Thursday, November 18, 2021

Impact sports and the ream and run: handball, as an example.

Handball is sport full of impact, in that the ball is hit with the thinly gloved palm, rather than a racket or paddle.



Impact comes not only from the hand striking the ball, but also from the player diving for the ball on the hard court floor.

 

A taste of this sport can be seen by clicking on this link. The history of handball is told here.

Handball players are seriously dedicated to their sport and often wish to continue to play into their 6th, 7th or 8th decade. Like other athletes, they don't like for problems like shoulder arthritis to prevent them from participating. Because of the impact nature of the sport, handballers can be concerned about the ability of the plastic socket used in standard total shoulder joint replacement to hold up. Some consider the alternative of a ream and run procedure (see this link).

Here are the right shoulder x-rays of a 50 year old player with pain on activity and glenohumeral arthritis with a posteriorly decentered humeral head on the axillary "truth" view.


His post ream and run radiographs are posted below, showing a centered humeral head and radiographic joint space between the prosthetic humeral head and the glenoid bone.


Five and a half years after his ream and run, he sent this update. 

 

"Prior to surgery, I conducted extensive research on all available options for managing shoulder arthritis.  I knew going in a traditional total shoulder replacement would probably be the end of playing handball and many other activities due to the delicate component traditionally used to reconstruct the socket.  When I discovered the Ream and Run technique I was sold because this approach creates a  new socket from your own bone.   R&R patients return to normal activities including contact sports.  Eliminating the delicate socket component is what makes this technique unique.

 

Physical Therapy took a commitment performing a series of stretches several times a day.  Strength building exercises, swimming, speed bag work, bands, etc. added after first couple months as shoulder permits.  I was soft tossing a handball in month seven and back to playing within a year.  I’m five and-a-half years out from surgery and really don’t even think about the right shoulder any longer.  Zero limitations."

Another example is a hand baller now in his seventies. Ten years ago he had a ream and run on his left shoulder and four years ago he had a ream and run on his right shoulder.

Here are the followup films for the left shoulder

and the right shoulder


He sent this recent report, "As my father used to say, "Those who talk about the good-old days...weren't there." Previous generations of handball players with arthritic shoulders simply had to quit playing. There was no alternative. The choice for me was easy. A conventional shoulder replacement would immediately change my quality of life. Not only did I want to continue playing handball but I also didn't want any future concerns from accidentally falling or tripping. I was 62 and 68 years old when I had the procedures. 


After initial surgery, the outcome is very much dependent upon the patient. Any potential candidate must have the proper mindset ahead of time. Fortunately, dedication is nothing new for handball players. With Ream and Run though, you really have to 'earn' a successful result. An excellent recovery is not a given, nor is it fast and easy. Rehabilitation takes a stern commitment, staunch perseverance, and enormous patience. Stretch, stretch, and stretch some more. Strengthen gradually but prudently and then stay on a conscientious maintenance program.

The Final Result.......... It's hard to describe the joy of playing again. Unlike before, there is no aching joint pain agerwards. Both shoulders feel solid and strong whether playing handball, doing push-ups, pull-ups, or most anything else. I feel very little, if any, in the way of restrictions. There is one minor caveat. It is strongly advised to stretch daily. Stretching though, is an insignificant price to pay for the enjoyment of being back playing again this wonderful sport."

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How you can support research in shoulder surgery Click on this link.

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.