Wednesday, September 11, 2019

Complications of shoulder surgery - an instructive history

Here is an instructive story:

Operation 1. A woman had a cuff repair that failed. 
Operation 2. A year later another repair was attempted, but failed. 
Operation 3. A year later she had a total shoulder arthroplasty. 
Operation 4. This failed and the humeral component was revised to a CTA head. Five years later she had painful dysfunctional shoulder she had these radiographs and pseudoparalysis of her shoulder.

Operation 5. This was revised to a reverse total shoulder 

Four months later she developed pain in the back of her shoulder. Radiographs showed a fatigue fracture of her scapular spine (see arrow in the x-ray below).

A month later the fracture displaced allowing the acromion to angulate inferiorly (compare the scapular spine to the immediate postoperative radiographs.

11 months later the fracture appeared to be healing

Four months later there was increased healing

Two months later the fracture was asymptomatic but the shoulder had very limited elevation with pain and popping as the superior aspect of the humeral component abutted against the inferior aspect of the lateral acromion.
Comment: This case demonstrates (a) complications of cuff surgery, (b) complications of total shoulder, (c) complications of reverse total shoulder, and (d) consequences of a displaced scapular spine fracture. 

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link

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