An athletic young woman in her mid 20s was diagnosed with multidirectional instability of her right shoulder. She was treated elsewhere 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 - 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 radiographs showed bone on bone contact in both the AP and the axillary views as shown below, suggesting chondrolysis (noting that primary degenerative joint disease would be very unusual in such a young woman).
At surgery, the loss of cartilage over the humeral head was evident.
She elected to have a ream and run procedure to avoid the potential risks and limitations associated with a total shoulder arthroplasty (glenoid component wear and loosening).
Her postoperative films are shown below. Note the absence of a plastic glenoid and the absence of bone cement. Note the humeral stem was secured using impaction auto grafting with bone harvested from the humeral head.
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.
At two years out from the procedure and fully functional as shown by these images she recently sent to us along with this message "Today is my two year anniversary of my ream and run surgery! We did it! I am so happy and proud to say that my shoulder feels better and stronger than it has in 15 years, since before my very first surgery in 2003! Thank you both from the bottom of my heart for giving me the chance at a much greater quality of life! Aloha, "
She adds "I can now perform all 12 functions of the Simple Shoulder test :) (the 8lb one is challenging but I can do it!)"
Recently she posted, "I am recently six years out from my ream and run surgery and I have to say it was one of the best decisions I’ve made. My story is a little different from some others so I wanted to share it in case it can help someone who may be on the fence. At age 23 I worked in the bars and would dislocate my shoulder so much I could Lethal Weapon it back in place myself lol. I had surgery to tighten loose tendons and ligaments. At age 26, after a bad car accident, the laxity returned. After months and months of physical therapy it was determined I needed surgery again. Following this surgery, in 2006, my surgeon put a pain pump with a catheter directly into my chest for pain management. It looked like a little battery pack. After 3 days I had a friend help me pull the catheter out of my chest, as instructed. Shortly after that surgery I knew something felt very different. Quarterly cortisone injections and 9 years of corrective surgeries including but not limited to clavicle resection, biceps tenodesis, AC joint repair, you name I feel like I had it. Not to mention the countless manipulations under anesthesia. At age 29, a different surgeon told me I had the shoulder of an 80 year old but “you’re too young for a replacement.” No one could tell me how my shoulder had gotten so bad. It got to the point it was painful moving a computer mouse. At age 34, I saw a new surgeon here in Hawaii. He knew right away what I had…Chondrolysis…from that pain pump in 2006. Chondrolysis is a severe type of shoulder arthritis in which the cartilage of the joint is abruptly lost. He referred me to the UW and at age 35 I had my ream and run. The recovery was tough but 9 years with no resolution was tougher! It’s all about Quality of Life 💕 I am so thankful and have a shoulder that I am no longer aware of every single day, a shoulder that is pain-free, and able to do all that I need it to do without hesitation. Happy I don’t do any power lifting or have a physically demanding career or anything like that but I’m 120lbs and just helped lift a gazebo roof that was at least my body weight. The r&r was the absolute best thing I ever did! I was just telling my husband that for nearly a decade I was aware of my shoulder every single day...now I’m never aware of it and haven’t been to a doctor for over three years! "
At six years after surgery she reports, "I am doing well! I am completely pain free and able to do everything I want to do with no limits. I actually forget that I have a metal shoulder most of the time" Her x-rays six years after surgery are shown below. Note the stability of the impaction grafted humeral component, the absence of glenoid erosion, and the remodeling of the glenoid surface.
Comment: Chondrolysis is a very challenging type of shoulder arthritis. Some patients continue to have problems with postoperative pain and stiffness after either a total shoulder or a ream and run procedure. Not infrequently a manipulation is needed to address stiffness. In some cases the glenoid bone may not respond with the same degree of strong remodeling seen in this case.
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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).
