ICL 207 Glenhumeral Arthritis in the Young Patient: Arthroscopic and Other Options-Savoie Handout

Savoie Handout

Pdf Summary

This presentation by Dr. Felix H. Savoie III addresses realistic treatment options for degenerative shoulder conditions, particularly in active populations. Glenohumeral arthritis, including primary and secondary types resulting from trauma, instability, chondrolysis, or rotator cuff arthropathy, significantly impairs daily living. Traditional management includes over-the-counter supplements, medications, physical therapy, injections (hyaluronic acid), arthroscopic intervention, and ultimately replacement surgery.<br /><br />Surgical treatments like arthroscopic debridement yield mixed results, while total shoulder arthroplasty (TSA) is effective in older patients but often unsuitable for younger, more active individuals due to early glenoid loosening and subscapularis dysfunction. The key appears to be preserving the subscapularis muscle, as dysfunction or insufficiency is common post-TSA and compromises outcomes.<br /><br />Realistic management options range from conservative measures—activity modification, NSAIDs, supplements, injections—to arthroscopic procedures (debridement, capsular release, microfracture) aimed at pain relief and preserving function. Arthroscopic glenoid resurfacing with commercial patches or allografts serves to “buy time” and maintain activity but offers less durable pain relief than TSA.<br /><br />Humeral head resurfacing using a minimally invasive, arthroscopically assisted subscapularis-sparing approach shows promising durability and patient satisfaction, with long-term follow-up indicating good outcomes, high return-to-activity levels, and minimal subscapularis damage on imaging.<br /><br />The presentation emphasizes subscapularis preservation as critical across treatments. Postoperative rehabilitation protocols support early range of motion and return to activity without restrictions.<br /><br />In conclusion, for active patients with degenerative shoulder conditions, a spectrum of options exists that focuses on joint preservation, pain management, and maintaining function. Minimally invasive arthroscopy and resurfacing techniques that spare the subscapularis offer effective alternatives to full replacement, enabling patients to continue an active lifestyle while deferring more invasive surgeries.

Keywords

degenerative shoulder conditions

glenohumeral arthritis

rotator cuff arthropathy

total shoulder arthroplasty (TSA)

subscapularis preservation

arthroscopic debridement

humeral head resurfacing

minimally invasive shoulder surgery

postoperative rehabilitation

joint preservation