OSTEOARTHRITIS OF THE GLENOHUMERAL JOINT

The patient is a 75-year-old lady presenting symptoms related to osteoarthritis of the glenohumeral joint. The signs and symptoms of glenohumeral osteoarthritis as presented by the patient includes:

Pain

 Pain in the shoulder is the main sign and symptom of glenohumeral osteoarthritis, which may occur either on the front or the back. Some individuals may experience excruciating pain when they are not moving the arm, and the pain can occur at any time of the day or night. The 75-year-old patient is therefore likely to experience difficulty in moving the hands due to pain in the shoulder and the writing. Osteoarthritis causes mild genu varum, which makes the shoulders unable to flex effectively (Schwerla et al., 2020 p. 28). Additionally, the symptoms of osteoarthritis of the glenohumeral joint normally worsen during cold days because of the severe pain; hence the patient will experience severe pain during cold days. Glenohumeral osteoarthritis causes gradual and progressive breakdown and dysfunction with the articular cartilage and other joint tissues (Veera et al., 2022 p.34). The patient experiences progressive pain in the shoulders as the pain progresses. The patient may have night pain due to a cold. For many patients with glenohumeral osteoarthritis, the pain is more intense when at rest, causing difficulty sleeping.

The patient is also likely to experience tenderness on the shoulder (Thomas et al. 2016, p. 205). The shoulder normally appears to swell, especially in the sagittal and coronal planes. The patient with osteoarthritis of the glenohumeral joint also experiences a lack of range of motion due to the severe pain, which contributes to the overall pain and tenderness on the shoulders. The tenderness and pain are essentially experienced during any significant motion of any range.

 As the pain and tenderness progress, the shoulder becomes stiffer, with the patient losing a hand motion. The loss of motion makes the individual unable to turn nor move the shoulder and, therefore, may rely on external assistance to move the shoulder, which may be painful (Campbell et al., 2012 p. 24).

Catching is another presentation of glenohumeral osteoarthritis, which causes an interruption in the movement, making the shoulder crunch. The patient is likely to experience shoulder weakness and muscle atrophy which causes the swelling of the shoulders. Due to the stiffness, the patient’s shoulder and surrounding bones and tissues are likely to become irritated and swell, causing pronounced pain (Schwerla et al. 2020 p.24). Cracking, clicking, and grinding may also be felt due to the stiffness and pain.

Evaluation on the osteopathic management options for patients with osteoarthritis of the Glenohumeral joint

Osteopathic management options for this patient with osteoarthritis are embedded in the different osteopathic philosophies and principles of the body being a unit with self-regulating and protecting mechanisms whose functions and structures are interrelated (Nicholas & Nicholas, 2008 p. 45). Osteopathic management also is a therapy that embeds all manipulative methods of treatment and osteopathic palpatory. The aim of osteopathic therapy for the patients is to increase the range of motion, relieve pain and inflammation, improve strength and flexibility along with helping the shoulder muscles relax, thus decreasing spasms (Mitchell, 2008, p.24). Additionally, osteopathic manual therapy will increase blood circulation in the shoulder by reducing pain and inflammation. Risk factors associated with glenohumeral joint osteoarthritis include shoulder injury, wrong repetitive movements, diabetes, and other health-related problems.

Anatomy, Physiology, and Pathophysiology of the Glenohumeral Joint Osteoarthritis

The upper arm bone forms the shoulder joint, and the humerus joins the scapula through the acromion. The shoulder comprises the rotator cuff, which includes tendons and muscles, and the bursa, a fluid sac that protects the rotator cuff. Strengths of the shoulder include the subscapularis, teres minor, infraspinatus, and supraspinatus (Ibounig et al. 2021 p. 356). Pressure in the workplace especially straining jobs like construction, welding, and working on computers for long hours likely to increase the development of osteoarthritis of the glenohumeral joint (Campbell et al. 2012 p24). The pain associated with the disorders is often described as an aching sensation most prevalent at night. The causes of glenohumeral joint osteoarthritis include the inflammation of the tendons and partial or complete tear at the rotator cuff part of the shoulder. The rotator cuff tear is highly influenced by age and general everyday activities. Therefore, in our patient’s case, the glenohumeral joint osteoarthritis is likely to be caused due to her age. Another cause for the disorder is the impingement of the rotator cuff, which occurs due to the inflammation-causing some fluid to form in the shoulder (Veera et al. 2020 p. 67). The liquid formed further causes the rotator tendon to be pushed further, reaching the bone causing more pain.

One of the early osteopathic management options for the patient is to rest and avoid putting pressure and overworking the shoulder. Rest makes the shoulder immobile, which is recommended for patients with glenohumeral joint osteoarthritis at least twenty-four hours. This will help the patient aggravate the pain and possible injury to the shoulder. However, if long-term rest is recommended for the patient, additional exercise would be prescribed to avoid atrophy, loss of shoulder movement, and related coordination.

