Monday, November 7, 2022

Bilateral cuff tear arthropathy in a 70+ year old farmer/rancher

A 77 year old farmer/rancher managing 200 head of cattle and spending much of his day getting on and off a tractor presented with bilateral cuff tear arthropathy, active elevation to 130 degrees and these radiographs. On the left side he had a prior acromioplasty which was of no clinical benefit to him.





Because of his active lifestyle, chance of falls on the farm, preserved active elevation, and desire to avoid the risks associated with a reverse total shoulder (e.g. dislocation, baseplate failure, and acromial/spine fracture), he elected a CTA hemiarthroplasty for the left shoulder 9 years ago and for the right 7 years ago. At each surgery both the supraspinatus and infrasinatus tendons were torn and retracted. The subscapularis was reparable on both sides.

He recovered well with a return to farming/ranching. His x-rays from five years ago are shown below.




His current films from an outside hospital are shown below - 9 year followup on the left and 7 year followup on the right.




His retained active elevation at the most recent followup is shown below.





Comment: As explained in The versatile, inexpensive and safe CTA hemiarthroplasty for patients with preserved active elevation, the CTA hemiarthroplasty is an attractive surgical alternative for active individuals with CTA and preserved active elevation. (See also 
CTA hemiarthroplasty or reverse total shoulder for cuff tear arthopathy? It depends.)

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).