A 37 year old man from a few states South, dedicated to body building, presented with a prior diagnosis of right shoulder arthritis, labral tears, bursitis, biceps tendinitis previously treated elsewhere with "an arthroscopic subacromial decompression, distal clavicle excision, capsular release, chondroplasty, humeral and glenoid osteoplasty, removal of loose bodies, and manipulation under anesthesia" without apparent benefit.
At his initial visit, he was 5ft 10in, very muscular with a body weight of 240lbs. His shoulder motion was very limited: 100 degrees of elevation and no rotation.
His Simple Shoulder Test on presentation is shown below.
His x-rays at presentation are shown below.
Because of his desire to return to heavy weight training, he elected to have a ream and run procedure. No CT scan or three dimensional preoperative planning software was used.
His surgery was performed without a brachial plexus block. An in situ head cut was used because the shoulder's muscularity and capsular tightness.
His postoperative films are shown below.
One week after surgery, he had regained excellent flexibility
At three months after surgery, he was working on strength of flexion
At seven months post op, he was progressing his exercises.
At a year after surgery he sent this video of his workouts.
Comment: As can be seen, this is no ordinary patient, but rather one who is extremely motivated and who has been committed to stay in close email contact with the surgical team, even though he lives over a thousand miles away. As emphasized in The ream and run: not for every patient, every surgeon or every problem, patient motivation and surgical technique are elements critical to the outcome of the ream and run procedure. All the videos shown here were part of the patient's communication with the ream and run team and are shown with the patient's permission.
While other arthroplasty options - anatomic total shoulder, augmented glenoid components, reverse total shoulder - could have been considered after his failed arthroscopic surgery, none seemed as compatible with his activity goals as the ream and run procedure.
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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).
