Thursday, April 13, 2017

A sudden 'crack' after a reverse total shoulder.

A middle aged man had a reverse total shoulder after multiple failed cuff repairs of the left shoulder. At the six week checkup, all was well clinically and radiographically.

He started gentle assisted flexion exercises. Two days after the office visit while reaching up he had sudden pain in the shoulder and heard a 'crack'. He returned to the office at which time tenderness was noted at the posterior acromion. The AP view was not remarkable.

However, the axillary view showed a non-displaced crack in the acromion.

This case reveals the potential of fracture of an acromion that is not used to being loaded.

Here's a similar case:
An 85 year old lady presented with severe cuff tear arthropathy as shown below.

She had a reverse total shoulder in early 2012. Two years after surgery she had excellent comfort and function. Here x-rays at that point are shown below.

Three and a half years after her procedure she developed the atraumatic onset of posterior shoulder pain. Her axillary x-ray shows a fatigue fracture of the scapular spine (to the left of the red line).

We anticipate that these will heal with non operative management.

Comment: It is worthwhile informing patients of this risk and advising a slow return to activities after a reverse total shoulder.


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