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Arthrosis
Articular cartilage pathology in the shoulder can present in many scenarios. The most common is some degree of osteoarthrosis or chondromalacia. The less common scenarios are avascular necrosis, rheumatoid arthritis, chondrolysis, and osteochondromatosis. The current arthroscopic treatment of these conditions is limited with little scientific evidence to guide orthopedic surgeons, but with increased knowledge and technology, this will inevitably change. The lesions that surgeons encounter in these conditions and may need to address surgically include chondral damage and deficiency, labral tearing, loose bodies, capsular thickening or hypertrophy, and synovitis. These findings can cause pain, stiffness, and mechanical symptoms that the surgeon tries to address ( ).
Diagnosis
The diagnosis of osteoarthrosis, rheumatoid arthritis, or avascular necrosis is made clinically with a combination of patient history, physical examination, laboratory tests, and imaging studies ( Figs. 7.1–7.3 ). There are still often situations in which cartilage lesions are unsuspected and are encountered during arthroscopic treatment for impingement, rotator cuff tear, or glenohumeral instability ( Figs. 7.4 and 7.5 ).
Nonoperative Treatment
Nonoperative treatment is largely palliative and consists of medication or injections to diminish the inflammatory response and physical therapy to maintain or improve shoulder range of motion and strength. Some alternative options such as the use of platelet rich plasma and stem cell injections have gained popularity and can be considered options. However, patients should be counseled that these interventions have no definitive proven benefit at the present time to modify the natural history of any of the conditions listed previously, and they may not improve pain relief either.
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