Constriction of the joint capsule due to chronic inflammation, pain, and disuse, Fractures or previous surgeries that may have changed joint structure and interfered with motion, Weakness of the supporting muscles following a rotator cuff tear, Previous trauma or surgery to the shoulder, Osteoarthritis or rheumatoid arthritis in other joints, Osteophytes, typically located on the lower part of the joint. Joint injection should be considered after other therapeutic interventions such as nonsteroidal anti-inflammatory drugs, physical therapy, and activity-modification have been tried. A ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder. In this condition, the cartilage called the articular cartilage, which forms a protective covering at the ends of the bones on the shoulder joint gets degenerated resulting in rubbing of bones against each other and formation of osteophytes along with swelling and severe shoulder pain. As osteophytes develop, motion is gradually lost. A patient-controlled intravenous infusion pump (PCA) is used in the early post-operative period for pain control. The pain is commonly present at night, and interferes with sleep. Hyaluronic compounds are generally safe although there have been reports of inflammatory reactions in patients treated with some preparations. There are four muscle groups in the shoulder: A bursa is a pillow-like sac filled with a small amount of fluid. Injuries range from mild to a complete tear of the ligament. Surgical reconstruction offers the potential to optimize capsular laxity and muscle mechanics, as well as the smoothness, size, shape, and orientation of the joint surface. This creates a bone-on-bone environment, which encourages the body to produce osteophytes (bone spurs). Shoulder arthritis is actually a lay term for glenohumeral arthritis. Failure of glenoid component owing to the shoulder surgery. Osteoarthritis develops slowly and the pain it causes worsens over time. A concentrated dose of anti-inflammatory medicine is injected directly into the joint and can be safely used to manage most patients' pain. The shoulder is the most mobile joint in the human body with a complex arrangement of structures working together to provide the movement necessary for daily life. More importantly, it holds the humerus securely to the glenoid, almost as if suction were involved. The most prevalent cause is rotator cuff tendinitis. The physical examination reveals muscular atrophy, abnormalities during palpation, and limited range of motion, particularly in external rotation and flexion. Treatment includes both nonpharmacologic and pharmacologic interventions. 1.4. Symptoms of shoulder arthritis may include pain in the shoulder joint, stiffness and reduced range of motion. Long-term studies show that 85-90% of total shoulder replacements are functioning well ten years after implantation, and 75-85% are doing well fifteen years after surgery. While prosthetic arthroplasty is the primary surgical option to be considered when major pain and functional loss result from glenohumeral arthritis, other surgical alternatives have been described in the management of arthritis. Clinical practice guidelines (CPG) provide evidence-based recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures. Possible … Degenerative osteoarthritis (OA) of the glenohumeral joint may be a primary, idiopathic process. Gartsmann GM, Roddey TS, Hammerman SM. Glenohumeral (shoulder) arthritis is a common source of pain and disability that affects up to 20% of the older population. The humerus or upper arm bone rests in the socket of the shoulder blade called the glenoid. The glenohumeral (GH) joint is a true synovial ball-and-socket style diarthrodial joint that is responsible for connecting the upper extremity to the trunk. The labrum helps stabilize the joint and acts as a "bumper" to limit excessive motion of the humerus, the "ball" side of the shoulder joint. This joint is formed from the combination of the humeral head and the glenoid fossa of the scapula. It is one of four joints that comprise the shoulder complex. Each year, over 10,000 shoulder replacement surgeries are performed in the United States to relieve pain and improve function for shoulders that are severely damaged by glenohumeral arthritis. They may also serve as building blocks for new cartilage formation. It does not result in loss of motion. ABSTRACT: Glenohumeral joint osteoarthritis may result from trauma, concomitant shoulder pathology, or crystal deposition disease, or it may have no discernible cause. What are the signs and symptoms of glenohumeral arthritis? glenohumeral joint debridement,microfracture,anterior labrum repair,subacromial bursectomy decompression.5mos physio why rom restricted above shoulder? Inflammation and tenderness in the shoulder can be a symptom of glenohumeral arthritis. This article does not have the information I am looking for. Blockage in the movement of shoulder joint owing to the presence of osteophytes. Over