Surgical Considerations in Rheumatoid Arthritis of the Shoulder

Patients with rheumatoid arthritis and intractable shoulder pain present unique challenges to the orthopedic surgeon. The inflammatory process affects not only the articular surfaces, but causes significant damage to the soft tissue restraints as well. Depending on the stage of the disease and the status of the rotator cuff musculature, various surgical options, including synovectomy, bursectomy, and shoulder arthroplasty, may be indicated. Total shoulder arthroplasty has demonstrated superior long-term results in glenohumeral arthritis with an intact rotator cuff. Hemiarthroplasty and humeral resurfacing are typically reserved for cases of poor glenoid bone stock or massive, irreparable rotator cuff tears. Reverse shoulder arthroplasty may have a role in these cuff-deficient cases but glenoid fixation in end-stage cases remains a challenge.