Monday, October 12, 2015

One year followup after a ream and run

Recently we received this followup note from a young active man in his late thirties who came to us for a ream and run surgery a year ago with shoulder arthritis shown on his AP x-ray

and posterior instability as shown on his axillary view taken with his arm in the functional position of elevation. Of note is the fact that he did not have glenoid retroversion to go along with his posterior decentering.

At the time of his ream and run, we used an anteriorly eccentric head to provide posterior stability.

No one has worked harder on his postoperative rehab than this man.

A week ago I received this followup note from him. As you can see, we still have some progress to achieve, but the trend is excellent.

"I thought I would send you a quick note regarding where I am at the 1 year mark. As you know I worked my butt off in rehab to get the best outcome I could. There are so many things that are better now about the shoulder, things I haven't been able to do for years. The first 6 months are brutal but you have to push through them. They are the most critical to the longer term outcome which I can now appreciate.

When you finally cleared me to do active movement with the arm I wasn't even able to press a broom stick from my chest straight up while lying on my back. Even with the help of my left arm! Yesterday at the gym I bench pressed 225 lbs for 6 reps with no help. Granted this is a far cry from what I used to be able to do in my 20's, I can't believe how far I have come. There is still significant weakness in the joint when doing this exercise and even at lighter weights it is the first thing to give out and there is some pain. But as I warm up more it gets easier to push forward. I am also able to swim again and I have even been able to build up to swimming proper butterfly which is brutal on the shoulders. When I first started rebab I couldn't even pull my arm through the water. Now I am swimming 2 miles in a 45 min workout.

I was also not able to raise my arm over my head (both front or to the side). It was locked so badly the only way I could lift my arm was to fire my traps and "shrug" my arm up. Yesterday I was able to do 10 full body weight pullups (don't forget I am 6'4 230 lbs). I couldn't reach the bar before let alone hang from it and fire muscles. There is little to no pain in this.

Also throughout the last few months I played on my corporate softball team again. In the past 10 years however I have never been able to throw the ball (only underhand). For the first time I was actually able to properly throw. This motion still hurts when you torque the arm back to put force on the ball but again as it warmed up it got a tad bit easier. The bright side, even with pain I have the ability to throw and fairly hard at that. Also I led the league in Home-runs with something like 18 in 10 games. Some sailing 350feet or more.

You have basically given me quality of life back. No it isn't perfect, I still have pain during some movements. I still have little to no internal rotation for some reason. (maybe there are some stretches I could do? or maybe you just needed to tighten me too much for stability). The shoulder is a little unstable at rest at my side too, meaning I can slip it in and out of position and still have a visible sulcus when this happens (its kind of annoying too). But other than that, its amazing what I can do vs prior to seeing you. 3 shoulder surgeries and about 10 years and the only thing I regret is not coming to you sooner.

I know you said things will continue to improve even past a year. I would like to know if there is anything I can proactively do to keep that progress chugging along.....especially to regain internal rotation / strength. I got your team's request for a 1 year xray and I am working on getting someone local to do that for you.

Thank you again for everything. Gotta get back to work then the gym later!"


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