Sunday, May 24, 2015

Unstable total shoulder in a young person

A young man under the age of 50 presented after four prior surgical procedures on his right shoulder. The first, 5 years ago, was an arthroscopic labral repair after which he noted increasing posterior instability. 4 years ago an arthroscopic debridement was performed with findings of severe arthritis. 3 years ago he had a hemicap with a cadaveric bone graft to the posterior glenoid fixed with two screws. 1 year ago he head a total shoulder followed by a wound infection.

Now he presents with pain and severe posterior instability as shown in this video

His radiographs show a tightly fixed humeral stem and posterior subluxation of the humeral head on the glenoid.

We are posting this case to illustrate the complexities of revision arthroplasty in a young man. We're still discussing the revision options with him. We are facing (1) a possible low grade infection, (2) a well fixed ingrowth stem, (3) screws that would complicate fixation of a new anatomic or a reverse glenoid  - all in an active muscular young man.

Be sure to click on this link to the Shoulder Arthritis Book.

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