Today in the office we saw a 70+ year old active physician-rancher from the opposite corner of the U.S. who we saw today two years after his CTA arthroplasty for a failed cuff repair. Before surgery his shoulder films were as shown below and he reported the ability to perform only 5 of the 12 Simple Shoulder Test functions.
At the time of surgery he had no supraspinatus, no infraspinatus and a detached subscapularis.
We were able to reattach is subscapularis.
Today he presents with excellent comfort and function. He reports the ability to perform 11 of the 12 SST functions (he cannot throw a ball 20 yards overhand with that shoulder). He has been active in his ranching and the shoulder has withstood a number of falls
His x-rays from today are shown below. Note the impaction grafted humeral stem and the articulation of the prosthesis with the undersurface of the coracoacromial arch.
He will have the same procedure performed on his right shoulder tomorrow. SST 4/12. x-rays shown below.
Comment: For reasons we are not able to identify, there are many surgeons who are disinclined to use this technique. One well known authority recently stated, "We don’t use a cuff tear arthropathy prosthesis in case of CTA even if the shoulder is able to raise > 90° of elevation: if there is correct active elevation, we believe that it is not a good indication for an arthroplasty. Acromio-humeral contact is rarely a cause of pain. In cases of massive rotator cuff tear, either we propose a partial rotator cuff repair with biceps release if there is correct active elevation or a reverse shoulder arthroplasty if there is loss of active elevation. We pay particular attention to the pre-operative quality of the external rotator muscles to inform the patient about the risk of paralysis of external rotation or about the possibility to perform a latissimus dorsi transfer."
From our standpoint, the CTA arthroplasty is a most attractive option for consideration by active individuals with cuff tear arthropathy and the ability to actively elevate the arm above 90 degrees without manifesting anterosuperior instability. Inserting the prosthesis with impaction grafting makes for an easy conversion to a reverse should that be necessary, but fortunately this is almost never the case.
Here is a video of a women years after her CTA prosthesis for cuff tear arthropathy. Additional relevant posts can be found here and here and here
Here is a video of a women years after her CTA prosthesis for cuff tear arthropathy. Additional relevant posts can be found here and here and here
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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'
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'
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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'
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'
