Comprehensive Post-Arthroscopic Management of a Middle-Aged Adult with Gelnohumeral Osteoarthritis: A Case Report

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A current challenge in the medical field is how to manage young and middle aged patients diagnosed with glenohumeral osteoarthritis (GHOA). In the general population, the incidence of GHOA is 5-17%. The gold standard for treating GHOA is Total Shoulder Arthroplasty (TSA), but for younger patients the hardware utilized may erode and lead to a non-functional shoulder. For this reason, only 10% of shoulder arthroplasties are performed on patients aged 55 years or younger. As a result, there is no clear management option to treat active, young and middle aged patients who present with significant arthrosis of the glenohumeral joint.

Total shoulder arthroplasty in a young population has been marked with a high percentage of unsatisfactory results. Due to the lack of success of shoulder arthroplasty on young patients, more complex arthroscopic procedures have been developed as a method to delay the more invasive arthroplasty. A new arthroscopic procedure for salvaging an arthritic glenohumeral joint has been named Comprehensive Arthroscopic Management (CAM). The CAM procedure is used to restore joint stability, decrease pain, improve range of motion, and delay the need for arthroplasty in younger, active patients. To date there are no studies on rehabilitation after a CAM procedure. Consequently, physical therapists need further information on how to treat patients who have undergone surgery using CAM techniques.

The CAM procedure for GHOA was developed by Dr. Peter Millet MD, of the Steadman Clinic in Vail, CO. The procedure involves several arthroscopic components including: A. scar tissue and chondral debridement, B. synovectomy, C. inferior humeral osteoplasty, D. capsular release, E. axillary nerve decompression, and F. tenodesis of the long head of the biceps. Previous arthroscopic procedures have not included humeral head osteoplasty or axillary nerve decompression as routine portions of an arthroscopic joint preservation procedure.

The primary purpose of this case report is to describe the course of treatment for a middle-aged woman with GHOA as well as the role that radiologic imaging played. This case report will benefit physical therapists and other medical professionals by describing the indications for the procedure and having a reference for the treatment of a patient following a CAM procedure.

Full Article: Comprehensive Post-Arthroscopic Management of a Middle-Aged Adult with Gelnohumeral Osteoarthritis: A Case Report