An active 80 year old presented with pain and stiffness of his left dominant shoulder. He could perform only 4 of the twelve functions of the Simple Shoulder Test. His images at the time of presentation showed posterior decentering of the humeral head on a biconcave retroverted glenoid.
How would you manage this man's shoulder?
The patient was a practicing orthopaedic surgeon, now retired. After discussion of the pros and cons of anatomic total shoulder with an augmented glenoid, reverse total shoulder with an augmented baseplate and a ream and run, he chose the latter.
His procedure was performed without a preoperative CT scan, 3D planning, or inter scalene block. His biceps tendon was intact and preserved (no tenotomy or tenodesis). The shoulder was approached through the deltopectoral interval with a subscapularis peel. The glenoid was conservatively reamed to a single concavity without attempt to change glenoid version. A smooth standard length humeral stem was fixed with impaction autograft providing a low filling ratio. An anteriorly eccentric humeral head was used to help center the head in the glenoid. The cuff was intact; the subscapularis repair was robust.
Here are his immediate postoperative x-rays
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).