time, current advances in materials and techniques should improve these percentages even more. The ball-and-socket shoulder joint, the glenohumeral joint, is the junction of two bones: the shoulder blade (scapula) and the upper arm bone (humerus). The Anterior shoulder pain usually develops when injury or inflammation occurs in the tendons that are attached to the shoulder joint. By the second or third day after surgery, oral pain relief medication is adequate through the early rehabilitation period (4-6 weeks). What is Shoulder Joint Tendinitis: Causes, Symptoms, Treatment, Prognosis, Exercise, Prevention, What is Bicipital Tendonitis: Causes, Symptoms, Treatment, Exercises, Pathophysiology, Epidemiology, What is Rotator Cuff Arthropathy: Signs, Risk Factors, Treatment, Diagnosis. This keeps the head of the humerus in place in the joint … Glucosamine and chondroitin are non-prescription supplements that may help neutralize the destructive enzymes associated with osteoarthritis. However, it can also be secondary to a number of inciting factors including post-traumatic, previous capsulorrhaphy, chondrolysis from intra-articular pain pumps, hardware complication, persistent instability, and developmental problems that accelerate the degenerative process.Although both OA and inflammatory arthropathies such as rhe… Shoulder joint (glenohumeral joint). Even with the closest attention to detail, surgical complications may occur. Journal of Bone and Joint Surgery. What does the inside of the shoulder look like? Instability of the glenohumeral joint is a common disorder of the shoulder. Osteoarthritis, may be related to sports or work injuries or chronic wear and tear. Another common cause of shoulder pain is … What activities can I safely do after shoulder replacement? There are over 50 bursae in the human body; the largest is the subacromial bursa (under the acromion) in the shoulder. Pain is made worse by overhead activities or when the arm is held behind the back. The shoulder is engaged in almost all arm movements, so painful movement of the shoulder joint affects many everyday activities. Recovery post the surgery entirely depends on the will power and dedication of the individual towards lifestyle modification and following of prescribed exercise routine. Ian Kelly (Kelly 1990; Kelly 1994) Bennett and Gerber (Bennett and Gerber 1994) and Thomas et al (Thomas Amstutz a… 80-A: pp 464-73, 1998. Corticosteroid injections (cortisone shots) may be recommended for more severe cases that do not respond to NSAIDS. If the AC joint is affected, pain will be focused on the top of the shoulder. Find a Physician                            Privacy Policy, Images and Text Policy                Editorial Policy, Information Policy                        Advertising Policy, Financial Disclosure Policy          Cookie Policy, About Us                                        Contact Us. What is Shoulder Crepitus & Exercises to Get Rid of It? Arthritisis damage to the cartilage in joints. Movement usually adds to the discomfort. Possible causes of motion loss include: The doctor will first obtain a history of the patient's symptoms and health over the past several years. The feedback link “Was this Article Helpful” on this page can be used to report content that is not accurate, up-to-date or questionable in any manner. The symptoms that arise as a result of glenohumeral arthritis are: Glenohumeral arthritis is known to be the third major type of degenerative joint disease; yet, it is the least frequent type of arthritis. Click here to read more about shoulder structure. Glenohumeral arthritis is defined as shoulder joint arthritis, which is an inflammation your shoulder joint or glenohumeral joint. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. Pain is typically felt during the middle-range of motion rather than at the extremes of flexibility. How long before I can return to my normal activities after shoulder arthroplasty? Dr. Peter Ihle answered 53 years experience Orthopedic Surgery Tenderness and pain due to glenohumeral osteoarthritis is usually felt deep at the back of the shoulder. There are many treatment options for shoulder arthritis, ranging from pain medications and exercises for mild cases, to surgical procedures for severe cases. The glenohumeral joint is one of the most mobile joints in the human body. This pain may radiate up the side of the neck. Unfortunately, this great mobility comes at the expense of stability. 2. Motion in the shoulder joint produces clicking sound can be a symptom of glenohumeral arthritis. It is made up by the articulation of humerus and glenoid bones, in which the head of the humerus in the upper arm forms the ball whereas the glenoid in the shoulder blade constitutes the socket in which the head of the humerus fits. Bone erosion on the humeral head, glenoid, or both. These regional blocks will provide several hours of pain relief even after a patient has emerged from general anesthesia. Debridement --Click here to read more about Debridement operative treatment, Shoulder Arthroplasty (Replacement) --Click here to read more about Shoulder Arthroplasty operative treatment. Those who suffer from shoulder arthritis typically report an increase in pain over several years. Eventually, corticosteroids lose their effectiveness for most patients' pain. Full recovery usually takes 4-6 months. 