Shoulder Articular Cartilage Injury
Articular cartilage is a complex, living tissue that lines the bony surface of the shoulder joint and completely surrounds the joint. Its function is to allow the shoulder bones to be separated from each other more than 2.5 cm., a requirement so that extreme range of motion, which is peculiar to the shoulder joint and is needed to perform activities of daily living as well as athletic endeavors, can take place.
Etiology
Articular cartilage injuries can occur as a result of either traumatic mechanical destruction, or progressive mechanical degeneration (wear and tear). With mechanical destruction, a direct blow or other trauma can injure the articular cartilage. Depending on the extent of the damage, and the location of the injury, it is sometimes possible for the articular cartilage cells to heal.
Articular cartilage has no direct blood supply; thus, is has little capacity to heal itself. If the injury penetrates the bone beneath the cartilage, the underlying bone supplies some blood to the area, improving the chance of healing. Occasionally an articular cartilage fragment breaks loose from the underlying bone. This chip, called a loose body, may float in the joint interfering with normal joint motion.
Symptoms
In many cases, a patient will experience shoulder swelling and vague pain. At this point continued activity may not be possible. If a loose body is present, words such as "locking" or "catching" are often used to describe the problem. With mechanical degeneration (wear and tear), the patient often experiences one or more of the following:
- Stiffness
- Decreased range of motion
- Joint pain
- Swelling
Diagnosis
The physician examines the shoulder, looking for decreased range of motion, pain along the joint line, fluid on the shoulder, abnormal ailment of the bones making up the joint, and ligament injury. Injuries to the articular cartilage are difficult to diagnose, and evaluation with MRI (magnetic resonance imaging) or arthroscopy may be necessary.
Home Treatment
For patients with osteoarthritis, non-surgical treatment consists of:
- Physical therapy
- Lifestyle modification (e.g. reducing activity)
- Shoulder bracing and supportive devices
- Oral and injection drugs (i.e., non-steroidal anti-inflammatory drugs)
- Cartilage protective drugs such as glucosamine.
Surgical options are very specific to osteoarthritis severity and can provide a reduction in symptoms that are generally only short lived.
Medical Treatment
When a joint is injured, the body releases enzymes that may further break down the already damaged articular cartilage. Injuries to the cartilage that do not extend to the bone will generally not heal on their own. Injuries that penetrate to the bone may heal, but the type of cartilage laid down is structurally unorganized and does not function as well as the original articular cartilage.
Defects smaller than 2cm have the best prognosis and treatment options. These options include arthroscopic surgery using techniques to remove damaged cartilage, and increase blood flow from the underlying bone. For larger defects, it may be necessary to transplant cartilage from other areas of the joint.
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