The role of the anterior shoulder joint capsule in primary glenohumeral osteoarthritis

Abstract

The pathogenesis of primary glenohumeral arthritis (GHOA) is mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. Recently, there has been growing interest in characterizing the association between the anterior shoulder joint capsule and primary GHOA because of the potential for targeted treatment interventions. Emerging evidence has shown substantial synovitis, fibrosis, and mixed inflammatory cell infiltrate in the anterior capsule of osteoarthritic shoulders. In addition, increased thickening of the anterior shoulder joint capsule has been associated with greater posterior glenoid wear and humeral head subluxation. While these findings suggest that anterior capsular disease may play a causative role in the etiology and progression of eccentric GHOA, further studies are needed to support this association. The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research. The pathogenesis of primary glenohumeral arthritis (GHOA) is mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. Recently, there has been growing interest in characterizing the association between the anterior shoulder joint capsule and primary GHOA because of the potential for targeted treatment interventions. Emerging evidence has shown substantial synovitis, fibrosis, and mixed inflammatory cell infiltrate in the anterior capsule of osteoarthritic shoulders. In addition, increased thickening of the anterior shoulder joint capsule has been associated with greater posterior glenoid wear and humeral head subluxation. While these findings suggest that anterior capsular disease may play a causative role in the etiology and progression of eccentric GHOA, further studies are needed to support this association. The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research. Primary glenohumeral osteoarthritis (GHOA) is one of the most common causes of shoulder pain3Cadogan A. Laslett M. Hing W.A. McNair P.J. Coates M.H. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks.BMC Musculoskelet Disord. 2011; 12: 119https://doi.org/10.1186/1471-2474-12-119Crossref PubMed Scopus (78) Google Scholar,18Harkness E.F. Macfarlane G.J. Silman A.J. McBeth J. 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Progression of glenoid morphology in glenohumeral osteoarthritis.J Bone Joint Surg Am. 2018; 100: 49-56https://doi.org/10.2106/JBJS.17.00064Crossref PubMed Scopus (63) Google Scholar While the true prevalence of GHOA is difficult to determine, a recent review estimates that 16%-20% of the middle-aged and elderly population have radiographic evidence of shoulder osteoarthritis.25Ibounig T. Simons T. Launonen A. Paavola M. Glenohumeral osteoarthritis: an overview of etiology and diagnostics.Scand J Surg. 2021; 110: 441-451https://doi.org/10.1177/1457496920935018Crossref PubMed Scopus (34) Google Scholar After the hip and knee, the shoulder is the third most commonly affected large joint.26Izquierdo R. Voloshin I. Edwards S. Freehill M.Q. Stanwood W. Wiater J.M. et al.Treatment of glenohumeral osteoarthritis.J Am Acad Orthop Surg. 2010; 18: 375-382https://doi.org/10.5435/00124635-201006000-00010Crossref PubMed Scopus (98) Google Scholar Shoulder arthroplasty is a highly successful procedure for symptomatic GHOA,27Jensen A.R. Tangtiphaiboontana J. Marigi E. Mallett K.E. Sperling J.W. Sanchez-Sotelo J. Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly.J Shoulder Elbow Surg. 2021; 30: S131-S139https://doi.org/10.1016/j.jse.2020.11.030Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar,54Walch G. Young A.A. Melis B. Gazielly D. Loew M. Boileau P. Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years.J Shoulder Elbow Surg. 2011; 20: 385-394https://doi.org/10.1016/j.jse.2010.07.011Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar,58Wright M.A. Keener J.D. Chamberlain A.M. Comparison of clinical outcomes after anatomic total shoulder arthroplasty and reverse shoulder arthroplasty in patients 70 years and older with glenohumeral osteoarthritis and an intact rotator cuff.J Am Acad Orthop Surg. 2020; 28: e222-e229https://doi.org/10.5435/JAAOS-D-19-00166Crossref PubMed Scopus (72) Google Scholar although the generally excellent outcomes may be less consistent in cases with substantial posterior glenoid deformity and posterior humeral head subluxation (PHHS).23Hsu J.E. Ricchetti E.T. Huffman G.R. Iannotti J.P. Glaser D.L. Addressing glenoid bone deficiency and asymmetric posterior erosion in shoulder arthroplasty.J Shoulder Elbow Surg. 2013; 22: 1298-1308https://doi.org/10.1016/j.jse.2013.04.014Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar,24Iannotti J.P. Norris T.R. Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis.J Bone Joint Surg Am. 2003; 85: 251-258https://doi.org/10.2106/00004623-200302000-00011Crossref PubMed Scopus (335) Google Scholar,53Walch G. Moraga C. Young A. Castellanos-Rosas J. Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid.J Shoulder Elbow Surg. 2012; 21: 1526-1533https://doi.org/10.1016/j.jse.2011.11.030Abstract Full Text Full Text PDF PubMed Scopus (264) Google Scholar While a variety of surgical techniques have been described to address these challenges, there are a paucity of studies that explore the etiology and progression of arthritic changes in the glenohumeral joint.11Domos P. Checchia C.S. Walch G. Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head.J Shoulder Elbow Surg. 2018; 27: 181-188https://doi.org/10.1016/j.jse.2017.08.014Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar,52Walch G. Ascani C. Boulahia A. Nove-Josserand L. Edwards T.B. Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult.J Shoulder Elbow Surg. 2002; 11: 309-314https://doi.org/10.1067/mse.2002.124547Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar,55Walker K.E. Simcock X.C. Jun B.J. Iannotti J.P. Ricchetti E.T. Progression of glenoid morphology in glenohumeral osteoarthritis.J Bone Joint Surg Am. 2018; 100: 49-56https://doi.org/10.2106/JBJS.17.00064Crossref PubMed Scopus (63) Google Scholar Further understanding of this process may aid in the development of disease-modifying strategies to delay or reduce the need for shoulder arthroplasty, which is of particular importance in young and active patients.6Chainani A. Matson A. Chainani M. Marchand Colon A.J. Toth A.P. Garrigues G.E. et al.Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.J Shoulder Elbow Surg. 2020; 29: e253-e268https://doi.org/10.1016/j.jse.2019.11.013Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar,11Domos P. Checchia C.S. Walch G. Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head.J Shoulder Elbow Surg. 2018; 27: 181-188https://doi.org/10.1016/j.jse.2017.08.014Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar,52Walch G. Ascani C. Boulahia A. Nove-Josserand L. Edwards T.B. Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult.J Shoulder Elbow Surg. 2002; 11: 309-314https://doi.org/10.1067/mse.2002.124547Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research. A landmark study by Harryman et al19Harryman 2nd, D.T. Sidles J.A. Clark J.M. McQuade K.J. Gibb T.D. Matsen 3rd, F.A. Translation of the humeral head on the glenoid with passive glenohumeral motion.J Bone Joint Surg Am. 1990; 72: 1334-1343Crossref PubMed Scopus (682) Google Scholar in 1990 described the effects of anterior capsular tightness on translation of the humeral head with passive motion of the osteoarthritic shoulder. When the anterior capsule is tight and contracted, external rotation of glenohumeral joint produces a posteriorly directed force that causes posterior decentering of the humeral head on the glenoid19Harryman 2nd, D.T. Sidles J.A. Clark J.M. McQuade K.J. Gibb T.D. Matsen 3rd, F.A. Translation of the humeral head on the glenoid with passive glenohumeral motion.J Bone Joint Surg Am. 1990; 72: 1334-1343Crossref PubMed Scopus (682) Google Scholar,34Matsen F.A. Lippitt S.B. Sidles J.A. Harryman D.T. Practical evaluation and management of the shoulder. W.B. Saunders Company: Philadelphia, PA, 1994Google Scholar (Fig. 1). Over time, posterior subluxation of the humeral head causes erosion of the posterior glenoid, which in turn limits external rotation of the glenohumeral joint and subsequently leads to more stiffness of the anterior capsule – thus continuing this “vicious cycle”33Matsen F. The vicious circle of glenohumeral arthritis - can it be stopped?. Blogger: Seattle, WA, 2022Google Scholar (Fig. 2).Figure 2The “vicious cycle” of glenohumeral arthritis.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Walch et al52Walch G. Ascani C. Boulahia A. Nove-Josserand L. Edwards T.B. Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult.J Shoulder Elbow Surg. 2002; 11: 309-314https://doi.org/10.1067/mse.2002.124547Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar was among the first to define, quantify, and categorize the concept of static posterior subluxation of the humeral head. In their study, 13 males (mean age, 40 years) with symptomatic GHOA were evaluated by computed tomography (CT) imaging and found to have PHHS without evidence of posterior glenoid bone erosion. Each patient underwent various surgical procedures in attempt to correct the subluxation, including arthroscopic Bankart repair, the Bristow-Latarjet procedure, arthroscopic synovectomy, a posterior bone-block procedure, posterior opening wedge osteotomies of the scapula neck, arthrolysis of the anterior compartment with lengthening of the subscapularis tendon and posterior capsulorraphy, or removal of hardware used in previous stabilization surgery. At 46 months postoperatively, all patients had progression of arthritis with subsequent development of posterior glenoid wear and recurrent posterior humeral subluxation. It was suggested that static PHHS in the young adult could be the first step in the development of primary GHOA. This theory was corroborated nearly two decades later. In 2018, Walker et al55Walker K.E. Simcock X.C. Jun B.J. Iannotti J.P. Ricchetti E.T. Progression of glenoid morphology in glenohumeral osteoarthritis.J Bone Joint Surg Am. 2018; 100: 49-56https://doi.org/10.2106/JBJS.17.00064Crossref PubMed Scopus (63) Google Scholar evaluated the longitudinal history of primary GHOA in 65 shoulders by comparing CT findings at an average time interval of 74 months. It was found that the humeral head remained centered in most Walch A-type with progression to PHHS or asymmetric posterior glenoid bone In were associated with progression to and that the of posterior humeral head translation may to the development of posterior glenoid bone and progression While the etiology and progression of GHOA is P. Checchia C.S. Walch G. Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head.J Shoulder Elbow Surg. 2018; 27: 181-188https://doi.org/10.1016/j.jse.2017.08.014Abstract Full Text Full Text PDF PubMed Scopus (48) Google morphology than humeral a on the glenoid in total shoulder arthroplasty.J Shoulder Elbow Surg. 2012; 21: Full Text Full Text PDF PubMed Scopus Google Scholar it to be mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. While most of the on the of the rotator on glenoid D. Keener J.D. rotator and glenoid deformity in primary glenohumeral osteoarthritis.J Bone Joint Surg Am. PubMed Scopus Google Ricchetti E.T. Iannotti J.P. The association between rotator and glenoid morphology in glenohumeral osteoarthritis.J Bone Joint Surg Am. 2018; 100: PubMed Scopus Google M.A. P.J. et and to glenoid deformity in primary glenohumeral osteoarthritis.J Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus (7) Google Scholar,55Walker K.E. Simcock X.C. Jun B.J. Iannotti J.P. Ricchetti E.T. Progression of glenoid morphology in glenohumeral osteoarthritis.J Bone Joint Surg Am. 2018; 100: 49-56https://doi.org/10.2106/JBJS.17.00064Crossref PubMed Scopus (63) Google Scholar there has been increased interest in characterizing the role of the anterior capsule in primary GHOA because of the potential for targeted treatment to and The role of the anterior shoulder joint capsule in the development of primary GHOA may be with the concept of which the of glenohumeral the surgical treatment of recurrent anterior shoulder A.M. S. B. Matsen 3rd, F.A. The of total shoulder arthroplasty on in shoulder in patients with Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google Scholar follow-up studies have shown rates of GHOA of to after a repair, Bankart repair, and D.L. M. with the Bankart and Bristow-Latarjet recurrent shoulder and Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google J. I. L. The of the with particular to and of external Shoulder Elbow Surg. Full Text PDF PubMed Scopus Google S. M. I. A. A. Results of the procedure for shoulder review of Surg PubMed Scopus Google R. Glenohumeral after Shoulder Elbow Surg. Full Text PDF PubMed Scopus (72) Google Scholar of these the anterior capsule is with or without or of the subscapularis This is to external rotation and the shoulder in which it is to anterior A.M. S. B. Matsen 3rd, F.A. The of total shoulder arthroplasty on in shoulder in patients with Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google Scholar of the anterior soft may in posterior translation of the humeral head and posterior wear a of joint 2nd, D.T. Sidles J.A. Clark J.M. McQuade K.J. Gibb T.D. Matsen 3rd, F.A. Translation of the humeral head on the glenoid with passive glenohumeral motion.J Bone Joint Surg Am. 1990; 72: 1334-1343Crossref PubMed Scopus (682) Google Scholar were further corroborated in a study by et C. The of capsular on humeral head Orthop 22: PubMed Scopus Google Scholar in which the effects of capsular on humeral head translation were study found that or total anterior increased posterior translation of the humeral head in and of that anterior capsular may the development of static subluxation and The PHHS and posterior erosion in is to that in primary GHOA with posterior glenoid anterior capsule a for the development of GHOA. is evidence to suggest that the pathogenesis of primary GHOA thickening and asymmetric of the A. Matson A. Chainani M. Marchand Colon A.J. Toth A.P. Garrigues G.E. et al.Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.J Shoulder Elbow Surg. 2020; 29: e253-e268https://doi.org/10.1016/j.jse.2019.11.013Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar capsular have been shown to in and are mediated by and with and capsular E.F. D. R. J.A. The of and in Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google J.A. J. of and their in of the Orthop PubMed Scopus Google Scholar Chainani et A. Matson A. Chainani M. Marchand Colon A.J. Toth A.P. Garrigues G.E. et al.Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.J Shoulder Elbow Surg. 2020; 29: e253-e268https://doi.org/10.1016/j.jse.2019.11.013Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar of the shoulders with primary GHOA at the time of and to that of with history of shoulder with the and in with primary GHOA had and by increased of a of and a has been shown to and is in the of to D.L. and and in in by PubMed Scopus Google Scholar have been in the pathogenesis of joint capsule including and joint of the hip and M. The cell joint capsule in a of joint 2012; PubMed Scopus Google M. S. J. G. J. The treatment of of joint and shoulder by in Scopus Google A. G. C. in patients with 2018; PubMed Scopus Google Scholar the and in with primary GHOA had a in the of and While are joint capsule and an role in the of J. D. J. et and the development of osteoarthritis in PubMed Scopus Google Scholar their is in E. F. et and evidence of associated with of arthritis in 2013; PubMed Scopus Google Scholar the Chainani et A. Matson A. Chainani M. Marchand Colon A.J. Toth A.P. Garrigues G.E. et al.Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.J Shoulder Elbow Surg. 2020; 29: e253-e268https://doi.org/10.1016/j.jse.2019.11.013Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar to that the and of primary GHOA patients may be in a of and without of the inflammatory In addition, it was found that the of transient receptor potential and was greater in the of arthritic shoulders. of and J. J.D. and Full Text Full Text PDF PubMed Scopus Google Scholar these an in the development of P.J. B. the PubMed Scopus Google Scholar and could provide a for of and thickening of the In et M.A. J.M. D. A. et association between anterior shoulder joint capsule thickening and glenoid deformity in primary glenohumeral osteoarthritis.J Shoulder Elbow Surg. 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Primary humeral head outcomes with the J PubMed Scopus Google A. et arthroplasty for primary shoulder by of the 2011; PubMed Google of anterior capsule disease on wear of the and end-stage glenohumeral Large Image Figure ViewerDownload Hi-res image Download (PPT) joint with capsular may provide a treatment to in young patients with T.R. P.J. Glenohumeral joint a review of management for active patients with 2012; PubMed Google Scholar the arthroscopic procedure that a of the capsule to a capsular Garrigues G.E. management of the PubMed Scopus Google M.A. L. Garrigues G.E. of the Shoulder and Full Text Full Text PDF PubMed Scopus Google Scholar This is in with a substantial in external or G.R. Iannotti J.P. management of of the glenohumeral Shoulder Elbow Surg. 2002; 11: Full Text Full Text PDF PubMed Scopus Google A.A. Glenohumeral osteoarthritis in the young Am Acad Orthop Surg. 2018; PubMed Scopus Google Scholar a has been shown to reduce rotation the glenohumeral joint and has been in the progression of Glenohumeral arthritis in the young Shoulder Elbow Surg. 2011; 20: Full Text Full Text PDF PubMed Scopus Google Scholar et G. G. F. A. C.S. P. treatment of glenohumeral Orthop 2013; PubMed Scopus Google Scholar on patients to years after arthroscopic with or of for glenoid in patients with arthritic shoulders. At in the and Shoulder were and of patients clinical it was that outcomes were associated with and centered the to that soft procedures are for with arthritis and This leads one to the of in or the progression of GHOA. This is in of the humeral head findings described in the previous is found in cases of and the of joint motion could have these more and A.P. Chainani A. et of the humeral head in 2021; Full Text Full Text PDF Scopus Google Scholar In more shoulder arthroplasty anterior capsular in with has been shown to posteriorly humeral C. A. Static posterior humeral head