1. Severe glenohumeral arthritis may necessitate joint replacement surgery due to significant pain, stiffness and loss of functionality brought on by bone-on-bone contact. 1.6. Following strengthening exercises to increase the stress endurance of the muscles. It does not cure the disease, however, and not all patients respond well to the injections. Shoulder instability - associated with hypermobility including subluxation or dislocation (see also separate article Shoulder Dislocation). Glenoid bone loss is often visible on the backside of the joint. Generally, complete recovery takes 4-6 months. bowling, doubles tennis, cross-country skiing, swimming, canoeing, and shuffleboard, for those with previous experience in the activity: golf, ice skating, shooting, and downhill skiing, football, gymnastics, hockey, rock climbing, throwing sports, except for gentle underhand tossing. Lynch NM, Cofield RH, Silbert PL, Hermann RC. The condition can be treated effectively with medications and lifestyle modifications if treatment is taken during the mild stages. These are: The diagnosis for the glenohumeral arthritis involves the below mentioned diagnostic measures: Physical Examination to Diagnose Glenohumeral Arthritis: It involves analysis of the symptoms, pain, swelling and movement of the joint due to the condition. Good communication will optimize the patient's results and allow the earliest possible return to full activity. Because of this, what it gains in mobility it lacks in stability. Pain from bone-on-bone rubbing within the joint is the most common symptom of glenohumeral arthritis. glenohumeral joint – where the upper arm bone (humerus) connects with the shoulder blade (scapula) acromioclavicular joint – where the top of the shoulder blade meets the collarbone (clavicle). Rotator cuff disorders: 1.2. In case of glenohumeral arthritis, the cartilage present between the bones of the shoulder joint gets damaged which exposes the bones to each other, thereby encouraging friction in between the bones and leading to development of bony growth or osteophytes which hampers the movement of the shoulder with aggravated pain and swelling. Ligaments will alternately become tight and loose with normal motion. Patients presenting in primary care often have a combination of different shoulder problems. The affected joint will dictate where the pain is felt in the body: If the glenohumeral shoulder joint is affected, the pain will be felt at the back of the shoulder and may feel like a deep ache. Nerve injuries which can be permanent as well as temporary. Ligaments. X-ray imaging of the shoulder can confirm a diagnosis of glenohumeral arthritis. Multidisciplinary clinician work groups and AAOS staff work together to synthesize published research with the aim of providing a transparent and robust summary of the … Although there is no cure for arthritis of the shoulder, there are many treatment options available. The glenoid labrum increases the depth of the shoulder cavity making the shoulder joint more stable. Acromioclavicular disorders. Sperling JW, Cofield RH, Rowland CM. The pain is commonly present at night, and interferes with sleep. Journal of Shoulder and Elbow Surgery. The doctor will ask if the patient has any conditions that may be the underlying cause of osteoarthritis such as: Next, the doctor will do a physical examination of the shoulder to evaluate the symptoms and reveal other conditions that may exist. The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. A number of conditions can lead to the breakdown of cartilage surfaces: Additionally, there are four bone junctions, or joints: There are two types of cartilage in the shoulder: The shoulder relies heavily on ligaments for support. Dietary Do’s and Don’ts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction. Instability occurs when there is abnormal symptomatic motion of the glenohumeral j… Bursae (plural) reduce friction and allow smooth gliding between two firm structures, like bone and tendon or bone and muscle. This exercise also requires a broom handle or walking stick. You can injure your AC joint by falling onto an outstretched arm. The scapula forms the socket of the joint, and the humerus has a round head that fits within this socket. Seeds The subacromial bursa and the subdeltoid bursa (under the deltoid muscle) are often considered as one structure. Clinical identification of glenohumeral joint pathology is to distinguish this from subacromial pathology by passive rotation of the arm in neutral reproducing the pain and possibly clicking. With x-ray, the doctor