The Steadman Clinic, Vail, Colorado, USA.
Arthroscopy. 2011 Sep;27(9):1296-303. doi: 10.1016/j.arthro.2011.03.089. Epub 2011 Jul 31.
Glenohumeral arthrosis frequently results in substantial discomfort and activity limitations. Shoulder arthroplasty has been shown to provide reliable pain relief under these circumstances in older, less active populations. Younger patients, however, who desire to continue participation in high-demand activities, may not be optimal candidates for glenohumeral arthroplasty. Arthroscopic debridement has been reported to provide incomplete symptomatic relief in this cohort of patients. It is evident from cadaveric studies that the axillary nerve runs in close proximity to the inferior glenohumeral capsule. An inferior humeral osteophyte of sufficient size may compress the axillary nerve and potentially contribute to posterior shoulder pain in a manner similar to quadrilateral space syndrome. Therefore we present a technique for and early results of the arthroscopic management of glenohumeral arthrosis in young, high-demand patients. This technique combines traditional glenohumeral debridement and capsular release with inferior humeral osteoplasty and arthroscopic transcapsular axillary nerve decompression. In the appropriate patient, these additions may provide symptomatic relief that is greater than that with simple debridement alone.
肩盂肱关节炎常导致严重不适和活动受限。在这种情况下，对于年龄较大、活动较少的人群，肩关节置换已被证明能可靠地缓解疼痛。然而，对于那些希望继续从事高要求活动的年轻患者来说，肩盂肱关节炎置换术可能不是最佳选择。关节镜下清理术在这组患者中仅能提供不完全的症状缓解。尸体研究表明，腋神经与肩胛盂下关节囊紧密相邻。足够大的肱骨下骨赘可能会压迫腋神经，并以类似于四边孔综合征的方式导致肩部后痛。因此，我们提出了一种针对年轻、高需求患者的肩关节镜治疗肩盂肱关节炎的技术及其早期结果。该技术将传统的肩盂肱清创术和囊松解术与肱骨下骨成形术和关节镜下经囊腋神经减压术相结合。在合适的患者中，这些附加操作可能会提供比单纯清创术更大的症状缓解。
