Note the use of an anteriorly eccentric humeral head to re-center his humeral head on the glenoid.
Four years after his surgery he had a comfortable shoulder and had returned to a wide range of physical activities with the ability to perform 10 of the 12 Simple Shoulder Test functions. He became interested in weight training. While attempting a dead lift (see this link) he felt something give in his shoulder and noted immediate onset of weakness.
Physical examination revealed supraspinatus and subscapularis weakness, but full active motion. His x-rays showed some superior displacement of his humeral head.
His anteriorly eccentric humeral head was replaced with a CTA head and the subscapularis was reconstructed with superior advancement. The immediate postoperative films show centering of the humeral head in both planes.
Comment: A cautionary tale showing that a previously repaired cuff can remain vulnerable to sudden loads. That having been said we are optimistic for a good functional return in this strongly motivated man.
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