Complex arthritis treated with a ream and run

A 50 year old active man from the East Coast developed pain and stiffness in his shoulder 34 years after a staple repair for anterior glenohumeral instability.  Four years ago a surgeon attempted staple removal, but was unsuccessful.

He presented to us with severely limited range of motion, an SST of 0 out of 12 and the x-rays shown below from his prior surgeon. These non-standard views made it difficult to assess what was going on with the shoulder, specifically the relationship of the staple to the humeral head and glenoid.

 We obtained a standard AP in the plane of the scapula.

and an axillary "truth" view.

These demonstrated contact between the staple and the humeral head and severe secondary degenerative joint disease with multiple loose bodies and a posterior glenoid cyst.

At surgery it was very difficult to remove this well-fixed barbed staple. It was necessary to cut the staple in two and to drill around each of the tines before extracting each of them with a needle-nosed vice grip.

With the staple removed, performance of a standard ream and run arthroplasty was straightforward.

On the evening of surgery he was able to achieve an easy 150 degrees of assisted elevation without the benefit of a brachial plexus block.

On the morning after surgery he was taking only Tylenol for pain and demonstrated his assisted motion before discharge:

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