Glenohumeral Arthritis in the Athlete

Arthritis of the glenohumeral joint is a challenging shoulder injury for athletes.  As our generations change, we will continue to see less and less sedentary patients in the later stages of life. Their functional goals in rehabilitation will be much greater than in past decades.  Traditionally, care for the older individual with glenohumeral osteoarthritis was based solely on pain relief rather than maximization of functional activities.  Options included activity modification, medications, injections, physical therapy, and possibly joint replacement.

Patients now want to continue with recreational activities such as tennis, golf, and swimming.  This is especially true when a patient has an early onset of arthritis symptoms.  Recent attention has been made in the orthopedic communities to attempt to maximize function in these patients as much as possible.

This month’s journal issue of Operative Techniques in Sports Medicine focuses exclusively on this topic, glenohumeral arthritis in the athlete. The issue includes descriptive current concepts articles on all aspects of care of the arthritic shoulder, except for physical therapy unfortunately.

The issue begins with a nice article focusing mainly on evaluation and a treatment algorithm.  The article is fairly thorough with reviews of several arthritic conditions (primary osteoarthritis, dislocation arthropathy, osteonecrosis, and rheumatoid arthritis to name a few) and then an algorithmthat sets up the following sequence of articles on arthroscopic management, biological resurfacing, surface replacement, conventional shoulder arthoplasty, and reverse total shoulder arthroplasty.  These are surely exciting times as many new procedures are being developed to maximize function in these patients.  There are some generic postoperative information for rehabilitation but this is clearly not the focus of the issue.  Still, the issue is excellent and a great place to freshen up on the latest management options for the athletic patient with glenohumeral arthritis.

Reg Wilcox over at the Brigham and Womans Hospital in Boston has published two excellent articles on the rehabilitation following total shoulder arthroplasty in JOSPT in 2005 and following reverse total shoulder arthroplasty in JOSPT in 2007.  I had the pleasure of speaking at the MA state APTA meeting last year with Reg and Dr. Higgins, one of his co-authors, and they truely did an excellent job.  These two articles have been especially helpful in my practice.

Todd Ellenbecker, who am sure is recognized by many of the readers, also published a case study in JOSPT earlier in 2008 on humeral resurfacing hemiarthroplasty with a meniscal allograft in a young patient.  This was also a good read and very interesting case.  We certainly are coming a long way with our treatment interventions.  Todd was also kind enough to contribute a chapter on glenohumeral arthritis in my book, The Athlete’s Shoulder (which I received information yesterday that it is finally published and available!).

Photo by University of South Florida