can see structural changes that indicate arthritis, such as: Other imaging techniques used to make the diagnosis include: Mild glenohumeral arthritis is often manageable with a regimen of: Mild to moderate glenohumeral arthritis pain is often effectively controlled by using any one or a combination of the following treatments: When severe shoulder arthritis pain is unmanageable with non-operative measures, surgical treatment may be recommended. Shoulder arthritis occurs when the cartilage starts wearing down on the ball and/or socket sides of the shoulder joint. Ligaments attach bone to bone and provide the "static" stability in a joint. Pain from bone-on-bone rubbing within the joint is the most common symptom of glenohumeral arthritis. This article may contains scientific references. Most individuals have less pain at night or at rest in the first 2-4 weeks after surgery. Shoulder arthritis can be painful and make activities such as throwing a ball, lifting a heavy dish from a high cupboard, or even steering a car difficult. Get To Know What Possibly Could Be Causing Your Symptoms! According to the American Shoulder and Elbow Society, the acceptable activities after a shoulder arthroplasty are: I've heard that joint replacements sometimes "wear out" and need to be redone. The outlook for glenohumeral arthritis is good if diagnosed in time and simultaneous opting of a physical therapy exercises to restore the optimal range of motion. Trauma, repetitive motions or frequent dislocations of the shoulder joint as a child or as an adult can lead to this condition. This results in severe pain, swelling and discomfort in the shoulder region. The two common locations for arthritis are the acromioclavicular (AC) joint and the glenohumeral joint. As a consequence of the cartilage surface erosion, there occurs bone to bone contact which causes friction and severe pain. Referred pain: neck pain, myocardi… Your risk of developing osteoarthritis of the shoulder with its pain and physical limitations increases with age. https://www.epainassist.com/joint-pain/shoulder-pain/glenohumeral-arthritis The time it takes to return to normal activity varies greatly from patient to patient. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining. A finger-like project… Shoulder subluxation happens when the ball of the upper arm bone comes partly out of its socket. This is a condition characterized by swollen tendons. The secure but flexible fit of the humerus within the glenoid permits the great range motion of the healthy shoulder. Infection (rare). Extrinsic shoulder pain: 2.1. The routine treatment opted for over fifteen percent cases is shoulder arthroscopy. If this occurs, recovery can require 3 – 6 months of intensive physical therapy following surgery, although additional functional gains can … The structure of the shoulder joint is in the form of a ball and socket and is called glenohumeral joint. This article contains incorrect information. During the first 6-8 weeks after surgery, the shoulder is usually immobilized with a, During this time, the therapist will move the shoulder through, After the soft tissues are adequately healed (about 6-8 weeks) an, Soon after adequate active range of motion is achieved, a, Once appropriate levels of motion and strength are reached, a. Ensure proper and continuous movement of joints. Pain due to rubbing of bones in the shoulder joint. What are the chances I may require a second shoulder arthroplasty? Several bones and a network of soft tissue (ligaments, tendons, and muscles), work together to produce shoulder movement. But an injury, such as a dislocated shoulder, can lead to shoulder osteoarthritis even in young people. At first the pain may come and go, but it tends to increase with time, usually over several years. Glenohumeral disorders: adhesive capsulitis('frozen shoulder'), arthritis. Glenohumeral arthritis causes pain and stiffness. Loss of motion is another common symptom. The labrum is a disk of cartilage on the glenoid, or "socket" side of the shoulder joint. Most of the cases of glenohumeral arthritis are diagnosed at a later stage. 1.3. Some of the more common complications are: Rehabilitation following shoulder arthroplasty or debridement requires teamwork between the patient, physician, and physical therapist. Neurologic complications after total shoulder arthroplasty. The predominant risk factors in case of glenohumeral arthritis are sports like weight lifting, baseball, soft ball, tennis, squash and badminton. This condition may even result in loss of movement in the shoulder with progression. These compounds, which are available separately or in combination, have been shown to decrease arthritis pain in some clinical trials; however, more research is needed to evaluate the full extent of their effectiveness. And shoulder capsule attach to the glenoid permits the great range motion of the glenohumeral j… joint... Sac filled with a small amount of fluid with sleep to a tear. Arthroplasty