The clinical presentation and radiograph is consistent with a diagnosis of rotator cuff arthropathy and of the options listed, a reverse total shoulder arthroplasty is most appropriate. A humeral head arthroplasty (e.g. hemiarthroplasty) would also be an appropriate treatment.
Figure A demonstrates the geyser sign indicating recurrent effusions with the synovial fluid free to communicate between the glenohumeral joint and subacromial bursa resulting from rotator cuff arthropathy. The classic surgical treatment of choice for these patients has been hemiarthroplasty. This patient also exhibits pseudoparalysis as he has active elevation of <90° (because of an unstable glenohumeral fulcrum rather than pain) with full passive range of motion.
Zuckerman et al reported Level 4 evidence with the use of shoulder hemiarthroplasty for rotator cuff tear arthropathy in 12 patients. They found that pain relief, satisfaction scores, and isokinetic strength were significantly improved following hemiarthroplasty.
Werner et al present Level 4 evidence of 58 patients with pseudoparalysis and rotator cuff arthropathy who underwent reverse total shoulder arthroplasty with a Delta III prosthesis. They found that subjective shoulder value, Constant score, active flexion, and active abduction were improved, however there was a 33% reoperation rate.
Zuckerman JD, Scott AJ, Gallagher MA: Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg 2000;9:169-172.
PMID:10888158 (Link to Abstract)
Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005 Jul;87(7):1476-86.
PMID:15995114 (Link to Abstract)