A 58 year old woman with type II diabetes presented with several year history of pain and weakness of the right shoulder. This started while she wasworking as a stocker grocery distributorship following lifting heavy bins of hominy and other produce. On one occasion she noted an audible pop. At evaluation she had passive elevation of 140 and active elevation of 80 degrees. She had grade three strength of elevation, grade four strength of external rotation and grade 5 strength of internal rotation. There was palpable crepitus on active and passive shoulder movement.
Her images at the time of presentation are shown below.
Her symptoms did not respond to 2 months of PT.
After discussion of the alternatives, including superior capsular reconstruction, biologic patches, tendon transfers and reverse total shoulder arthroplasty, the patient elected to have smooth and move: an outpatient fifteen minute open procedure performed through an anterior deltoid split without sacrifice of acromial or coracoacromial ligament integrity with excision of the hypertrophic bursa, resection of the ragged ends of the torn tendons, and resection of the prominent aspects of the uncovered greater tuberosity followed by a manipulation to assure full range of passive motion.
At surgery the findings of the MRI were confirmed. The undersurface of the coracoacromial arch was smooth. The long head tendon of the biceps and subscapularis were intact; no biceps surgery was performed.
After surgery she was encouraged to perform range of motion exercises and to return to active use of her shoulder immediately.
At six weeks after surgery she returned for routine followup, reporting that her preoperative pain was relieved by the afternoon of surgery and had not returned. She was able to return to full use of her shoulder.
A video of her active motion at her 6 week visit is shown here.
In contrast to the alternatives, this procedure is inexpensive, allows immediate post operative return to function, and does not preclude subsequent procedures in the unusual circumstance of recurrent symptoms.
For this woman, the smooth and move was a wise choice.
Great horned owl
Ravenna Park, Seattle
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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).
