Comprehensive Arthroscopic Management (CAM) Procedure for Shoulder Osteoarthritis

Authors:

Peter J Millett, Marilee P Horan, Andrew T Pennock, Daniel Rios

Abstract:

Treatment options for shoulder arthritis are well established. Initial nonoperative measures include nonsteroid anti-inflammatory medications, physical therapy, exercise, and injections. Nonoperative treatment modalities are often effective in minimizing associated symptoms and maintaining quality of life1; however, when they fail, more severe cases of osteoarthritis are often treated with shoulder arthroplasty. Long-term results of shoulder arthroplasty are encouraging in older patients; however, results in younger patients are not as successful. Younger patients have higher activity levels and place more stress on the shoulder arthroplasty, potentially leading to premature implant failure. Complications such as implant loosening, fractures, and dislocation are more commonly seen in younger patients.

Arthroscopic joint-preserving surgery has some advantages in that it may delay the need for total joint replacement while at the same time decreasing pain and improving function. Arthroscopy of the shoulder has been used to treat young patients with glenohumeral osteoarthritis, who due to their age, demanding activity level, or their own desire for joint preservation are not good candidates for a shoulder arthroplasty.

Arthroscopic treatment of glenohumeral osteoarthritis is not new, and others have shown improvement in symptoms with this treatment. Some investigators have reported less successful outcomes when performing arthroscopy and large inferior ostophytes are present. Experience in our center has shown that inferior humeral osteophytes may tension the axillary pouch and may be capable of compressing the axillary nerve. In a manner similar to quadrilateral space syndrome, this compression may result in pain, weakness, and decreased range of motion, thereby potentially explaining suboptimal results in this cohort of patients.

Therefore, we describe a novel procedure for comprehensive arthroscopic management (CAM) of glenohumeral osteoarthritis coupling an extensive debridement and capsular release with arthroscopic excision of the inferior osteophytes from the humeral head and trans- capsular axillary nerve decompression. Axillary nerve neurolysis is done only in selected patients; compression of the axillary nerve can result in pain, weakness, and atrophy in some patients. Our preliminary experience has shown that this alleviates pain and improves glenohumeral motion.

For the complete study: Comprehensive Arthroscopic Management (CAM) Procedure for Shoulder Osteoarthritis

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Comprehensive Arthroscopic Management (CAM) Procedure for Shoulder Osteoarthritis

Authors:

Abstract:

About the Author: Peter Millett, MD