subluxation and total shoulder arthroplasty.J Shoulder Elbow Surg. 18: Full Text Full Text PDF PubMed Scopus Google P. P. S. the humeral head for glenoid deficiency in total shoulder Orthop PubMed Scopus Google Scholar et C. A. Static posterior humeral head subluxation and total shoulder arthroplasty.J Shoulder Elbow Surg. 18: Full Text Full Text PDF PubMed Scopus Google Scholar shoulders with PHHS subluxation with primary capsular and glenoid At a follow-up of PHHS was in of The suggested that anterior capsule may have to of the glenohumeral joint and that PHHS may be to of the subscapularis tendon or rotator interval In a P. P. S. the humeral head for glenoid deficiency in total shoulder Orthop PubMed Scopus Google Scholar of arthritic shoulders with PHHS and posterior glenoid of the humeral head was in all patients at follow-up by surgical of glenoid or glenoid bone with soft capsular rotator and tendon in with In the most recent study of patients with GHOA with posterior glenoid erosion and Garrigues et G.E. E. Walch G. L. et clinical and radiographic outcomes of anatomic total shoulder arthroplasty with a posterior glenoid for patients with posterior glenoid Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google Scholar used an anatomic glenoid with or capsular and PHHS that the was with a A component of anatomic is of the and anterior and capsular J.W. P. P. in shoulder the role of soft 2020; Full Text Full Text PDF PubMed Scopus Google L. 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PubMed Scopus Google Scholar While most a longitudinal including the capsule a primary anatomic for glenohumeral arthritis Figure Figure have found that of a with in soft and of it is to that these are of cases in a head to head anterior capsule with a is the subscapularis which is with a Large Image Figure ViewerDownload Hi-res image Download capsule is the can be it is nearly Large Image Figure ViewerDownload Hi-res image Download (PPT) In a is with an the the anterior After and development of the the is it between the subscapularis and the anterior humeral This is by the which a on the with one in the and of the with the the the head of the tendon is At this the and subscapularis tendon are the in external of the is and an of in and in the subscapularis is at the A is between the subscapularis and the which to the and The capsule is the the is and to for capsular the humeral After are and the humeral head is is the first step in glenoid A is posterior to the glenoid to the humeral head and two are in the between the capsule and the to the a is used to the the capsule to that the is in the capsule is to at the on the This capsule is to the rotator The capsule and are and contracted, with of After the is the is and the posterior and capsule is to the glenoid After the glenoid and humeral prosthesis are the is a the role of anterior capsular disease in osteoarthritic shoulders more there is growing interest on the of targeted management strategies to delay and the recent and in the of arthritic A. Matson A. Chainani M. Marchand Colon A.J. Toth A.P. Garrigues G.E. et al.Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.J Shoulder Elbow Surg. 2020; 29: e253-e268https://doi.org/10.1016/j.jse.2019.11.013Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar there is a to the role of in the and management of primary Glenohumeral osteoarthritis: the role for and cell 2020; Scopus Google Scholar While studies are in and in pain and in shoulder have been with the of A. the of with for the treatment of 2013; PubMed Scopus Google arthroplasty with and in young patients with glenohumeral of months of at Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google Scholar and bone J. S. A prospective study of a of bone for the treatment of shoulder rotator and osteoarthritis.J PubMed Scopus Google Scholar which may of the inflammatory S. J. J. et clinical of in the Am Acad Orthop Surg. 27: PubMed Scopus Google Scholar targeted of anterior capsular disease could be an step in the of the arthritic shoulder studies the effects of capsular or anterior capsular on the progression of primary GHOA. it be to there is a in of motion and outcomes after shoulder arthroplasty with in patients with primary GHOA. and of the have been in the pathogenesis of glenohumeral in cases with posterior glenoid erosion. While it anterior capsular disease a causative role in the etiology and progression of eccentric GHOA, further understanding of this may for the study of targeted management strategies or of surgical techniques total shoulder to

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