35 year old man with a painful, stiff shoulder after three prior arthroscopic labral surgeries -anchor arthropathy

A 35 year old man presented with a history of having dislocated his shoulder 18 years ago in college football when he was pushing up from the ground and another player fell onto his shoulder. He had labral surgery which did not restore stability. He had another surgery a year later - a revision where prominent anchors were found. He still had instability anteriorly, and then underwent yet another labral repair 15 years ago. He subsequently served in the military for 5 years. He has stage 3 chronic kidney from taking non-steroidal anti inflammatory drugs for his shoulder pain..

He presented to us with a painful, stiff right shoulder, answering "no" to all  12 questions of the Simple Shoulder Test.  He wants to return to heavy physical activity.

On examination his passive glenohumeral forward elevation was painful, limited to 70 degrees, and accompanied by catching and grinding. X-rays at presentation are shown below. 

After discussion of the alternatives, he desired to proceed with a ream and run procedure.

At surgery his humeral head was arthritic and two prominent metallic suture anchors were found on the face of the glenoid,

The anchors were removed with a trephine (see Anchor arthropathy in a young athlete).

Reaming was then carried out followed by a standard ream and run procedure that included Betadine lavage and topical Vancomycin to be followed by a 3 week course of Doxycycline as infection prophylaxis. The procedure was performed under general anesthesia without a brachial plexus block.

Prior to discharge on the postoperative morning, his passive flexion was measured at 150 degrees and took place without the grinding and catching that was present preoperatively.

Functional outcome results will be reported as they become available. 

Comment: Anchor arthropathy is an important cause of arthritis in young athletes. The instructive posts below merit careful review by shoulder arthroscopists, arthroplasty surgeons and patients. 

Anchor arthropathy in a young athlete

Suture anchors - never out of the woods.

40 year old athlete with severe anchor arrthropathy

Anchor arthropathy

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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).