Ream and run for the B2, retroverted glenoid

Shoulder arthroplasty surgeons are justifiably concerned about the management of arthritic shoulders with the bad arthritic triad (BAT) of (a) glenoid retroversion, (b) glenoid biconcavity and (c) posterior decentering of the humeral head on the glenoid.

This situation was exemplified in a case from this week - a 63 year old physically active executive with a preoperative axillary view showing 40 degrees of retroversion, a biconcave glenoid, and posterior displacement of the head on the glenoid - all demonstrated by an axillary view taken with the arm in the functional position of forward elevation (the 'truth' view).

He desired a ream and run procedure to avoid the risks of a plastic socket. At surgery there was no attempt to 'correct' his glenoid version - reaming was only used to covert his biconcavity to a single concavity; thus the amount of bone removed was minimal. We used an anteriorly eccentric humeral head prosthesis to restore centering of his humeral articular surface in the reamed glenoid.

He is now well-launched on the active assisted range of motion program.

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Ream and run for the triad of biconcavity, retroversion and posterior humeral subluxation

Can the Ream and Run Procedure Improve Glenohumeral Relationships and Function for Shoulders With the Arthritic Triad?

It is recognized that glenoid biconcavity, glenoid retroversion, and posterior displacement of the humeral head on the glenoid are associated with an increased risk of failure of the glenoid component in total shoulder joint replacement. The combination of these three pathologic elements have come to be known as the "bad arthritic triad" or BAT.

In that the ream and run procedure manages arthritic pathoanatomy without a glenoid component, these authors sought evidence that this procedure can be effective in improving the centering of the humeral head contact on the glenoid and in improving the comfort and function of shoulders with the arthritic triad without subjecting the shoulder to the risk of glenoid component failure.

They reviewed 30 shoulders in 30 patients that had the ream and run procedure for the arthritic triad and had two years of clinical and radiographic follow-up.  The average age of the patients was 56 ± 8 years; all but one were male.

Two of the 30 patients requested revision to total shoulder arthroplasty within the first year after their ream and run procedure because of their dissatisfaction with their rehabilitation progress.

For the 28 unrevised shoulders the mean followup was 3.0 years (range, 2–9.2 years). In these patients, the ream and run procedure resulted in improved centering of the humeral head contact point on the face of the glenoid - from 75% posterior to 59% posterior - notably without a significant change in the glenoid version.

Patient-reported function as assessed by the Simple Shoulder Test was improved from 5 ± 3 to 10 ± 4. Ten of the individual functions of the SST were significantly improved:

Comment: While this report shows that the ream and run can be successful in managing selected shoulders with the arthritic triad, the authors point out that this procedure is not for every patient with an arthritic shoulder and not for every surgeon. Patient selection and surgeon experience are critical to the outcome.

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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Use of a ream and run to manage the bad arthritic triad without changing glenoid version.

Here's a brief report of a case from this week's OR. A large, strong, man in his mid sixties presented to the office requesting a ream and run for his arthritic shoulder.

His preoperative films showed synovial chondromatosis

and a retroverted, biconcave glenoid with posterior humeral subluxation on the glenoid face (= the bad arthritic triad).

 His ream and run procedure included the use of a rotator interval plication and an anteriorly eccentric humeral head.

Note that his humeral head was centered even though his glenoid version was not changed.


He was discharged on his second postop day with a comfortable 150 degrees of assisted elevation.

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Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.