Thursday, September 29, 2022

Management of cuff tear arthropathy in an active patient - less is more

An active, muscular man in his early 60s presented with pain on use of his right shoulder after a number of failed attempts at rotator cuff repair. His radiographs are shown below.



He had a stable shoulder with retained active elevation in spite of having irreparable subscapularis, supraspinatus and infraspinatus tendons.

Because of his active life, he did not want to have a reverse total shoulder, electing instead a CTA hemiarthroplasty. At surgery the irreparability of his cuff and subscapularis was confirmed.

One year after surgery, he returned with a comfortable shoulder with full comfortable active motion and progressively improving strength. He reported no problems with shoulder instability.



His x-rays at that time show an impaction-grafted, smooth, standard length stem and an extended head prosthesis articulating with the undersurface of the acromion and centered in the glenoid socket.




Comment: In selected patients with cuff tear arthropathy who have preserved active elevation, the CTA hemiarthroplasty can restore shoulder comfort and function, avoiding the risks of dislocation, acromial/spine fractures, and scapular notching that are associated with a reverse total shoulder.

Our technique for this procedure is shown in this link.

You may be interested in these related posts:





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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).