Monday, April 3, 2017

Posterior instability and arthritis: ream and run

An active patient fell on his outstretched arm 17 years ago.
He had a SLAP surgery, but continued to have symptoms of his shoulder slipping when he raised it.
5 years ago at the age of 34 this x-rays looked like this.

He elected to continue trying to cope with his ongoing shoulder instability. Four months ago his symptoms of instability and pain and progressed to the point of needing an arthroplasty. At that time his radiographic posterior instability had also progressed as seen on the 'truth view' below.

Because of his young age (<40) and his desire to participate in high level activities, he elected to proceed with a ream and run surgery. This procedure required an anteriorly eccentric humeral head and a rotator interval plication.

Two months after surgery he had regained full assisted elevation of a comfortable shoulder without feelings of instability. His radiographs at that time are shown below.

Note the improved centering of the humeral head on the glenoid.

While it is still very early, this is a most encouraging demonstration of the effectiveness of the ram and run coupled with a rotator interval plication and an anteriorly eccentric humeral head prosthesis.

Other approaches that might have been considered include a fusion, posterior bone graft, total shoulder with a posteriorly augmented glenoid, or a reverse total shoulder.

Consultation for those who live a distance away from Seattle.

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