An active young man from the opposite corner of the U.S. presented for evaluation of his right shoulder. He was a pitcher in high school, but began having pain and symptoms of instability without a known injury. Five years prior he was riding a motorcycle and crashed because he was unable to move his arm. He was diagnosed with posterior instability with a labral injury for which he had an arthroscopic labral repair. While this surgery helped with stability, he continued to have pain, stiffness and decreased function. He experienced pain at rest, at night after use of the arm, stiffness and some numbness in his hand. He had tried physical therapy for a few months, did home stretches and had not had any injections.

His x-rays at that time showed loss of joint space, a fractured inferior humeral osteophyte, and severe posterior decentering of the humeral head on a posteriorly biconcave glenoid as shown on the axillary "truth" view (see this link).

He elected a ream and run procedure (see this link) to avoid the limitations and risks of a conventional total shoulder, a total shoulder with a posteriorly augmented glenoid component and a reverse total shoulder. No preoperative CT was obtained. No patient specific instrumentation was used. The procedure was performed under general anesthesia without a brachial plexus block.

His glenoid was conservatively reamed to a single concavity without a specific attempt to modify glenoid version. A smooth, thin, standard length humeral component with an anteriorly eccentric head (used to manage the excessive posterior translation noted at surgery (see this link)) was inserted with impaction autografting. Our technique for this procedure is shown in this link.

After surgery this man completely dedicated himself to the rehabilitation program (see this link). Here are some of his exercises at several months after surgery

Two years after his ream and run, he sent in these x-rays, showing a radiagraphic joint space between the reamed glenoid and the well-centered eccentric humeral head prosthesis. He has no evidence of instability on his activities, which range from hockey to salsa dancing.

This case demonstrates the effect of the man's dedication to his rehabilitation. It also shows the remarkable regenerative capability of the reamed glenoid and the stabilizing effect of an anteriorly eccentric humeral head component, which can be seen on the comparable pre and postoperative axillary "truth" views.