A 57 year old man with rheumatoid arthritis on methotrexate and Humira presented with pain, crepitance and weakness of the left shoulder coming on after doing pushups. His symptoms did not respond to 12 weeks of physical therapy. Of note he had a reverse total should on the contralateral side for irreparable cuff tear.
On examination he had active and passive elevation to 140 degrees, but pronounced crepitance and discomfort on active motion.
His AP radiograph showed a narrowed acromiohumeral interval.
After discussion of the alternatives, he elected a smooth and move procedure. A preoperative MRI was not obtained.
At surgery hypertrophic bursa and an irreparable supraspinatus tear were identified along with an irregular prominence of his tuberosity at the supraspinatus insertion site. The remainder of his cuff was intact.
After one hour in the recovery room he was dressed and ready for discharge with full, smooth and comfortable active elevation.
Comment: The smooth and move is a conservative surgical procedure that can be offered to patients with irreparable cuff tears and retained active elevation. It preserves the coracoacromial arch. It does not include the implantation of balloons or patches. It enables immediate resumption of active elevation and all activities as tolerated. Finally, it does not burn bridges to subsequent procedures should they become necessary.
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).
