A woman in her mid thirties developed painful arthritis of the right shoulder after prior arthroscopic Bankart with remplissage and a subsequent Latarjet procedure for glenohumeral instability. On exam her shoulder was very stiff and felt unstable with "clunking" on movement.
X-rays at presentation showed glenhumeral arthritis, posterior decentering on a biconcave glenoid, and fixation of the coracoid on the anteroinferior glenoid by two large screws.
After discussion regarding the pros and cons of the alternatives, the patient elected an anatomic total shoulder arthroplasty.
No preoperative CT scan or 3D planning was used. The procedure was performed under general anesthesia without a brachial plexus block.
The arthritic humeral head showed a large posterior Hill-Sachs defect.
The long head tendon of the biceps was preserved.
After concentric reaming with a nubbed (non-cannulated) reamer, one of the pegs on the glenoid component could not be fully seated because of interference with one of the screws. A pine-cone bur was used to remove part of the screw to allow for full, secure seating of the glenoid component. A posteriorly eccentric humeral head was used to control excess anterior translation.
After careful mobilization of the subscapularis, a robust repair was achieved with 6 fiber wire sutures and two additional reinforcement sutures placed in the lateral rotator interval.
In the post anesthesia care unit, the patient demonstrated near full assisted flexion without the preoperative "clunking" and without feelings of instability.
Comment: In this case it was elected not to attempt removal of the screws to avoid the risk of damage to the musculocutaneous nerve, axillary nerve, and axillary artery that may be scarred in non-anatomical positions.
Comments welcome at shoulderarthritis@uw.edu
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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).
