A 51 year old general contractor, competitive bow hunter and swimmer presented with persistent and limiting left shoulder pain and grinding that has been refractory to arthroscopic “debridement” and intraarticular steroid injections. On examination he had limited motion with 80 degrees of glenohumeral flexion, 0 degrees of external rotation, and internal rotation to the gluteal area. His x-rays at presentation show osteoarthritis with inferior and posterior decentering and severe B2 pathoanatomy.
CT scanning and the use of planning software were avoided. The procedure was performed under general anesthesia without a nerve block. A subscapularis peel was performed, preserving the long head tendon of the biceps.
His humeral head showed the “Friar Tuck” pattern of central cartilage loss.
Conservative glenoid reaming was performed without attempt to modify glenoid version. Intraoperative trialing indicated that a 54 20 anteriorly eccentric humeral head provided the optimal balance of mobility and stability. The postoperative x-rays are shown below.
Five months after surgery he reported ” Shoulder doing good saw great improvements this month. Strength is improving and have resumed construction work with some limitations. Haven’t started shooting a bow yet but soon I think. Thanks for a great shoulder” and provided the video shown below of his active motion.
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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).
