Mehl J, Imhoff A B, Beitzel K
Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
Orthopade. 2018 May;47(5):368-376. doi: 10.1007/s00132-018-3542-7.
Osteoarthritis of the shoulder is characterized by a progressive degenerative process, which is based on chronic inflammation with intra-articular release of different cytokines and proteolytic enzymes. The main predisposing factors are a history of trauma or surgery, as well as chronic overuse or instability of the glenohumeral joint. Affected patients especially suffer from impaired joint function and pain, which are often associated with cognitive and psychosocial restrictions.
Possible co-pathologies have to be evaluated carefully both clinically and radiologically as they must be taken into account in the therapeutic procedure. If arthroplasty of the shoulder is planned, a pre-operative CT scan is mandatory in order to evaluate the bone stock of the glenoid, which has a decisive influence on the choice of implant.
Conservative treatment options are oral pain medication, physical therapy, and intra-articular injections, whereby, in comparison to corticosteroids, hyaluronic acid seems to be advantageous especially with respect to the duration of a positive clinical effect.
肩部骨关节炎的特征是进行性退行性过程，其基于慢性炎症，伴有不同细胞因子和蛋白水解酶的关节内释放。主要诱发因素是创伤或手术史，以及盂肱关节的慢性过度使用或不稳定。受影响的患者尤其遭受关节功能受损和疼痛，这通常与认知和社会心理限制有关。
必须在临床和放射学上仔细评估可能的合并病症，因为在治疗过程中必须考虑到它们。如果计划进行肩部关节成形术，术前CT扫描是必需的，以便评估肩胛盂的骨量，这对植入物的选择具有决定性影响。
保守治疗选择包括口服止痛药、物理治疗和关节内注射，与皮质类固醇相比，透明质酸在临床积极效果的持续时间方面似乎具有优势。
