Back to open water swimming 8 months after ream and run for a B2 glenoid with details of recovery.

A vigorous athlete in his fifties presented with pain and loss of function of his right shoulder.

His x-rays showed glenohumeral arthritis with the humeral head posteriorly decentered on a biconcave glenoid.

Wishing to avoid the risks and limitations associated with the use of a prosthetic glenoid component used in a conventional total shoulder arthroplasty, he elected to proceed with a ream and run procedure.

CT scans and preoperative planning were not needed. A general anesthetic was used without a brachial plexus block. At surgery some excessive intraoperative posterior translation was manged with an anteriorly eccentric humeral component.  See How to do a ream and run arthroplasty. His postoperative x-rays are shown below showing the impaction grafted smooth standard length humeral stem and an anteriorly eccentric humeral head centered in the glenoid.

At one month after surgery he reported:

Medication:

Oxycodone: Stopped taking on day 4

Doxycycyline: took through 21 days

Gabapantin: took for 7 days

Tylenol:  still taking 3 X per day. 

 

Wound:

Swelling in my arm went down within a week.  I had some bruising down my arm and in to my palm but all that is now gone.  Staples were removed after 10 days.  Steri strips were applied.  They started coming off in 2 days and were completely off in 4 days – much faster than they said but no issues.

 

Exercise/PT

The pain has been diminishing as I have healed.  At the beginning I assume it was a delightful combination from several things in there – the wound, trauma, bone….  I have maintained my PT exercises 6 or more times per day.  For the first week I was doing the arm on table exercise.  It was giving me a good stretch and fully supporting the arm on the table vs. the other exercises seemed to help not be so painful vs. the others that were really difficult to manage.  I have maintained full motion.  Week 2 I added the on your back floor exercise.  Week 3 I added the cable raise exercise.  I have a PT appointment set for week 5 to understand additional exercises after week 6 when I can start adding some weight and working on outward rotation.  Per my last Email they had wanted me to be doing outward rotation to 40 degrees which I did not do on your instruction.

 

I am continuing with the on your back and pully exercises at least 8 X per day including during the night because of sleeping issues (below).  Although I am periodically feeling some moderate pain at certain points of the exercise motion, and moderate pain consistently at the top of each exercise I am not having any issues with needing to push any “stretch” or tightness in order to get full motion.  The first exercise is slightly “tight” or more painful at the top.  After doing 5 – 8 the motion is pain free throughout the motion except for holding the stretch at the top.  I am finding that doing around 8 repetitions and holding the stretch for 30 seconds to 1 minute works best vs 5. Here are some photos of my range of motion at one month after surgery

Sleeping

This for me has been an issue.  I started with sleeping sitting propped up with pillows and gradually have gone flat, however, I am waking up every 3 hours.  The pain is not great – an ache vs. a sharp pain – but it is sufficient to wake me.  It is a bit exhausting.  When I wake up I hit the floor and do 8 reps of the on your back exercise.  Although there is pain per the description above, by the time I finish the exercise calms the pain to almost nothing and I can go back to sleep.  I also bend over and with my arm hanging do some forward and back and circle movement with my arm.  This pain cycle may be due to my flat sleeping position but I am not great at sleeping sitting up either (and I do not own a “lounger” as I have seen some other patients discussing) so I’m just hoping the night time pain cycle will diminish in the not to distant future.  I’m thinking this is pain from the shoulder joint / bone healing but I have no idea.  I’m not sure what my expectations should be in regard to the pain diminishing and the reasonable duration for the bone to heal sufficiently to not be painful.  It’s really not that bad though.

 

 

At 8 months after surgery he reported:

I had a check up with my doctor here.  He said all is well and no need to come back. I have full motion and am ocean swimming again. 

He sent this video 

This man was extremely faithful to the ream and run rehabilitation program (see this link).

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).