The severely B2 glenoid in active patients

 The B2 glenoid is characterized by posterior decentering of the humeral head on a biconcave glenoid. This pathoanatomy can be managed by anatomic total shoulder (without or with an augmented glenoid component) or by a reverse total shoulder arthroplasty. However, neither of these options may be suitable for active individuals who wish to avoid the risks and limitations of a prosthetic glenoid component. 

Here are two such cases.

Case 1 - A 64 year old active carpenter with shoulder pain, stiffness and symptoms of posterior instability. His preoperative axillary "truth" view demonstrated severe posterior decentering of the humeral head on a posteriorly eroded glenoid.

He elected to have a ream and run procedure. At surgery a concentric humeral head was not stable on the reamed glenoid. However, an anteriorly eccentric humeral head was stably centered on the reamed glenoid.

Three months after surgery his shoulder was comfortable and clinically stable. At that time he was returning to his trade. He kindly gave us permission to show his active range of flexion.

Case 2 - A 51 year old general contractor presented with pain, stiffness and instability of his left shoulder after previous arthroscopic shoulder debridement. His shoulder condition prevented him from swimming and archery. His preoperative axillary "truth" view showed his humeral head was posteriorly decentered on a convex glenoid. 

He elected to have a ream and run procedure. At surgery a concentric humeral head was not stable on the reamed glenoid. However, an anteriorly eccentric humeral head was stably centered on the reamed glenoid.

Three months after surgery his shoulder was comfortable and clinically stable. At that time he was returning to his trade. He kindly gave us permission to show his active range of flexion.

Comment: We've found that the anteriorly eccentric humeral head is a reliable solution to achieving humeral head centering when intraoperative assessment reveals that a concentric humeral head allows excessive posterior translation.  See Management of intraoperative posterior decentering in shoulder arthroplasty using anteriorly eccentric humeral head components.  While some surgeons have expressed concern that the anterior eccentric head may jeopardize the subscapularis repair. We have not found this to be the case as long as the subscapularis is well released and secured to the lesser tuberosity. 

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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).