Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis
The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, ph...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Advances in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2012/846843 |
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| author | Sanjeev Bhatia Andrew Hsu Emery C. Lin Peter Chalmers Michael Ellman Brian J. Cole Nikhil N. Verma |
| author_facet | Sanjeev Bhatia Andrew Hsu Emery C. Lin Peter Chalmers Michael Ellman Brian J. Cole Nikhil N. Verma |
| author_sort | Sanjeev Bhatia |
| collection | DOAJ |
| description | The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions. |
| format | Article |
| id | doaj-art-f3300686daa94f278577dfe3f115a503 |
| institution | Kabale University |
| issn | 2090-3464 2090-3472 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Orthopedics |
| spelling | doaj-art-f3300686daa94f278577dfe3f115a5032025-02-03T05:59:28ZengWileyAdvances in Orthopedics2090-34642090-34722012-01-01201210.1155/2012/846843846843Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral ArthritisSanjeev Bhatia0Andrew Hsu1Emery C. Lin2Peter Chalmers3Michael Ellman4Brian J. Cole5Nikhil N. Verma6Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USADivision of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite No. 300, Chicago, IL 60612, USAThe diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions.http://dx.doi.org/10.1155/2012/846843 |
| spellingShingle | Sanjeev Bhatia Andrew Hsu Emery C. Lin Peter Chalmers Michael Ellman Brian J. Cole Nikhil N. Verma Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis Advances in Orthopedics |
| title | Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis |
| title_full | Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis |
| title_fullStr | Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis |
| title_full_unstemmed | Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis |
| title_short | Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis |
| title_sort | surgical treatment options for the young and active middle aged patient with glenohumeral arthritis |
| url | http://dx.doi.org/10.1155/2012/846843 |
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