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.