Thursday, August 20, 2015

The arthritic glenoid - evaluation and management

There is a lot to be learned about evaluation and management of the arthritic glenoid as shown in a recent article. In this article the x-rays below illustrate some of these. The first figure shows a non-standard axillary view that makes assessment of the glenohumeral pathoanatomy difficult.

This is in comparison to a standardized view (showing the spinoglenoid notch) where it is straightforward to document the glenoid type, version and degree of posterior displacement of the humeral head on the glenoid as shown below:

The shoulder shown in the first figure was treated with total shoulder complicated by postoperative posterior subluxation. Even though the postoperative x-ray below is non standard, one can see that the stem was inserted so that the head was displaced posteriorly and in addition a humeral head component was used that had a posterior offset -both of these factors contributed to the posterior instability.

The standardized axillary view is taken as shown in the figures copyrighted by Steve Lippitt shown below. It is important that the spinoglenoid notch is seen to verify the orientation of the image. With this standardized view, the additional expense and radiation of a CT scan and 3-D reconstruction is avoided.

When the humeral head is posteriorly subluxated, it is important that the stem not be angled posteriorly and that the humeral head eccentricity be anterior, as shown below, rather than posterior as in the case above.


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