Severe B2 glenoid in a 40 year old active man - how to manage?

 A young active man presented with pain, stiffness and the ability to perform only 5 of the 12 functions of the Simple Shoulder Test. His preoperative films are shown below.

His axillary "Truth" view showed essentially a complete posterior decentering of his humeral head on a biconcave glenoid. 

He elected to have a ream and run procedure.

He returned two years after his procedure to have a ream and run on the opposite side. His right was comfortable and his Simple Shoulder Test and improved to 8 out of 12. His function is continuing to improve. We obtained two year followup right shoulder films prior to his left shoulder surgery (see below).

Note the use of an anteriorly eccentric humeral head that is now centered in his reamed glenoid.

Comment: This case demonstrates the conservative reconstruction of a severe B2 glenoid with a ream and run procedure, rather than the other options of posterior bone graft, posteriorly augmented glenoid component or reverse total shoulder. 

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