Tuesday, April 16, 2013

The Walch B2 glenoid in a young active person - a recurrent theme.

This morning I received these images from an active 40+ individual who reports the inability to lift the left shoulder much more than parallel to the ground for nearly 4 years.  In the beginning pain was the primary issue and now the problem is lack of use. The individual desires to continue sports and weight training.

We share this case with you for a couple of reasons. First, the AP view (first image below) makes this look like a straightforward case of osteoarthritis, but the axillary view (second image) shows that in fact it is a type B2 glenoid with biconcavity and severe posterior displacement of the humeral head on the glenoid. No need for a CT scan to show the pathology!

The second reason for showing this case is that it is now recognized that this pathology has been associated with a high rate of glenoid component loosening, instability and wear if a total shoulder arthroplasty is performed. Currently some surgeons are recommending a reverse total shoulder for this pathoanatomy, however that would seem suboptimal for a person in middle age desiring to be physically active.

These situations are not rare: osteoarthritis and capsulorrhaphy arthropathy not uncommonly produce this pathoanatomy. Our practice is to offer such shoulders a ream and run procedure, recognizing that the surgery is technically difficult and the rehabilitation tougher than with a 'cake walk' type A glenoid. See such a case here.

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