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Glenohumeral Arthritis Classifications

  1. Glenoid morphology in OA: Walch classification
  2. OA with massive rotator cuff tears: Favard classification
  3. Cuff Tear Arthropathy: Seebauer Classification
  4. Cuff Tear Arthropathy: Hamada Classification
  5. Glenoid erosion in cuff tear arthropathy: Sirveaux Classification
  6. Dislocation arthropathy of the shoulder: Samilson & Prieto Radiological Classification
  7. Stages of Glenoid wear in RA: Levigne and Franceschi Classification
  8. Stages of Humeral head wear in RA: Levigne and Franceschi Classification
  9. Radiological classification of shoulder RA: Levigne and Franceschi Classification
  10. Radiological classification of RA: Larsen Classification
  11. Avascular necrosis of humeral head: Neer’s Classification
  12. Extent of AVN of the Humeral head: Hattrup and Cofield Classification


Glenoid morphology in OA: Walch classification
Walch G et al, J Arthroplasty, 14:756-760, 1999

Type A: Humeral head centered       
    A.1- minor erosion
    A.2- major erosion

Type B: Humeral head subluxed posteriorly
    B.1- posterior joint space narrow, subchondral sclerosis
                     and osteophytes
    B.2- Retroverted glenoid with posterior rim erosion

Type C: Glenoid retroversion > 25 degrees regardless of erosion


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OA with massive rotator cuff tears: Favard classification
Favard et al, OA with massive RCT: the limitations of its current definitions. In: The Cuff, edited by Gazielly D, Elsevier, 1997

Group 1: Humeral head migrated upward,
      superior gleno-humeral space narrow,
      acromion shaped by humeral head imprint

Group 2: Central gleno-humeral space narrowing,
      No change in acromion shape

Group 3: Gleno-humeral joint space narrowing minimal,
      Bony destruction / lysis of acromion or humeral head


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Cuff Tear Arthropathy: Seebauer Classification
Visotsky, Seebauer et al, JBJS-A, 86-A: 35-40, 2004

Type 1A - Centered stable, Minimal superior migration,
               C-A arch acetabularization

Type 1B - Centered medialized, Minimal superior migration,
              medial glenoid erosion, C-A arch acetabularization

Type 2 A - Decentered limited stable, superior translation,
               superior-medial erosion
               significant C-A arch acetabularization

Type 2 B - Decentered unstable, anterior superior escape,
                C-A arch and anterior structures deficient


Cuff Tear Arthropathy: Hamada Classification
Hamada et al, CORR, 254: 92-96, 1990

Grade 1: AHI > 6mm

Grade 2: AHI 5mm or less

Grade 3: Grade 2 with acetabularization of acromion
(concave deformity of acromion undersurface)

Grade 4: Grade 3 changes with narrowing of gleno-humeral joint

Grade 5: Bony destruction- humeral head collapse

(AHI: Acromio- Humerus Interval)

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Glenoid erosion in cuff tear arthropathy: Sirveaux Classification
Sirveaux et al, JBJS (B), 86: 388-3985, 2004

E0: Humeral head migration without glenoid erosion
E1: Concentric glenoid erosion
E2: Superior glenoid erosion
E3: Inferior glenoid erosion

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Dislocation arthropathy of the shoulder:
Samilson & Prieto Radiological Classification

Mild Arthrosis: inferior humeral and/or glenoid exostosis < 3mm in height

Moderate Arthrosis: inferior humeral and/or glenoid exostosis
           measuring  3mm to 7mm
           slight gleno-humeral irregularity

Severe Arthrosis: inferior humeral and/or glenoid exostosis
        measuring > 7mm
        gleno-humeral joint narrowing and sclerosis

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Stages of Glenoid wear in RA: Levigne and Franceschi Classification
Levigne and Franceschi, In: Shoulder Arthroplasty, Edited by Walch and Boileau, 221-230.

Stage 1: Subchondral bone intact or minimally deformed
Stage 2: Erosion reaching the base of coracoid
Stage 3: Erosion going beyond the base of coracoid

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Stages of Humeral head wear in RA: Levigne and Franceschi Classification
Levigne and Franceschi, In: Shoulder Arthroplasty, Edited by Walch and Boileau, 221-230.

Stage 1: Subchondral bone intact
Stage 2: Anatomical neck deformed by notch > 10mm
Stage 3: Loss of spherical form of the head


Radiological classification of shoulder RA: Levigne and Franceschi Classification
Levigne and Franceschi, In: Shoulder Arthroplasty, Edited by Walch and Boileau, 221-230.

Ascending form: Most frequent, upward migration of head humerus,
                  Head retains sphericity, Head initially ascends then medialises,
                 inferior glenoid notches the humeral neck at late stage

Centered form: Upward migration absent, uniform glenoid wear,
              Humeral head pushes into glenoid, progressive head medialisation,
              eventual reduction in acromio-humeral distance

Destructive form: Destruction of humeral head, loss of sphericity
        notching of humeral neck, simultaneous glenoid destruction


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Radiological classification of RA: Larsen Classification
Larsen et al, Acta Radiol Diagn, 18:481-491, 1977

Grade 0: Normal conditions, marginal bone deposits

Grade 1: Slight abnormality, peri-articular soft tissue swelling, osteoporosis or Joint space narrowing

Grade 2: Definite early abnormality, erosion and joint space narrowing present, erosion obligatory except in weight bearing joints

Grade 3: Medium destructive abnormality, erosion and joint space narrowing present, erosion obligatory in all joints

Grade 4: Severe destructive abnormality, erosion and joint space narrowing present, bone deformation in weight bearing joints

Grade 5: Mutilating abnormality, gross bony destruction, dislocation and ankylosis

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Avascular necrosis of humeral head: Neer’s Classification
Neer II CS, In : Shoulder Reconstruction, Edited by Neer II CS, 143-271, 1990

Stage 1: Subtle changes, picked up on MRI
    Head retains shape, subchondral calcification, pain may be present

Stage 2: Pain present, severe
    Articular surface appears intact ,can be indented on pressure
    Meniscus sign on radiographs- area of subchondral collapse

Stage 3: Wrinkled/ loose articular cartilage, wedge shape area of subchondral
    collapse    articular flap, pain ++, step off deformity on x-ray, glenoid normal

Stage 4: Incongruous humeral head, glenoid involvement, secondary arthritis
    posterior subluxation, osteochondral loose bodies

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Extent of AVN of the Humeral head: Hattrup and Cofield Classification
Hattrup et al, JSES, 8: 559-564, 1999

Group 1: Less than one quarter head involved
Group 2: Between one quarter to one half head involved
Group 3: Between one half and three quarters head involvement
Group 4: More than three quarters head involvement
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