Wednesday, July 16, 2014

7 month progress note on a ream and run

We received this email today:

"Been meaning to email you for a while. You did my L shoulder, hemi arthroplasty with glenoid reaming, just before Thanksgiving last year. Since I live in the SF Bay Area we emailed back and forth. I felt I wasn't making much progress the first 4-5 months and the tone of my emails may have reflected that - sorry.

I was considering a manipulation, saw a few local shoulder surgeons, but decided against it. Interestingly, one of them, Dr. XX, implied I would never get full strength back. He said the glenoid reaming 'medialized' the center of rotation of the shoulder, weakening the cuff muscles by altering the muscle length tension relationship. Not surprisingly he suggested implanting a gleniod component would fix that. Of course when I mentioned a recent large study orthopedic article showing a 37% glenoid failure rate after 10 years, he glossed over and ignored that. Looks like one should only have a total shoulder if they are not going to out live their complication!

At about the 5th month (April) the shoulder started getting much better; less pain, more ROM, stronger. It's still weaker and stiffer than he other side, but functional and in some ways less painful than my other (also bad) shoulder. For the last 2 months I've been mountain biking, sailing in regattas, and weight training at my gym."

Comment: It's worth making a few comments on this informative email. First of all it is not uncommon that shoulders having a ream and run turn the corner at about 6 months as shown here. This individual hung in there and now is getting back into his desired activities. Second, the ream and run does not 'medialize' the center of rotation of the shoulder. Only enough reaming is done to create a smooth concentric concavity 2mm greater than that of the humeral head prosthesis. The muscle length tension relationships are optimized by the selection of the thickness of the humeral head prosthesis as well as by its positioning. Finally, the shoulders having ream and run shoulder arthroplasty have often been inactive for months or years prior to the surgery, so it is not a surprise that it takes time to recover strength after the procedure. Here are the preop films

and the immediate post op films on this patient's shoulder


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