An 80 yo active man was 8 years after an anatomic right total shoulder and had returned to full function (including swimming) in spite of some early evidence of cuff tear arthropathy of the left shoulder as seen on the x-rays below taken 10 years prior to his recent presentation. Because of his high level of function, there were no interim x-rays taken.
He presented 16 months ago with the sudden atraumatic onset of the inability to raise his left arm (that had been fully functional the day before).
Imaging revealed a fragmented acromial fracture and advanced cuff tear arthropathy.
Stage one was internal fixation of the acromion. After cleaning out the fracture site, commercial allograft was placed in the fracture site. After temporary fixation with a clamp and two 0.045 K-wires, a 2.4 mm plate was placed, cutting the plate to fit the patient's anatomy, bending it and placing nonlocking screws on either side. Locking screws were placed in the distal segment with the hooks from the plate holding into the deltoid insertion. This provided good stability. Another plate was added medially with good positioning. At this point, a FiberTape was placed through the deltoid insertion anteriorly and then passed posteriorly around the posterolateral corner creating a figure-of-eight. Fluoroscopic imaging demonstrated good reduction and good position of all the components. Another another 1 mL of allograft was placed over top of the fracture and medially.
Three months later there was clinical a radiographic union of the acromial fracture.
Stage two was then performed: a reverse total shoulder arthroplasty.
Recently he wrote: "I just finished filling out the 8-year followup study for my right total shoulder. I have full use of my right shoulder without limitation. In addition, my left reverse total shoulder recovery is equally good now that I’m seven months post-op. I’m back to swimming with no symptoms of pain at all, doing freestyle, backstroke and breast stroke. With the long period of restricted activity after the original injury in December 2022, I have had a profound loss of upper extremity strength, mostly manifested by very slow swimming speeds. This certainly qualifies as first-world whining. Orthopedically both shoulders are a complete success, and I know that I will eventually regain at least some vestige of my pre injury shoulder strength."
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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).
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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).
