This man presented with a three year history of progressive pain in his right “shooting” shoulder that prevented him from carrying out his work as a professional firearms instructor.
His examination revealed a painful stiff shoulder. His x-rays at presentation revealed glenohumeral arthritis with posterior decentering of the humeral head on a biconcave glenoid.
Because of the large, repeated impacts sustained by the shoulder in his occupation, he elected to have a ream and run procedure, rather than an anatomic or reverse total shoulder arthroplasty.
This was performed without preoperative CT scans, 3D planning, brachial plexus block, or sacrifice of the biceps tendon. The glenoid was conservatively reamed to preserve bone stock; no attempt was made to alter glenoid version. An anteriorly eccentric humeral head component was used to center the humeral head on the glenoid. The stem was smooth and fixed with impaction autografting.
Six years after his ream and run on the right, dominant, side, he returned to have a similar procedure on his left side (scheduled for when he’ll be 79 years old).
He reported excellent function of his right shoulder and full return to his work as a pistol instructor. His range of arm elevation 6 years after surgery is shown below.
His six year followup x-rays show secure fixation of his humeral component, with no stress shielding, and with the prosthetic head centered in the glenoid. There is no evidence of medial erosion or wear of his glenoid in spite of the heavy use to which this shoulder has been subjected.
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).
