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GLENOID DYSPLASIA: A Not So Rare Cause of Shoulder Pain

Glenoid Dysplasia refers to an abnormality in the development of the glenoid portion of the scapula (the socket bone of the shoulder joint).  This can range from a mild abnormality in development of the bony glenoid to a very severe abnormality.  As the process is thought to occur at some point during development, the surrounding soft tissues, especially the glenoid labrum (bumper cushion that deepens the socket), tend to overdevelop (hypertrophy) in order to compensate for the missing bony support.

An article in the American Journal of Roentgenology noted that although historically thought to be a rare entity, moderate to severe glenoid dysplasia had an incidence of almost 15% in their study using high field MRIs.  Because of the lack of full bony support in the posterior aspect of the shoulder joint, the soft tissues are placed under increased stress, and these patients are at significantly increased risk of developing shoulder pain, posterior shoulder instability, and premature shoulder arthritis.

Patients with Glenoid Dysplasia that present with shoulder pain in their teens, 20s, and even early 30s in our experience often have extensive labrum tearing that more often than not involve the entire circumference of the glenoid (global or 360 degree tear).  Those patients that have had chronic injuries also develop shoulder arthritis, secondary anterior superior rotator cuff tears and traction/torque neuropraxia involving the suprascapular and axillary nerves as well.Glenoid-Dysplasia-treatment

Patients with Glenoid Dysplasia that present in their late 30s and beyond typically have developed significant arthritis in addition to all the other pathology already mentioned for the younger group of patients.

Once severe arthritis is the predominant symptom generator and conservative measures for treatment are no longer helpful, we proceed with our detailed evaluation to determine the best type of shoulder replacement for each unique patient.

For patients that still have a reasonable level of available shoulder motion and meet other specific criteria, an entirely arthroscopic all suture biologic reconstruction is our preferred approach.  This approach is designed to restore balance to the shoulder and repair all available damaged tissues (labrum, biceps, rotator cuff, etc.) in order to preserve the patient’s native joint, provide pain relief, increase function, and hopefully slow down the progression of the arthritic process.  While several other types of surgeries have been described for these patients, we find that in our hands, an entirely arthroscopic approach allows thorough evaluation of the entire shoulder joint as well as comprehensive global treatment that would simply not be possible with a traditional open surgery.  This minimally invasive arthroscopic (keyhole surgery) also results in much less damage to surrounding tissues and patients also uniformly prefer minimally invasive surgery.   Unfortunately, these techniques are only reliably performed by a handful of shoulder specialists.  The causes for shoulder pain can range from the simple to the very complex, so it is important to clearly establish the true cause for your shoulder pain before considering any type of treatment.

A good example of this issue is a recent article warning patients and physicians to be careful not to mistake Glenoid Dysplasia for shoulder trauma: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904540/

Because we have the privilege of treating patients that travel long distances to seek treatment and have often had multiple failed shoulder surgeries, one of the most common errors we find is the tendency of both patients and physicians to ascribe a simple solution for a complex problem.  For instance, we have treated many patients with disabling shoulder pain and instability because of glenoid dyplasia that were treated with a relatively simple shoulder arthroscopy with debridement and acromioplasty (spur removal).  When removed from the unique pressures and stress of the individual case, it is easy to see that this treatment can do nothing but worsen the core problem for the patient but we find that most patients are even more eager to grasp for an easy and quick solution rather than take the time to find a true and comprehensive diagnosis before moving ahead with a real solution.  This natural tendency for a simple solution when a complex one is needed is so seductive that we often see patients that have had multiple (nine failed operations is the most we have seen) failed operations before considering the possibility that an alternative opinion may be appropriate.  This is often referred to as anchoring, the tendency to grasp onto the first available option rather than entertain the fact that the true solution may be more complex.  So when faced with persistent shoulder pain that hasn’t responded to several simple treatment options, take the time to do you research and get a second, third, or fourth opinion if needed.

Comments

  1. Ian Caldwell says:

    Hello, I have read your site and wish to ask of a proceedure with a pyrotitan insert. I have severe glenoid dysplasia and have had debridement and anchors of my left shoulder and my right has become a problem. I am 52 year old from Australia and the specialists here are not helpful and reading your note can see why if they do not have the experience to resolve the issue. I am being pressured by governemnt to get fixed but no one can help. I am at my wits end to be well again. I look forward to your thoughts . regards and thank you. Ian Caldwell

    • Dear Ian Caldwell,
      The Pyro Titan insert is not approved in the United States but is essentially a partial shoulder replacement with the wear surface made of PyroCarbon which will hopefully prove to be more compatible with bone and cartilage over the long term. The problem with these types of devices in other joints to date has been that a reliable form of ingrowth or mating to the native bone has not been devised and loosening has been an issue. Regardless, it is difficult to provide clear guidance for you as there are many factors to consider before making specific recommendations.
      Best regards,
      Dr. Agrawal

  2. A common area for shoulder pain is along the inside edge of the shoulder blade (the scapula). This is often due to tight pectoral muscles over the chest at the front. When these pectoral muscles tighten, trigger points within them keep the muscles shortened and as a result pull the bones of the whole shoulder girdle forward. This then gives the appearance of ’round shouldered’ and flat chested.

Trackbacks

  1. [...] we look at this computed tomography scan showing arthritis with asymmetric wear of the posterior glenoid we are reminded that the largest radiographic finding in arthritic shoulders is asymmetric [...]

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