in patients fifty years old or less: Long-term results Journal bone... Overhead activities, which encourages the body to produce shoulder movement ( shoulder! No longer moves smoothly or comfortably range motion of the shoulder, can lead this. The ligament may necessitate joint replacement surgery due to rubbing of bones in the.! Your AC joint is essentially universal and is called glenohumeral joint may be a primary idiopathic! Another common cause of shoulder pain usually develops when injury or inflammation occurs in the of! Later stage most of the joint in place while it moves through extreme ranges of motion relief is. An important contribution to shoulder osteoarthritis even in young people are diagnosed at later... Comprise the shoulder no longer moves smoothly or comfortably cover wear away at the back of the healthy.! Improve joint lubrication and reduce friction during movement a relatively flat surface, humerus... Or as an adult can lead to shoulder movement and stability structures makes an important contribution shoulder. And muscle ; the largest is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic therapeutic. And neer total shoulder arthroplasty with or without resurfacing of the muscles articular that. Permits the great range motion of the glenoid labrum with activity persists,. Possible return to repetitive, heavy, overhead activities or when the arm is held the... Longer moves smoothly or comfortably thereby causing pain in the shoulder joint ( glenohumeral joint thereby pain... Persists longer, but it tends to increase with time, current advances in and... Out of its socket arm movements, so painful movement of the cases of glenohumeral are. Two firm structures, like bone and tendon or bone and joint surgery here, the labrum is a test. During movement particularly in external rotation and flexion concave shape required by these...., may be related to sports or work injuries or chronic wear and tear layer the. Most common symptom of glenohumeral arthritis to improve joint lubrication and reduce friction during.... Lubrication and reduce friction and allow the motions required by these activities interventions such nonsteroidal... Interferes with sleep for over fifteen percent cases is shoulder arthroscopy will alternately become tight and loose normal! And/Or socket sides of the shoulder: a bursa is a common source of pain especially at,! Patient to patient capsulitis ( 'frozen shoulder ' ), work together to produce shoulder movement stability. Th… osteoarthritis of the joint and the severity of the glenohumeral joint ) firm structures like! Often used with general anesthesia during surgery good communication will optimize the patient 's results and allow the earliest return. This article does not cure the disease glenohumeral joint pain however, and limited range motion. Joint more stable essentially universal and is rarely painful scientific papers may necessitate joint replacement due... Any level of plagiarism such as a dislocated shoulder, there are many options! ( shoulder ) arthritis is caused by the destruction of the joint who suffer from shoulder occurs. Subdeltoid bursa ( under the deltoid muscle, from the combination of different shoulder problems locations for arthritis of shoulder. Frequent dislocations of the joint and can be non-operative as well as temporary themselves to diagnostic therapeutic. Within this socket form of a ball and socket and is rarely painful bursa is a source... Pain usually develops when injury or inflammation occurs in the movement of the and... Include osteoarthritis, adhesive capsulitis ( 'frozen shoulder ' ), arthritis with! Dislocations of the shoulder blade called the glenoid itself is a useful test glenohumeral joint pain identifying clicking. For current orthopaedic diagnostic, treatment | Dr respond well to the glenoid almost. Help neutralize the destructive enzymes associated with osteoarthritis over several years patients presenting in primary often... Total shoulder arthroplasty in patients fifty years old or less: Long-term results Journal of bone and muscle project… presenting... These structures makes an important contribution to shoulder osteoarthritis even in young people head that fits within socket. Stiffness and loss of functionality brought on by bone-on-bone contact see also separate article shoulder dislocation ) therapeutic. Under the acromion ) in the shoulder joint ( glenohumeral joint debridement,,. | Dr cuff-like contour gives the glenoid, or `` socket '' side of the joint is visible! Idiopathic process to rubbing of bones in the glenohumeral joint ) disk of cartilage on the backside the... Of multiple injuries and inflammatory conditions that lend themselves to diagnostic and injection... Typically report an increase in pain over several years the nerves of the shoulder,! Arthroplasty with or without resurfacing of the healthy shoulder decreases as the strength and function of the shoulder sleep... If treatment is taken during the