Saturday, September 22, 2012

An unusual course after a ream and run with a happy ending.

A 60 year old man who desires to get back to handball elects to have a ream and run on his arthritic left shoulder.
All seemed to have gone perfectly at surgery (July 2010) with a benign hospital course and the achievement of a comfortable 150 degrees of elevation.
Just on discharge, the patient noted numbness in the distribution of the musculcutaneous nerve which was followed by a complete biceps palsy confirmed by EMG. Fortunately, this resolved completely by January of 2011. The explanation remains a mystery to us.
All was not perfect, however, in that  the shoulder became progressively stiff. The labs were normal as were the clinical appearance and radiographs.

After a lot of discussion, we proceeded with an open surgical release in December 2011. At that time there was a massive amount of scar through this shoulder with very tight limiting adhesions and contracture. The glenoid surface had healed nicely with a full fibrocartilagenous surface. the humeral stem was solidly fixed. There was no gross evidence of infection. The humeral head, and three tissue samples were harvested for culture before antibiotics were administered. After the surgical release and vigorous irrigation, a new humeral head prosthesis was inserted, followed by our standard rehab program.

The patient was placed on Augmentin until the cultures became final. These cultures all grew out Propionibacter Acnes! When the culture results were in, the patient was placed on PO Augmentin and Rifampin with IV Rocephin for the first six weeks. PO Augmentin since then. The Augmentin is continued until the one year annversery of the revision.

Today I received this email from the patient:

"I am nine months out from your shoulder revision and am doing great! Have been able to play golf for about six months, and as promised, am attaching a copy of my scorecard form yesterday.....first time I have broken 80 in 5 years!! I am playing without pain, and am loving every minute. Thanks again for your great care.
PS: planning to enter my first handball tournament in 5 years this coming January. I'll keep you posted!"

I have never experienced this chain of events before, but am so grateful to the patient for hanging in there with me through the challenging times. The lessen here is that things do not always go as planned, but with perseverance we can usually get to the goal line.
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