Wednesday, July 22, 2015

Shoulder arthritis with posterior humeral subluxation managed with the ream and run

Posterior humeral subluxation is an important, but under-recognized component of shoulder arthritis.
Here is the anteroposterior view of the right shoulder of a 60 year old very active man with shoulder pain who reported he was able to perform only two of the twelve functions of the Simple Shoulder Test. This radiograph seems incongruent with the severity of his symptoms.

However the 'truth view' - the axillary view taken with the arm in a functional position of elevation in the plane of the scapula is remarkable in that it shows almost total posterior subluxation of the humerus with bone on bone contact on the humerus. 

Because of this man's high desired activity level and his desire to avoid the risks of glenoid component failure, he chose to have a ream and run glenohumeral arthroplasty.

Today he came back for his one year follow-up reporting that he could perform 12 out of 12 Simple Shoulder test functions, including throwing with this shoulder. 

His postoperative 'truth view' shows that the use of an anteriorly eccentric humeral head component successfully centered his humeral head in the reamed glenoid. Note that conservative glenoid reaming provided a functional glenoid concavity.

Comment: (1) CT scans are unnecessary to assess arthritic glenohumeral pathoanatomy - the 'truth' view gives the necessary information by imaging the arm in a position of function. (2) Posteriorly augmented glenoid components or reverse total shoulders may not be the optimal method for managing arthritic posterior subluxation of the humeral head.

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