Management of Articular Cartilage Defects in the Glenohumeral Joint

Adam J. Seidl, MD; Matthew J. Kraeutler, MD

Disclosures

J Am Acad Orthop Surg. 2018;26(11):e230-e237. 

In This Article

Diagnosis

Chondral defects of the glenohumeral joint are often asymptomatic and well tolerated.[19] In some patients, these lesions may cause unremitting, activity-related shoulder pain for years after minor shoulder trauma.[20,21] This pain may result in substantially reduced active range of motion.[22] These lesions can cause mechanical symptoms within the joint, with patients describing the joint "grinding" or "catching" during specific shoulder motions.[20,22] Some correlation between shoulder symptoms and weather changes has been discussed.[21]

Unlike articular cartilage lesions of the knee, those in the glenohumeral joint are often diagnosed incidentally during arthroscopic assessment or management of other pathologies.[19] These lesions can be diagnosed using MRI when chondral injury is suspected.[23,24] However, studies have shown that both MRI and magnetic resonance arthrography can fail to accurately demonstrate glenohumeral lesions and have only fair interobserver reliability.[24,25] Denti et al[26] reported 60% accuracy and 87% sensitivity of MRI for diagnosing osteochondral lesions of the humeral head in patients with anterior shoulder instability. When seen on MRI, focal chondral defects appear as contour deformities with areas of abnormal signal intensity.[23] They may be adjacent to a Hill-Sachs lesion in patients with anterior shoulder instability.[23] Patients with an acute injury may demonstrate bone marrow edema in the underlying bone.[23]

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