Saturday, October 14, 2017

Ream and run for chondrolysis in a young woman - two year outcome

An athletic young woman 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  show the characteristic appearance of chondrolysis (see this link).

After a thorough discussion of the alternatives, she elected to proceed with a ream and run procedure. Here are her 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.

She is now two years out from the procedure and fully functional as shown by these images she recently sent to us along with this message "Today is my two year anniversary of my ream and run surgery! We did it! I am so happy and proud to say that my shoulder feels better and stronger than it has in 15 years, since before my very first surgery in 2003! Thank you both from the bottom of my heart for giving me the chance at a much greater quality of life! Aloha, "

She adds "I can now perform all 12 functions of the Simple Shoulder test :) (the 8lb one is challenging but I can do it!)" 

It reminds of the important principle: "it is the patient and not the shoulder that we're treating".  In this case the patient was incredibly motivated and worked to earn her result.

The reader may also be interested in these posts:

Information about shoulder exercises can be found at this link.

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