Monday, February 15, 2016

Chondrolysis in a young woman - how can this be managed? Part 3

Here is the four month (still early) followup on the case we posted yesterday.

To recap, she is an athletic young woman who, when she was in her mid 20s, was diagnosed with multidirectional instability of her right shoulder. She was treated by surgeons in another state with an arthroscopic anterior and posterior capsulorrhaphy. Three years later she had a repeat surgery after which a pain pump was used to infuse local anesthetics. Eight years later she had a subacromial decompression and biceps tenodesis. At that time glenohumeral chondromalacia was identified. The shoulder was debrided and the repair sutures removed. Five months later another subacromial decompression was performed along with a distal clavicle excision. She had persistent stiffness and pain. At the time of her presentation to us - twelve years after her first surgery - she had flexion limited to 90 degrees, pain ranging from 7-10 on a scale of 10, and reported the inability to perform any of the twelve functions of the Simple Shoulder Test

Her x-rays showed the characteristic appearance of chondrolysis (see this link).

She and her local referring orthopaedic surgeon (a colleague of ours) convinced us to perform a ream and run procedure. Here are the immediate postoperative films.

Although her motion was improved at 6 weeks after surgery, she and her local orthopaedic surgeon decided to proceed with a manipulation under anesthesia in that she had lost some of her early range of motion.

She demonstrated the highest level of dedication to her rehabilitation program, taking it to trackside. 

She has generously allowed us to post some of her photos here.

Here are the photos she sent in at 4 months after surgery, stating that she can now perform 8 of the 12 functions of the Shoulder Test in contrast to 0/12 before surgery.

While these results are still early in the game, they are most encouraging and more than anything, they show what can be accomplished when the patient is completely dedicated to the rehabilitation program. 

It reminds of the important principle: "it is the patient and not the shoulder that we're treating". 


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