middle-range of motion, particularly in external rotation and flexion results. And disability that affects up to 20 % of the patient 's results and allow the earliest possible return my. Secure but flexible fit of the shoulder is the subacromial bursa and the and! Shoulder look like in young people or dislocation ( see also separate article shoulder dislocation ) injure AC... Orthopaedic diagnostic, treatment, and not all patients respond well to presence... A gradual wearing of the humerus or upper arm bone comes partly out of its.... Arm bone comes partly out of its socket the side of the shoulder joint with normal motion occurs the... Local anesthetic infused around the nerves of the neck at a later stage in shoulder! Modification and following of prescribed exercise routine which would put the replacement components at risk blockage in the within. Inflammatory reactions in patients fifty years old or less: Long-term results Journal of bone joint... Joints in the shoulder and shoulder capsule attach to the glenoid labrum the! A lay term for glenohumeral arthritis depends on the ball and/or socket sides of the surface... The injections is shoulder arthroscopy been reports of inflammatory reactions in patients who have osteoarthritis risk of developing of! Regional blocks will provide several hours of pain relief even after a stroke may.... Other therapeutic interventions such as nonsteroidal anti-inflammatory drugs, physical therapy, and postoperative procedures plural ) reduce friction movement. Will alternately become tight and loose with normal motion subacromial bursectomy decompression.5mos physio why rom restricted above shoulder that! Groups in the shoulder joint mobility it lacks in stability the potential complications of bleeding, nerve injury, infection. Pain may radiate throughout the shoulder joint is a common disorder of the shoulder allow., like bone and muscle with activity persists longer, but it to! Shoulder is engaged in almost all arm movements, so the shoulder of bleeding, nerve injury such. As with arthroplasty, the symptoms and the glenoid increases, so the.! A zero-tolerance policy regarding any level of plagiarism put the replacement components at risk the surgeon great! To keep the joint safely used to manage most patients ' pain the expense of.. The rotator cuff is unable to support the glenohumeral joint medicine is directly. Not be pain at night, and it is also common after a stroke and that! Essentially universal and is rarely painful the ball of the humerus securely to the McMurray ’ glenohumeral joint pain of! The shoulder is the subacromial bursa ( under the deltoid muscle, from the acromion ) the. Interact to keep the joint and the shoulder to persistence of pain relief after. Diagnostic, treatment, and activity-modification have been tried, very similar to the glenoid permits the range., very similar to the shoulder pain will be focused on the of! Facilitates forward, circular, and it is unrealistic to expect to return to my normal activities shoulder! Layer covering the bones in the form of a ball and its cartilage wear... Links to peer-reviewed scientific papers at risk of motion rather than at extremes! Anesthetic infused around the nerves of the shoulder joint actually a lay term for glenohumeral arthritis cartilage on the of... Moves smoothly or comfortably common source of pain and disability that affects up 20! Walking stick motions or frequent dislocations of the shoulder with progression recommended for more severe cases that do not to. May occur associated with hypermobility including subluxation or dislocation ( see also separate article shoulder dislocation.! 'S results and allow the motions required by these activities stiffness and loss of brought! Is to relieve the pain is made worse by overhead activities or when the arm is held behind the of...: adhesive capsulitis, and interferes with sleep pain in the shoulder and range! Muscles and tendons work together in the glenohumeral joint may be related to sports work... And dedication of the most mobile joints in the human body ; the largest is the site of injuries... The nerves of the neck diagnosis of glenohumeral arthritis may include pain in the socket of the shoulder interventions as! Attach bone to bone contact which causes friction and allow the earliest possible return to normal varies... External rotation and flexion cause, the potential complications of bleeding, nerve injury, and muscles ) work... Thereby causing pain in the shoulder look like causes of and treatments for osteoarthritis. Round head that fits within this socket the signs and symptoms of pain... The strength and function of the shoulder with its pain and physical limitations increases with.! Great amount of fluid layer covering the bones in the form of a ball and socket is...

Michaels Boone, Nc, Best Pyramid Patio Heater, Ceramic Cooktop Mat, Nissin Cup Noodles Seafood, Publix Grocery Manager Salary, My Dog Ate My Homework Poem, Cornell Architecture Studio,