Ream and run for selected patients or "reverse for everything"? RnR vs RFE.

Some surgeons hold the view that all types of arthritis should be treated with a reverse total shoulder to avoid the risk of subscapularis, rotator cuff and glenoid component failure, accepting the risks associated with reverse total shoulder, such as baseplate failure, dislocation and acromion/spine fractures.

Some active patients are not comfortable with this approach, however, and wish to pursue the ream and run procedure. 

Consider the example of an athletic man, high school football coach, and firefighter in his early 40s who had a surgical procedure on his left shoulder for instability while he was a collegiate football player two decades earlier. At the time of that surgery, early arthritic changes were noted.

At the time of presentation he reported the Simple Shoulder Test results shown below.

His shoulder was stiff:

His x-rays showed secondary arthritis.

After discussion of the treatment options, he elected to proceed with the ream and run. The procedure was performed without a preoperative CT scan and under general anesthesia without a brachial plexus block. The long head tendon of the biceps was preserved. 

In that he lives on the opposite side of the U.S. we have not seen him in person since surgery. However, he has kept us posted regarding his progress.

To track his rehab culminating in a half-ironman 8 months after surgery see this link.

One year after surgery, he sent us these videos.

He is excited to be returning to his favorite activities.

Comments welcome at shoulderarthritis@uw.edu

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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).