Wednesday, October 11, 2017

Ream and run for arthritis with severe posterior decentering

A 50 year old active man presented with pain, stiffness and posterior instability of his right shoulder. He could perform only 5 of the 12 functions of the Simple Shoulder Test.
His AP x-ray showed 'ordinary' arthritis.
 However his axillary 'truth' view showed essentially 100% posterior decentering of the the humeral head on a posteriorly eroded glenoid. This is another of those glenoids that doesn't fall neatly into a 'type' - the native glenoid was not retroverted, the head was decentered and there was a posterior pathologic concavity.
He elected to have ream and run. An anteriorly eccentric humeral head and a rotator interval plication were used to manage the severe posterior instability.  His postoperative films are shown below.

The morning after surgery he was off all narcotic medications and busy with his stretching exercises, having no feelings of posterior instability.

Here's his motion at one week post surgery.

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Information about shoulder exercises can be found at this link.

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