The application of ice is another effective osteopathic management option for the patient. The application of ice on the affected part of the shoulder is a form of osteopathic therapy that reduces blood flow to the affected area (Schwerla et al., 2022 p. 27). Additionally, the ice constricts blood vessels, reducing blood flow and consequently reducing possible shoulder swelling. The application of ice on the shoulder involves wrapping the ice on a thin towel before putting it in contact with the skin. The direct application is likely to cause tissue damage and frostbite, especially given the patient’s old age. The ice should be put on the last for approximately ten to thirty minutes for effective results (D’ Amato & Rogers, 2012, p.76). However, the use of this osteopathic therapy requires being cautious by ensuring the patient’s health record is well known. Using this technique on the 75-year-old patient would require analyzing the patient’s health record to determine any underlying health issues like diabetes that may affect the patient’s blood flow and circulation. The use of ice therapy on patients with underlying health issues is likely to reduce their blood circulation, which may deteriorate their health.

Heat therapy is another effective osteopathic management option that can be applied to the patient after the inflammation has reduced. Heat can be used on the affected area for approximately twenty to thirty minutes at an interval of two to four hours, depending on the need. Heat contains analgesia, which is produced to relax the muscle spasms and nerve endings (Brantigham et al., 2011 p.340). Heat also reduces the synovial fluid viscosity, thus reducing the shoulder stiffness and facilitating motion. Additionally, heat increases the rate of blood flow and the process of vasodilation, thus ensuring that the affected part of the shoulder is supplied with adequate blood, leukocytes, oxygen, and enzymes. In addition to all these options, the patient should avoid anything or any activity that could aggravate the pain or inflammation in the affected area. The osteopathic therapist can also encourage the patient to exercise their affected muscle through the muscle energy technique, which helps contract the affected muscles (Veera et al., 2022 p. 7). The muscle energy technique effectively strengthens the patient’s muscles by reducing the swelling and numbness of the affected area (Santiago et al., 2022). With the guidance of the osteopathic therapist, the management options for patients with osteoarthritis can be effective. Osteopathic therapy encourages more effort on joint mobilization, which will increase blood flow on the affected area, decrease the pain, and ultimately promote movement (Mihara & Lee, 2015 p. 106).

References

Brantingham, J.W., Cassa, T.K., Bonnefin, D., Jensen, M., Globe, G., Hicks, M. and Korporaal, C., 2011. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. Journal of manipulative and physiological therapeutics, 34(5), pp.314-346.

Campbell, S.M., Winkelmann, R.R. and Walkowski, S., 2012. Osteopathic manipulative treatment: novel application to dermatological disease. The Journal of Clinical and Aesthetic Dermatology, 5(10), p.24.

D’Amato, K.E. and Rogers, M., 2012. “Frozen Shoulder”—A Difficult Clinical Problem. Osteopathic Family Physician, 4(3), pp.72-80.

Ibounig, T., Simons, T., Launonen, A. and Paavola, M., 2020. Glenohumeral osteoarthritis: an overview of etiology and diagnostics. Scandinavian Journal of Surgery, p.1457496920935018.

Mihara, T. and Lee, T.Q., 2015. Clinical outcomes of superior capsule reconstruction for irreparable rotator cuff tears without osteoarthritis in the glenohumeral joint. Journal of Shoulder and Elbow Surgery, 24(4), pp.e107-e109.

Mitchell, C. (2008). Management of shoulder disorders in primary care. HANDS ON-ARTHRITIS RESEARCH CAMPAIGN-, 14.

Nicholas, A.S. and Nicholas, E.A., 2008. Atlas of osteopathic techniques. Lippincott Williams & Wilkins.

Santiago, R.J., Esteves, J.E., Baptista, J.S., Magalhães, A. and Costa, J.T., 2022. Results of a feasibility randomised controlled trial of osteopathy on neck-shoulder pain in computer users. Complementary Therapies in Clinical Practice, 46, p.101507.

Schwerla, F., Hinse, T., Klosterkamp, M., Schmitt, T., Rütz, M. and Resch, K.L., 2020. Osteopathic treatment of patients with shoulder pain. A pragmatic randomized controlled trial. Journal of Bodywork and Movement Therapies, 24(3), pp.21-28.

Thomas, M., Bidwai, A., Rangan, A., Rees, J.L., Brownson, P., Tennent, D., Connor, C. and Kulkarni, R., 2016. Glenohumeral osteoarthritis. Shoulder & elbow, 8(3), pp.203-214.

Veera, S., Chin, J., Kleyn, L., Spinelli, S. and Tafler, L., 2020. Use of osteopathic manipulation for treatment of chronic shoulder injury related to vaccine administration. Cureus, 12(7).