Management of severe B2 glenoid in an active young man

An active surfer/athlete presented with pain and stiffness of both shoulders and the x-rays shown below. Each of the axillary "truth" views shows posterior decentering of the humeral head on a biconcave glenoid.

 

After considering the options of an anatomic total shoulder, an anatomic total shoulder with a posteriorly augmented glenoid component, and a reverse total shoulder, the patient elected to proceed with a ream and run procedure on each shoulder, two years apart.

The four year post operative films for the right shoulder are shown below. Note the use of an anteriorly eccentric humeral head component to control posterior translation.

The two year postoperative films of the left shoulder are shown below. Note again the use of an anteriorly eccentric humeral head component. 

He is back to surfing, tennis, lifting weights and swimming 1,000 yards, activities he was unable to perform before his shoulder arthroplasties.

The active motion of both shoulders is shown below.

As expected, these shoulders had difficulty in regaining functional motion after their prolonged stiffness. In such cases, we use outpatient manipulation under anesthesia and complete muscle relaxation to supplement the patient's rehabilitation effort. In this case several manipulations were peformed on each shoulder. 

We asked him to comment on the use of manipulation in his case. He responded, "Regarding the MUA experience, with both shoulders the MUA benefits seemed to wear off within a couple of weeks until the ones I had done at the two year mark. I could tell each time within even a couple of days that I was tightening up again. But for some reason two years seems to be long enough that my body stops laying down so much scar tissue."

He adds, "one other thing I wanted to mention that has been extremely helpful. For the last few weeks once a day I spend about ten minutes with a baseball (lacrosse ball without seams would likely be better) and lay on my back and use body weight on the ball to work the sore part of the joint. It has made a big difference in soreness that would occur normally from lifting weights, playing tennis, swimming, which are all things I do on a fairly regular basis (each activity at least once a week)"

Comment: This is an exceptionally motivated young man, who has been completely dedicated to his rehabilitation program. His experience with manipulation as long as two years after surgery has been instructive. 

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

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Note that author has no financial relationships with any orthopaedic companies.