Arthroscopic Management of Glenohumeral Arthrosis: Humeral Osteoplasty, Capsular Release, and Arthroscopic Axillary Nerve Release as a Joint-Preserving Approach

Glenohumeral osteoarthrosis is classically characterized by pain, weakness, restricted motion, and cartilage loss, and it can be associated with inferior humeral or glenoid osteophytes. Whereas osteoarthrosis of the shoulder is less common than arthrosis of other joints, it can be equally limiting. Nonoperative treatment modalities are often effective at minimizing associated symptoms and maintaining quality of life. If these measures fail, glenohumeral arthroplasty has been shown to provide substantial relief.

It is established that glenohumeral arthrosis typically manifests after the sixth decade of life. Younger patients, however, are also occasionally afflicted, and many of these patients maintain demanding lifestyles. Concerns regarding polyethylene glenoid wear, component loosening, functional loss, and the potential need for multiple revisions over the patient’s lifetime potentially make young, high-demand patients poor candidates for shoulder arthroplasty. Prior reports indicate that arthroscopic debridement can yield pain and functional improvements in this patient population.

Previous studies have suggested that outcomes of arthroscopic debridement are less effective when a large inferior osteophyte is present. We speculate that inferior humeral osteophytes may limit abduction by tensioning the axillary pouch and are capable of compressing the axillary nerve. As evidenced by quadrilateral space syndrome, patients with axillary nerve compression often describe posterior shoulder pain, weakness, and decreased athletic performance. Similarly, patients with glenohumeral arthrosis frequently report posterior shoulder pain and often exhibit large inferior humeral osteophytes in close proximity to the axillary nerve. Data from our laboratory have shown that these osteophytes are capable of encroaching on the axillary nerve, changing the course of the nerve, and potentially affecting axillary nerve function (P.J.M., unpublished data, May 2010). Therefore we believe that removal of the large inferior humeral osteophytes could decompress the axillary nerve and alleviate pain in patients with glenohumeral arthrosis.

The purpose of this article is to describe a comprehensive arthroscopic management (CAM) technique that couples extensive glenohumeral debridement and capsular release with meticulous osteophyte removal from the humerus in addition to an arthroscopic transcapsular axillary nerve decompression (Video 1, available at www.arthroscopyjournal.org). This joint-preserving approach may provide added benefit to some young, active patients with mild or moderate glenohumeral arthrosis.

Full Article: Arthroscopic Management of Glenohumeral Arthrosis: Humeral Osteoplasty, Capsular Release, and Arthroscopic Axillary Nerve Release as a Joint-Preserving Approach