Thursday, November 16, 2017

Ream and run for arthritis in a 37 year old - 5 month progress report

A very active 37 year old male presented to us with a long standing history of right shoulder pain. He had history of a right shoulder dislocation at the age of 16 for which he underwent an arthroscopic bankart repair. He did well until approximately 2003, when he was involved in a motor cycle accident in which he sustained a shoulder fracture. He subsequently underwent a debridement and did well up until 2011 when he had a bicycle accident and sustained a second shoulder fracture (unsure of anatomic location). He then developed progressive stiffness and pain that did not respond to steroid injections. At the office visit he could perform only 3/12 of the Simple Shoulder Test functions. His radiographs are shown below

Because of his active lifestyle, he elected to have a ream and run procedure.

He recently sent this email from his home in South Africa:

"I wanted to touch base with you since now I am five months out of having the Ream and Run. Its been a bit up and down, as I'm sure you are aware of, but overall I know in the long run my shoulder is going to be much better off than it was prior to the procedure. I wanted to ask you about certain exercises to focus on and avoid. I've been sticking to the rowing, lat pulldowns, light yoga, and strengthen my back. The physiotherapist I am working here has added some external rotation exercises and I am finding them very problematic. I remember reading to avoid them for at least three months after surgery, which I did, but at five months one set of external rotation exercises will cause pain and stiffness in the front part of the shoulder for several days. I wanted to see if that was normal and what your thoughts were on the type of rehab exercises I should focus on?

On a side note, South Africa is a gorgeous country. After living in big Asian cities the last seven years it's nice to get back to a place, much like the Northwest, that I can enjoy an outdoor lifestyle. I'm not back to cycling yet, but once back on the bike I know I will enjoy it even more here. Appreciate your time and feedback."

He also sent these videos of his shoulder motion, which he generously gave us permission to show here

Comment: This five month progress report points out that the recovery of motion and function after a ream and run requires dedication and time. It also points to the importance of avoiding external rotator stretching until it can be performed comfortably