA isolated to the radiocapitellar joint, an isolated radiocapitellar joint arthroplasty has demonstrated favorable early outcomes.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Timothy Leroux MD, Med

  2. Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital – University Health Network, 399 Bathurst Street, East Wing Rm 1-440, Toronto, ON, M5T 2S8, Canada

    Christian Veillette MD, MSc, FRCSC

  3. University of Toronto, Toronto, ON, Canada

    Christian Veillette MD, MSc, FRCSC

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  1. Timothy Leroux MD, Med
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Correspondence to Christian Veillette MD, MSc, FRCSC .

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Editors and Affiliations

  1. Division of Genetics and Development, Toronto Western Research Institute, University Health Network and Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Mohit Kapoor

  2. Division of Orthopaedics, Toronto Western Hospital, Toronto, Ontario, Canada

    Nizar N. Mahomed

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Leroux, T., Veillette, C. (2015). Shoulder and Elbow Osteoarthritis. In: Kapoor, M., Mahomed, N. (eds) Osteoarthritis. Adis, Cham. https://doi.org/10.1007/978-3-319-19560-5_3

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