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HPI

A 62-year-old male, right-hand dominant, presents with chronic right shoulder pain for many years. He has noted progressively decreased function and has failed a course of physical therapy, NSAIDs and corticosteroid injections. He is a laborer and wishes for pain relief and increased function.

PMH

PMH/PSH: non-contributory

PE

Focused physical examination of the right shoulder reveals no prior incisions. He has active forward flexion to 80, ER to 5, and IR to his sacrum. He has 5/5 deltoid and rotator cuff strength. He is neurovascularly intact.

Poll
1 of 12
1. In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
13%
100/735
Yes - additional radiographs (aXR)
0%
1/735
Yes - CT scan
30%
222/735
Yes - MRI
31%
228/735
Yes - aXR + CT
2%
18/735
Yes - aXR + MRI
1%
14/735
Yes - MRI + CT
15%
111/735
Yes - aXR + CT + MRI
2%
16/735
Outside my area of expertise - best if I don't vote
3%
25/735
2. Would you use a classification system to guide management?
No - a classification system would not help me
43%
286/664
Yes - Walch
46%
307/664
Yes - Other
2%
18/664
Outside my area of expertise - best if I don't vote
7%
53/664
3. If you choose Walch classification, how would you classify the glenoid?
I would not choose Walch classification
17%
104/607
A1
0%
5/607
A2
5%
35/607
B1
11%
68/607
B2
17%
106/607
B3
17%
105/607
C1
8%
54/607
C2
2%
16/607
D
0%
3/607
Outside my area of expertise - best if I don't vote
18%
111/607
4. How would you manage this patient?
Nonoperative
4%
28/627
Operative
92%
581/627
Outside my area of expertise - best if I don't vote
2%
18/627
5. If you choose Operative management, what technique would you use?
I would not choose Operative management
0%
4/640
Arthroscopic debridement
3%
24/640
CAM (comprehensive arthroscopic management) procedure
4%
27/640
Arthroplasty
86%
556/640
Arthrodesis
0%
4/640
Outside my area of expertise - best if I don't vote
3%
25/640
6. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
0%
6/643
Hemiarthroplasty (HA)
3%
24/643
Ream and Run (non-prosthetic glenoid)
2%
14/643
Anatomic total shoulder arthroplasty (TSA)
58%
373/643
Reverse total shoulder arthroplasty (RSA)
30%
198/643
Outside my area of expertise - best if I don't vote
4%
28/643
7. If you choose Anatomic Total Shoulder Arthroplasty (TSA), how would you take down the subscapularis?
I would not choose TSA
7%
45/605
Subscapularis-sparing approach
16%
99/605
Peel
22%
135/605
Lesser tuberosity osteotomy
22%
135/605
Tenotomy
21%
131/605
Outside of my area of expertise - best I don't answer
9%
60/605
8. If you choose Anatomic Total Shoulder Arthroplasty (TSA), how would you manage the glenoid version?
I would not choose TSA
8%
46/572
High-side reaming
16%
93/572
Augmented glenoid component
38%
218/572
Bone graft augmentation
7%
43/572
Combination of above
17%
99/572
Outside my area of expertise - best if I don't vote
12%
73/572
9. If you choose Anatomic Total Shoulder Arthroplasty (TSA), what type of glenoid component would you use?
I would not choose TSA
8%
45/542
Inlay
31%
171/542
Onlay
42%
233/542
Outside my area of expertise - best if I don't vote
17%
93/542
10. If you choose Anatomic Total Shoulder Arthroplasty (TSA) with an Onlay glenoid, what type of glenoid design would you use?
I would not choose TSA with Onlay glenoid
9%
47/511
Keel without augment
3%
17/511
Keel with augment
13%
68/511
Pegged without augment
12%
62/511
Pegged with augment
44%
225/511
Other
1%
6/511
Outside my area of expertise - best if I don't vote
16%
86/511
11. If you choose Anatomic Total Shoulder Arthroplasty (TSA), what type of humeral stem/head would you use?
I would not choose TSA
5%
27/513
Long stem (diaphyseal fitting)
13%
68/513
Short stem (metaphyseal fitting)
46%
239/513
Stemless
16%
86/513
Resurfacing humeral head
2%
14/513
Alternate bearing surface (i.e Pyrocarbon)
0%
5/513
Convertible stem
5%
27/513
Outside of my area of expertise - best I don't answer
9%
47/513
12. If you choose Anatomic Total Shoulder Arthroplasty (TSA) with an inlay glenoid component, what post-operative weight limit would you advise the patient?
I would not choose TSA with inlay component
18%
88/485
No restrictions on weight bearing
14%
71/485
10 lbs
30%
147/485
20-25 lbs
21%
104/485
30-40 lbs
2%
12/485
50 lbs
1%
6/485
Outside my area of expertise - best if I don't vote
11%
57/485
PROCEDURE #1

Right total shoulder arthroplasty with inlay glenoid

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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