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Glenohumeral Arthritis (Shoulder Arthritis)
Posted: May 1 2020 #(C101448)
A

Glenohumeral osteoarthritis in 58F - Posterior bone loss

HPI

A 58-year-old female presents with a 3-year history of worsening right shoulder pain.  Previously a cortisone injection provided moderate, short lived relief.

PMH

PE

On physical exam there is tenderness to palpation over the biceps tendon with none over the AC joint or greater tuberosity. She has active forward elevation is to 120 degrees, with pain and crepitus. She has active external rotation in adduction to 30 degrees, and internal rotation to the SI joint. She has good strength in the supraspinatus with external rotation testing. She has an intact belly press. Sensation to light touch is intact throughout. There is a palpable 2+ distal radial pulse.

Poll
1 of 12
1. Would you require additional to determine your treatment?
No - Current xrays are sufficient
18%
169/926
Yes - Additional xrays
0%
5/926
Yes - CT of shoulder (CT)
36%
341/926
Yes - MRI of shoulder (MRI)
19%
184/926
Yes - CT + Additional xrays
1%
15/926
Yes - MRI + Additional xrays
0%
3/926
Yes - MRI + CT
18%
169/926
Yes - MRI + CT + Additional xrays
1%
14/926
Outside my area of expertise - best if I don't vote
2%
26/926
2. Would you use a classification system to guide management?
No - a classification system would not help me
27%
248/887
Yes - Walch wear classification (original)
25%
226/887
Yes - Modified Walch / Iannotti (additional B3 and C2 glenoid subtypes)
36%
325/887
Yes - other
1%
14/887
Outside my area of expertise - best if I don't vote
8%
74/887
3. How would you manage this patient?
Nonoperative
11%
107/922
Operative
84%
775/922
Outside my area of expertise - best if I don't vote
4%
40/922
4. If you choose Operative management, what technique would you use?
I would not choose Operative management
1%
18/916
Arthroscopic debridement (comprehensive arthroscopic management)
4%
41/916
Biologic resurfacing (Interpositional allografting)
0%
9/916
Prosthetic resurfacing
7%
68/916
Arthroplasty
81%
747/916
Outside my area of expertise - best if I don't vote
3%
33/916
5. If you choose Arthroplasty, what would you do?
I would not choose Arthroplasty
1%
15/912
Hemiarthroplasty
4%
45/912
Anatomic total shoulder arthroplasty (TSA)
72%
660/912
Reverse total shoulder arthroplasty (RTSA)
17%
156/912
Outside my area of expertise - best if I don't vote
3%
36/912
6. If you choose Anatomic total shoulder arthroplasty (TSA), what approach would you use?
I would not choose TSA
2%
24/890
Deltopectoral
88%
789/890
Anterosuperior
4%
38/890
Outside my area of expertise - best if I don't vote
4%
39/890
7. If you choose Anatomic total shoulder arthroplasty (TSA), how would you manage the subscapularis?
I would not choose TSA
1%
16/873
Subscapularis tenotomy
28%
250/873
Subscapularis peel
26%
228/873
Lesser tuberosity osteotomy
21%
192/873
Subscapularis-sparing
14%
124/873
Outside my area of expertise - best if I don't vote
7%
63/873
8. If you choose Anatomic total shoulder arthroplasty (TSA), what kind of instrumentation would you use?
I would not choose TSA
1%
13/850
Conventional
65%
557/850
Patient-specific
17%
147/850
Computer-assisted
8%
70/850
Robotic-assisted
1%
9/850
Outside my area of expertise - best if I don't vote
6%
54/850
9. If you choose Anatomic total shoulder arthroplasty (TSA), what type of humeral component would you use?
I would not choose TSA
1%
12/844
Stemless
18%
155/844
Short-stem
62%
527/844
Long-stem
12%
104/844
Outside my area of expertise - best if I don't vote
5%
46/844
10. If you choose Anatomic total shoulder arthroplasty (TSA), what type of glenoid component would you use?
I would not choose TSA
1%
15/829
Pegged only
51%
430/829
Keeled only
7%
65/829
Pegged and keeled
29%
241/829
Outside my area of expertise - best if I don't vote
9%
78/829
11. If you choose Anatomic total shoulder arthroplasty (TSA), how would you address the posterior glenoid bone loss?
I would not choose TSA
2%
18/815
I would not address the posterior glenoid bone loss
7%
64/815
Eccentric reaming only
54%
441/815
Structural allograft only
16%
133/815
Custom patient-specific component
12%
104/815
Outside my area of expertise - best if I don't vote
6%
55/815
12. If you choose Anatomic total shoulder arthroplasty (TSA), would you anticoagulate the patient post-operatively?
I would not choose TSA
1%
10/531
No - I would not anticoagulate the patient post-operatively
50%
268/531
Yes - for 2 weeks post-operatively
23%
126/531
Yes - for 4 weeks post-operatively
14%
79/531
Yes - for 6 weeks post-operatively
4%
22/531
Outside my area of expertise - best if I don't vote
4%
26/531
PROCEDURE #1

CPT 23472: Total Shoulder Arthroplasty

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