UW Shoulder and Elbow Academy: Chondrolysis in a young person, managed with a ream and run

This week, we had the opportunity to meet a woman in her thirties who had had multiple prior procedures on the right shoulder, the first two were performed over a decade ago for multidirectional instability (arthroscopic anterior and posterior capsulorraphies). At least one of these included the use of a pain pump for the postoperative infusion of local anesthetics. Subsequently her shoulder became stiff and painful. About four years ago, a right shoulder subacromial decompression and biceps tenodesis were performed at which time substantial chondromalacia was noted. Next a manipulation was performed in an attempt to manage the painful stiffness. Then a repeat subacromial decompression and distal clavicle resection were performed. Finally, three years ago another manipulation was performed.

At the time of her visit with us she had a stiff painful shoulder and was unable to perform any of the 12 functions of the Simple Shoulder Test.

Her radiographs show bone on bone contact in both the AP and the axillary views as shown below, suggesting chondrolysis (noting that primary degenerative joint disease would be very unusual in a young woman).

At surgery, the loss of cartilage over the humeral head was evident.

She elected to have a ream and run procedure to avoid the potential risks associated with a total shoulder arthroplasty (glenoid component wear and loosening).

Her postoperative films are shown below. Note the absence of a plastic glenoid and the absence of bone cement. Note the humeral stem has been secured using impaction auto grafting using bone harvested from the humeral head.