UW Shoulder and Elbow Academy: Ream and run for capsulorraphy arthropathy

A man in his late 40's had pain and stiffness in his right shoulder. 28 years ago he had a labrum repair for chronic subluxation with a "fantastic result with 100% recovery." 13 years ago he re-tore his labrum throwing a baseball. At the time of his repair arthritis and severe cartilage damage was noted so the surgeon also did micro-fracture. After that he never recovered his range of motion or full pain relief, but was "functional". He could still play basketball until earlier this year and throw a baseball until about 2 years ago. Less than a year ago he had a cortisone shot. It modestly improved range of motion, pain, and stiffness. However, he immediately started getting more grinding and popping in my shoulder.

He presented to us 6 months later with the x-rays shown below.
Note the presence of suture anchors, the flattening of the humeral head, the large osteophytes and the medialization of the humeral head

On the axillary "truth" view, note the glenoid biconcavity and retroversion.

Because of his young age, his high desired activity level, and his risks to avoid the risks and limitations associated with a polyethylene glenoid, he desired a ream and run procedure.

His postoperative x-rays are shown below with an impaction grafted standard stem, low filling ratio, and a smooth glenoid concavity.

His axillary view shows the use of an anteriorly eccentric humeral head. The glenoid was reamed conservatively, without attempt to alter preoperative glenoid version.

The centering of his humeral head is shown by first drawing a circle around the humeral articular surface.

Finding the center of the circle.

And drawing the perpendicular bisector of the line segment connecting the anterior and posterior edges of the reamed glenoid. Thee excellent centering is shon below.

One month after surgery, he sent this message and the photos below of his exercises. "It takes some loosening up each day before I get to this position. I get some 'snaps and pops' as I push it, but I haven't been concerned about them. I've been able to slowly but consistently improve each day.

I've also been rowing every other day, which is uncomfortable but not too too painful. I have not done any lat pull-downs yet because I don't have access to a machine, but I'm going to try to set up some bands to work with. I am able to use my arm for most basic daily things that don't require me to lift it.

I am now taking 3000 mg of acetaminophen and 7.5 mg meloxicam a day. I will run out of meloxicam tomorrow and was planning to switch to 440 mg of naproxen 2x a day, unless you suggest anything different. "

Here he's showing his exercises at 4 weeks post op.

Abduction stretch

Pulley

Supine stretch

Forward lean/table slide

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To see a YouTube video on how the ream and run is done, click on this link.

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How you can support research in shoulder surgery Click on this link.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

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