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Review
. 2022 Oct 18;3(1):21-27.
doi: 10.1016/j.xrrt.2022.09.005. eCollection 2023 Feb.

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

Suleiman Y Sudah  1 , Mariano E Menendez  2 , Michael A Moverman  3 , Richard N Puzzitiello  3 , Dianne Little  4 , Allen D Nicholson  5 , Grant E Garrigues  2
Affiliations
Review

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

Suleiman Y Sudah et al. JSES Rev Rep Tech. .

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.

Keywords: Anterior shoulder joint capsule; Fibrosis; Glenohumeral osteoarthritis; Glenoid erosion; Pathogenesis; Thickening.

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Figures

Figure 1
Figure 1
Obligate posterior translation of the humeral upon external rotation of the glenohumeral joint as a consequence of anterior capsular tightness. (Reproduced with permission from Elsevier).
Figure 2
Figure 2
The “vicious cycle” of glenohumeral arthritis.
Figure 3
Figure 3
Central (A) and peripheral region (B) cartilage thickness and heat map (C). Central (D) and peripheral region (E) subchondral bone area and heat map (F). Central (G) and peripheral region (H) subchondral bone plate thickness and heat map (I) for zones 1-8 circumferentially around resected humeral heads. Black line P < .05 between zones. ∗ Central region significantly different from periphery, P < .0001. S, superior; A, anterior; I, inferior; P, posterior. (Reproduced with permission from Osteoarthritis Research Society International).
Figure 4
Figure 4
The influence of anterior capsule disease on central chondral wear of the humerus and end-stage glenohumeral osteoarthritis.
Figure 5
Figure 5
The anterior capsule (grasped with forceps) remains attached to the humerus, while the subscapularis has been completely dissected off.
Figure 6
Figure 6
The anterior capsule (grasped with a Kocher clamp) is fully separated from the subscapularis muscle, which is reflected medially with a Cobb elevator.
Figure 7
Figure 7
The resected capsule is held so the cross section can be seen. Note it is nearly 1 cm thick.
See this image and copyright information in PMC

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