Dislocation
arthropathy describes the development of progressive degenerative changes of the glenohumeral joint in the setting of instability. Although the specific etiology remains unclear, the
trauma of a single dislocation, repetitive injury associated with recurrent dislocations, changes in shoulder biomechanics, and complications associated with instability surgery have all been implicated in its development.
Pain and restricted range of motion are the most common patient complaints.
Conservative management, consisting of
pain control, activity modification, and
physical therapy, is the first-line treatment after the development of
arthropathy. If
conservative management fails, multiple surgical options exist. Arthroscopic débridement can be attempted in young, active patients and in those patients with mild-to-moderate
arthropathy. Open subscapularis lengthening and
capsular release can be done in patients with prior instability repairs that are overly tight. In young patients with minimal bone loss and glenoid wear, surface
replacement arthroplasty and
hemiarthroplasty are surgical options. In older patients with moderate-to-severe
arthropathy, total shoulder or reverse shoulder
arthroplasty is the preferred treatment option. Further study is needed to better predict which patients will develop dislocation
arthropathy and will thus benefit from early surgical intervention.