From time to time a patient presents with a shoulder disability characterized by restriction of glenohumeral motion, pain in this joint when it is moved, and roentgenographic evidence of narrowing of the joint space and irregularity of the humeral head. Cadaver studies and clinical observations have shown that degenerative alterations in the humeral articular surface may be present in a shoulder of satisfactory function. Because of this fact, other causes of shoulder pain, both intrinsic and extrinsic, must be sought before concluding that glenohumeral incongruity is the basis of the problem. Degenerative changes in the humeral head may be accelerated by rheumatoid arthritis, trauma, metabolic disturbances of the cartilage (gout, ochronosis), bone infarction (Gaucher's disease, sickle-cell anemia), irradiation necrosis, or another secondary factor. Nonoperative treatment must always precede surgical intervention and should be continued as long as improvement is noted. The indication for surgery is the persistence of intolerable pain. Over the past eight years a vitallium prosthesis has been used for relief of pain in 15 patients with primary or secondary osteoarthritis of the joint in question, with results sufficiently good to justify additional trials in carefully selected patients, provided the rotator cuff is intact or can be restored.
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From time to time a patient presents with a shoulder disability characterized by restriction of glenohumeral motion, pain in this joint when it is moved, and roentgenographic evidence of narrowing of the joint space and irregularity of the humeral head. Cadaver studies and clinical observations have shown that degenerative alterations in the humeral articular surface may be present in a shoulder of satisfactory function. Because of this fact, other causes of shoulder pain, both intrinsic and extrinsic, must be sought before concluding that glenohumeral incongruity is the basis of the problem. Degenerative changes in the humeral head may be accelerated by rheumatoid arthritis, trauma, metabolic disturbances of the cartilage (gout, ochronosis), bone infarction (Gaucher's disease, sickle-cell anemia), irradiation necrosis, or another secondary factor. Nonoperative treatment must always precede surgical intervention and should be continued as long as improvement is noted. The indication for surgery is the persistence of intolerable pain. Over the past eight years a vitallium prosthesis has been used for relief of pain in 15 patients with primary or secondary osteoarthritis of the joint in question, with results sufficiently good to justify additional trials in carefully selected patients, provided the rotator cuff is intact or can be restored.
Copyright remains with the authors and publisher.