Comprehensive Arthroscopic Management of Shoulder Arthritis

      Abstract: Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification, anti-inflammatory medications, physical therapy, and injections, is exhausted, surgical treatment ranging from simple debridement to arthroplasty is commonly offered. Given concerns regarding arthroplasty implant longevity, there is an interest in joint-preserving procedures. In this difficult population, the authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. CAM consists of the combination of arthroscopy, glenohumeral chondroplasty, synovectomy, loose body removal, microfracture, capsular release, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, and biceps tenodesis. Key perioperative care includes the use of regional nerve blocks to allow immediate physical therapy with the goal of restoring range of motion by 4 to 6 weeks with strengthening beginning at 6 to 12 weeks and return to full activities at 4 to 6 months. Although this is still considered a bridging procedure, the literature has reported 92% survival at 1 year, 85% survival at 2 years, 77% survival at 5 years, and 63% survival at 10 years. Predictors of failure of the CAM procedure include joint space <2 mm, flattening of the humeral head, and abnormal posterior glenoid morphology. Patient selection and education is therefore essential for optimizing outcomes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cheung E.V.
        • Sperling J.W.
        • Cofield R.H.
        Revision shoulder arthroplasty for glenoid component loosening.
        J Shoulder Elbow Surg. 2008; 17: 371-375
        • Deshmukh A.V.
        • Koris M.
        • Zurakowski D.
        • Thornhill T.S.
        Total shoulder arthroplasty: Long-term survivorship, functional outcome, and quality of life.
        J Shoulder Elbow Surg. 2005; 14: 471-479
        • Deutsch A.
        • Abboud J.A.
        • Kelly J.
        • et al.
        Clinical results of revision shoulder arthroplasty for glenoid component loosening.
        J Shoulder Elbow Surg. 2007; 16: 706-716
        • Williams B.T.
        • Beletsky A.
        • Kunze K.N.
        • et al.
        Outcomes and survivorship following arthroscopic treatment of glenohumeral arthritis: A systematic review.
        Arthroscopy. 2020; 36: 2010-2021
        • Millett P.J.
        • Gaskill T.R.
        Arthroscopic management of glenohumeral arthrosis: Humeral osteoplasty, capsular release, and arthroscopic axillary nerve release as a joint-preserving approach.
        Arthroscopy. 2011; 27: 1296-1303
        • Mitchell J.J.
        • Horan M.P.
        • Greenspoon J.A.
        • Menge T.J.
        • Tahal D.S.
        • Millett P.J.
        Survivorship and patient-reported outcomes after comprehensive arthroscopic management of glenohumeral osteoarthritis: Minimum 5-year follow-up.
        Am J Sports Med. 2016; 44: 3206-3213
        • Millett P.J.
        • Horan M.P.
        • Pennock A.T.
        • Rios D.
        Comprehensive Arthroscopic Management (CAM) procedure: Clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis.
        Arthroscopy. 2013; 29: 440-448
        • Mitchell J.J.
        • Warner B.T.
        • Horan M.P.
        • et al.
        Comprehensive arthroscopic management of glenohumeral osteoarthritis: Preoperative factors predictive of treatment failure.
        Am J Sports Med. 2016; 45: 794-802