We had the opportunity to work with an athletic young woman who, when she was 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 and after five surgeries - 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 showed the characteristic appearance of chondrolysis (see this link).
She and her local referring orthopaedic surgeon (a colleague of ours) convinced us to perform a ream and run procedure.
Here is the appearance of her humeral head a surgery showing global loss of articular cartilage
Here are the immediate 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 recently sent us this note, five years after surgery. "It is wonderful to hear from you! I am doing well! I am completely pain free and able to do everything I want to do with no limitations (provided I actually work out lol). I actually forget that I have a metal shoulder most of the time
I’m not one for heavy weight lifting but I do enjoy yoga, Pilates, isolation exercises and light weights to stay active. For me, the huge differences since having my ream and run surgery have been in my everyday life...being able to reach behind me or in the back seat to grab something with ease, reaching overhead, not having to think about something before I attempt to do it, movements feeling natural and normal, being able to sleep comfortably throughout the entire night, no longer having pain or discomfort, and basically ‘forgetting’ that I’ve even had a shoulder replacement. These are the differences that have been life changing. "
This result is product of a solid rehab effort on the part of the patient. For the details of the rehab program, click on this link.
For more on chondrolysis, click on this link.
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