Degenerative joint disease in the shoulder

1. What occurs in arthritis of the shoulder?
2. What are the symptoms and signs of shoulder arthritis?
3. What imaging should be ordered? What is seen on X-ray?
4. What is conservative treatment for shoulder arthritis?
5. What are the indications for total shoulder arthroplasty? What are the stages of recovery?
6. What is shoulder arthrodesis? What are indications for arthrodesis?

Answers:
1. Destruction of articular cartilage and narrowing of the joint space in either of the GH or AC joint.
2. Limitation and pain on AROM and PROM, worse with internal rotation, tenderness with palpation.
3. AP in internal and external rotation and 40 degrees, axillary view. Findings are irregular joint surfaces, joint space narrowing, subacromial sclerosis, osteophyte changes, flattened glenoid, cystic changes in humeral head.
4. NSAIDs, steroid injection, ROM, rotator cuff strengthening.
5. Indications for surgery are pain, avascular necrosis, neoplasm. In stage 1 (0-6 wks), avoid abduction and extension, ext rot >15 deg, NWB, sling immobilization, treat with pendulum exercises, isometrics, wall-walking. In stage 2 (6-12 wks), can start light wks, AROM. In stage 3 (>12 wks), no restrictions, start progressive resistive exercises.
6. Shoulder arthrodesis is surgical resection and fusion of shoulder joint. Indications are severe pain, loosening of arthroplasty, or joint infection.