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PRESENTATION
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POLLS
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OUTCOMES
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VIDEOS
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EVIDENCE
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Comments
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CASE DESCRIPTION
AGE 63 / Female
CC Right shoulder pain
HPI A 63-year-old female presents with right shoulder pain, worsening over the past 6 months. She has a history of rotator cuff repair in 2015 and revision cuff repair in 2016. Did well until 2020, then had atraumatic gradual onset of pain. She has undergone cortisone injection and attempted PT without relief. She now has difficulty reaching arm to shoulder height and above. Denies any numbness/tingling in the arm. VAS Pain score: 2/10 ASES: 83 Subjective Shoulder Value: 30% Constant: 56
PMH None
PE Focused physical examination of the right shoulder reveals well-healed arthroscopic portals without open wounds or abrasions. There is moderate infraspinatus muscle atrophy and mild scapular dyskinesia with repetitive forward flexion in the scapular plane. There is tenderness to palpation over the biceps grove and coracoid. Her ROM is as follows: Range of Motion (Active/Passive): Right Shoulder Forward Flexion (FF) 90/135 degrees External Rotation (ER) 5/10 degrees Internal Rotation (IR) T12 Abduction (ABD) 85/110 degrees Range of Motion (Active/Passive): Left Shoulder Forward Flexion (FF) 160/165 degrees External Rotation (ER) 45/50 degrees Internal Rotation (IR) T7 Abduction (ABD) 155/160 degrees   Strength Testing of the right shoulder reveals weakness of the supraspinatus (3+/5) and a 10-degree external rotation lag. There is 5/5 strength on belly press and bear hug.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101976/6eff2dab-ff9b-4017-a351-d15a82e5cb24_ap_1..jpg https://upload.orthobullets.com/cases/101976/9781a7ec-4eb0-494b-a9f6-6c94c8e15897_axillary_1..jpg
Pre-procedure VIDEOS:
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POLLS
OB Community
1) In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Other
2) Would you use a classification system to guide your management of this patient?
Other
3) If you would use the Hamada Classification, what grade would you give this patient?
Other
4) If concerned for an infection, how would you work up the patient?
Other
5) How would you definitively manage this patient?
Other
6) If you choose Operative treatment and the patient received a corticosteroid injection last week, how long would you wait to perform surgery?
Other
7) If you choose Operative treatment, what would you recommend?
Other
8) If you choose Arthroplasty, what procedure would you perform?
Other
9) If you choose Reverse Total Shoulder Arthroplasty (RSA), how would you manage the glenoid?
Other
10) If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
Other
11) If you choose Reverse Total Shoulder Arthroplasty (RSA) with subscapularis repair, what would be your immediate postoperative motion restrictions?
Other
12) If you choose Reverse Total Shoulder Arthroplasty (RSA) with a subscapularis repair, what would your immediate postoperative weight-bearing status be?
Other
CASE OUTCOMES
PROCEDURE 1: Right shoulder arthroscopic debridement with soft tissue and bone biopsies; 5 biopsies obtained from different locations, all negative for infection
DOP: 7/2/2021
PROCEDURE 2: Right Reverse Total Shoulder Arthroplasty; Wedged augment utilized to correct the superior inclination back to neutral
DOP: 9/9/2021
Post-procedure P2
https://upload.orthobullets.com/cases/101976/a44e264e-a707-4d49-b9d6-8e4d33e5aa22_post1..jpg https://upload.orthobullets.com/cases/101976/5f80e969-720b-4fbf-bfa0-56640276eeb2_post2..jpg
VIDEOS & PODCASTS (7)
EVIDENCE (40)
EXPERT COMMENTS