Wednesday, July 17, 2013

Ream and run for the posteriorly eroded type B2 glenoid with posterior humeral displacement

At a time when some surgeons are considering special plastic glenoid components or even reverse total shoulders for arthritic shoulders with major posterior glenoid erosion and posterior displacement of the humeral head on the glenoid, we continue to apply the ream and run technique to selected patients with this all-too-common pathology.

Here is a case from our OR yesterday in a very active gentleman in his forties. Note that the standardized x-ray revealed his glenoid pathology without a CT scan.

Using an eccentric humeral head and a rotator interval plication, his shoulder was stabilized. Note in the films below, his glenoid retroversion was not changed, yet his humeral head is now centered in the new glenoid concavity.

 In spite of having a very stiff shoulder before surgery, he was able to elevate his arm passively to 150 degrees on the evening of surgery.

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