An athletic young woman in her mid 20s was diagnosed with multidirectional instability of her right shoulder. She was treated elsewhere with an arthroscopic anterior and posterior capsulorrhaphy. Three years later she had a repeat surgery after which a pain pump was used to infuse local anesthetics. Eight years later she had a subacromial decompression and biceps tenodesis. At that time glenohumeral chondromalacia was identified. The shoulder was debrided and the repair sutures removed. Five months later another subacromial decompression was performed along with a distal clavicle excision. She had persistent stiffness and pain. At the time of her presentation to us - twelve years after her first surgery - she had flexion limited to 90 degrees, pain ranging from 7-10 on a scale of 10, and reported the inability to perform any of the twelve functions of the Simple Shoulder Test.
Her radiographs showed bone on bone contact in both the AP and the axillary views as shown below, suggesting chondrolysis (noting that primary degenerative joint disease would be very unusual in such a young woman).
At surgery, the loss of cartilage over the humeral head was evident.
She elected to have a ream and run procedure to avoid the potential risks and limitations associated with a total shoulder arthroplasty (glenoid component wear and loosening).
Her postoperative films are shown below. Note the absence of a plastic glenoid and the absence of bone cement. Note the humeral stem was secured using impaction auto grafting with bone harvested from the humeral head.
Although her motion was improved at 6 weeks after surgery, she and her local orthopaedic surgeon decided to proceed with a manipulation under anesthesia in that she had lost some of her early range of motion
She demonstrated the highest level of dedication to her rehabilitation program, taking it to trackside. She has generously allowed us to post some of her photos here.
Here are the photos she sent in at 4 months after surgery, stating that she can now perform 8 of the 12 functions of the Shoulder Test in contrast to 0/12 before surgery.
At two years out from the procedure and fully functional as shown by these images she recently sent to us along with this message "Today is my two year anniversary of my ream and run surgery! We did it! I am so happy and proud to say that my shoulder feels better and stronger than it has in 15 years, since before my very first surgery in 2003! Thank you both from the bottom of my heart for giving me the chance at a much greater quality of life! Aloha, "
She adds "I can now perform all 12 functions of the Simple Shoulder test :) (the 8lb one is challenging but I can do it!)"
Recently she posted, "I am almost six years out. I had mine done at 35 years old. I don’t do any power lifting or have a physically demanding career or anything like that but I’m 120lbs and just helped lift a gazebo roof that was at least my body weight 
Prior to my r&r I struggled for 9 years with a total of 9 shoulder surgeries/manipulations under anesthesia. The r&r was the absolute best thing I ever did! I was just telling my husband that for nearly a decade I was aware of my shoulder every single day...now I’m never aware of it and haven’t been to a doctor for over three years! "
Chondrolysis is a very difficult diagnosis to treat. It is characteristically found in young individuals (especially young women) who had arthroscopic labral surgery followed by an intra-articular pain pump that infused local anesthetics. Many motivated patients have a challenging post arthroplasty course after a ream and run or a total shoulder. In this case hard work and a good measure of good fortune has led to a good outcome.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link)
The smooth and move for irreparable cuff tears (see this link)
The total shoulder arthroplasty (see this link).
The ream and run technique is shown in this link.
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
