Ream and run - imaging the shoulder before and after surgery

Standardized imaging of the shoulder before and after the ream and run is important both for preoperative planning and for evaluating the arthroplasty. We use three views, as shown below: the AP in the plane of the scapula (Grashey view) on the left; the axillary "truth" view in the center, and the AP templating view on the right.

The AP templating view gives a good view of the humeral canal to anticipate any issues with placement of the stem as shown in the three examples below 

The AP in the plane of the scapula or Grashey is used for identifying medialization relative to the lateral acromial line, bone stock, glenoid inclination, foreign bodies and the size of the osteophytes.

This view is also used to evaluate proximal deformities that may require special placement of the humeral component.

And situations in which the humeral head cannot be dislocated safely so that an in situ osteotomy may be required.

The axillary "truth" view is used for evaluating the centering of the humeral head on the glenoid

Using this view, the centering can be compared before and after surgery

The axillary "truth" view is used to evaluate the glenoid bone stock and version relative to the plane of the scapula.

It can also be used to identify the glenoid type

However, we have found that the glenoid type is not an important consideration in the ream and run procedure, because in all cases the goal of reaming is to create a single glenoid concavity with maximal preservation of glenoid bone; changing glenoid version is not a priority and does not seem necessary for achieving stability or for a good functional result

Using these views we have not found that preoperative CT scans or 3D CT planning are needed.

=====

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

===

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

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  arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'