Juvenile degenerative osteoarthritis of the shoulder
Short Summary

39-year-old male with painful symptomatology of the right shoulder joint was diagnosed with Juvenile concentric osteoarthritis of right shoulder with lower osteophytosis. Arthroscopy is recommended in order to assess the shoulder injury and delay the “shoulder arthroprosthesis” operation.

Patient's Questions
1)    Do you confirm the diagnosis?

 
2)    Also taking the young age of the patient into consideration, what do you believe is the best treatment to propose?

 
3)    What are the centers of excellence in Italy?

 
4)    Prognosis?
Medical Background

Sex: M, Age: 39
Diagnosis: Juvenile degenerative osteoarthritis of the shoulder
 
Remote negative pathological anamnesis for pathologies worthy of note, except for reconstruction of the anterior cruciate ligaments of the right and left knees.
Onset of painful symptomatology of the right shoulder joint in 2004 without evident cause. An X-ray exam of the right shoulder was initially made on 4/2006 upon a specialist’s instructions, the finding of which states: “irregularity of the profile of the greater tuberosity of the humerus and of the lower edge of the glenohumeral joint caused by arthritic manifestations.
Scapulohumeral joint ratios retained.
Acromion-clavicle arthritis.
Subacromial space retained.
Dystrophic calcifications projected near the soft periarticular parts not documentable.”
 
In follow-up, an NMR of the right shoulder was performed on 6/2006, with evidence of “regular glenohumeral and acromion-clavicle joint ratios, with initial degenerative acromion-clavicle arthritic manifestations.
Reduction of the adipose tissue in the subacromial space, however without significant alterations of signal near the tendon of the supraspinatus.
Neither were there alterations of signal near the tendon of the infraspinatus and the subscapular tendon.
The long head of the biceps muscle is evenly notable along its entire course on the level of its anatomic sulcus.
There is a very slight flap of reactive synovitis near the armpit”.
 
In completing the diagnostic tests, the patient was then subjected to a CAT scan of the right shoulder/3D reconstruction CAT scan on 4/2008 from which it is deduced that “signs of acromion-clavicle arthritis with small marginal lower osteophytes on the articular surfaces, responsible for impingement on the supraspinatus muscle.
Several calcifications in the subcoracoid recess are noted.
Arthritic alterations of the articular surfaces in the glenohumeral region are seen, with marked ostephytosis both on the humeral epiphysis side and on the glenoscapular angle, especially along the front bottom edge.
The glenohumeral articular spacing is only slightly reduced.”
In light of what is described above, during the orthopaedic visit on 5/2008 Dr X set the diagnosis of “Juvenile concentric osteoarthritis of right shoulder with lower osteophytosis. Therefore, arthroscopy was recommended in order to assess the shoulder injury and any possible shaving, delaying as long as possible the “shoulder arthroprosthesis” operation that in any case will have to be done sooner or later.

Expert's Opinion

The information provided did not give a detailed physical examination which is important in order to sort out the truly clinically relevant information. The images demonstrate arthritis but there is no evidence of any rheumatoid component as there are no juxta-articular erosions of the glenoid or humeral head. If this is a young patient then an arthroscopic debridement is in order. A detailed examination would help me discern if the main problem is the radiographic appearance of arthritis or subacromial impingement; and if the latter is suspected then an injection of cortisone and xylocain into the subacromial space would help to clarify the diagnosis. As an arthroscopy is planned I think this is reasonable from the available information but careful assessment of the subacromial space, biceps and articular surface is necessary at time of surgery.

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