Tuesday, December 18, 2012

Ream and Run for Walch B2 & severe deformity

Ream and Run for flattened head, Walch B2 and severe posterior erosion from capsulorrhaphy arthropathy

Yesterday we had the opportunity to see the one year result for a ream and run on a 49 year old muscular man with severe deformity resulting from an instability surgery performed many years ago. We use the term capsulorrhaphy arthropathy to refer to glenohumeral arthritis coming on after a prior shoulder surgery performed for instability. When the anterior capsule is surgically tightened, attempts to externally rotate the arm force the humeral head out the back of the shoulder, predisposing to arthritis.

This man had presented to us one year ago with a Simple Shoulder Test score of six out of twelve 'yes' responses.
His preoperative films are shown below. Note the Walch B2 glenoid, the humeral head deformity and the retroversion of the glenoid.

Using our standard approach for this situation, we reamed his glenoid to a diameter of curvature of 58 mm and used a 56 mm curvature humeral head. The glenoid reaming converted his B2 to a concentric glenoid; no attempt was made to alter his glenoid version. His 'drop back' was managed with an anteriorly eccentric humeral head without a rotator interval closure. 

At one year he reported the ability to perform all twelve of the Simple Shoulder Test functions and that he had no limitation in his activities. Here are his one year post operative x-rays. 


Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty,  and rotator cuff surgery.