A 31 year old athletic man was referred from the opposite corner of the U.S. with a history of shoulder problems since the age of 16 having been diagnosed with a torn posterior labrum from pitching baseball. He continued to participate in weight training, golf and football. A decade later he had progressive and substantial pain and difficulty raising his arm. His symptoms were aggravated by a motorcycle accident. At that point he had a "posterior labrum slap tear surgery". Five years later he had increased shoulder pain and limitation that had not responded to dedicated physical therapy. His shoulder images at that time are shown below.
On his initial visit with us, his shoulder examination showed stiffness and pain on motion but excellent muscle strength.
After discussion of the risks and benefits of the surgical alternatives, he elected to proceed with a ream and run procure to avoid the potential issues with a plastic glenoid component. Preoperative CT planning was not used. The procedure was performed under general anesthesia without a nerve block. The shoulder was approached through a deltopectoral interval with a subscapularis peel rather than a lesser tuberosity osteotomy. The biceps tendon was preserved as was the glenoid labrum. The glenoid was conservatively reamed just enough to create a single concavity and without attempting to change glenoid version. A thin (8 mm) smooth stem was impaction grafted into the medullary canal. A 56 mm anteriorly eccentric humeral head was selected to manage the posterior laxity. He did a superior job of his rehabilitation, keeping in close touch with us, although he lives over 3,000 miles away. A year after surgery he reported that he could perform 12/12 of the functions of the Simple Shoulder Test.
At two years after surgery he provided these x-rays showing no evidence of stress shielding, a stable thin smooth humeral component, a centered anteriorly eccentric humeral head, and a completely remodeled stable glenoid articular surface.
Recently, at four years after surgery, he shared a couple of videos of his workouts.
Comment: Managing shoulder arthritis in a young active person is a challenge for some important reasons: the pathology is more complex (as seen in this case) than what is usually found in degenerative arthritis in older patients, the patient has a long projected postoperative lifespan, and the patient generally has high activity aspirations. Each of these factors places special demands on the procedure selected, on the surgical technique, the rehabilitation program, and on the patient-surgeon partnership.
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