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HPI

A 63-year-old female with extensive comorbidities presents with severe bilateral shoulder pain, right greater than left. She has tried conservative management without any significant improvement in her pain.

PMH

PMH: Significant for psoriatic arthritis requiring chronic prednisone use until 2020. She is not on any immunosuppressants currently. She has both cardiovascular and pulmonary issues and is obese (BMI 36). PSH: Hx of multilevel cervical spinal fusion.

PE

A focused physical examination of the right shoulder reveals severe limitations in range of motion with Elevation of ~ 20º, Abduction of ~ 10º, and External rotation of ~ 0º. Her posterior/middle and anterior deltoid all fire. She is neurovascularly intact.

Poll
1 of 7
1. In addition to the plain AP and LAT radiographs of the shoulder, would you obtain any additional imaging studies to guide?
No - AP and LAT radiographs are sufficient
3%
10/271
Yes - additional radiographic views (aXR)
0%
0/271
Yes - CT scan of the shoulder (CT)
56%
152/271
Yes - MRI scan of the shoulder (MRI)
8%
24/271
Yes - aXR + CT
4%
12/271
Yes - aXR + MRI
1%
3/271
Yes - CT + MRI
19%
54/271
Yes - aXR + CT + MRI
3%
9/271
Outside my area of expertise - best if I don't vote
2%
7/271
2. Would you use a classification system to guide your management of this patient?
No - a classification system would not help me
56%
148/262
Yes - Goutallier
5%
15/262
Yes - Hamada
8%
22/262
Yes - Seebauer
1%
4/262
Yes - Sirveaux
3%
9/262
Yes - Walch
9%
26/262
Yes - a combination of those named above
3%
8/262
Yes - other described Classification
9%
26/262
Outside of my area of expertise - best I don't answer
1%
4/262
3. If you choose Reverse total shoulder arthroplasty (RSA), would you use neuromonitoring for this case?
I would not choose Arthroplasty
0%
2/258
No
77%
201/258
Yes
14%
37/258
Outside my area of expertise - best if I don't vote
6%
18/258
4. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
0%
0/255
Hemiarthroplasty (HA)
1%
4/255
Ream and Run (non-prosthetic glenoid)
0%
2/255
Anatomic total shoulder arthroplasty (TSA)
7%
19/255
Reverse total shoulder arthroplasty (RSA)
87%
224/255
Other
0%
0/255
Outside my area of expertise - best if I don't vote
2%
6/255
5. If you choose Arthroplasty, would you use a CT scan based pre-operative templating software program to plan for this surgery?
I would not choose Arthroplasty
1%
3/253
No
22%
58/253
Yes
69%
177/253
Outside my area of expertise - best if I don't vote
5%
15/253
6. If you choose Reverse total shoulder arthroplasty (RSA), would you use patient-specific guides?
I would not choose RSA
0%
1/248
No
35%
89/248
Yes
54%
134/248
Outside my area of expertise - best if I don't vote
9%
24/248
7. If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
I would not choose RSA
0%
1/250
No
22%
55/250
Yes
72%
180/250
Outside my area of expertise - best if I don't vote
5%
14/250
POLL#
Surgeon's Choices
1
In addition to the plain AP and LAT radiographs of the shoulder, would you obtain any additional imaging studies to guide?
Yes - CT scan of the shoulder (CT)
2
Would you use a classification system to guide your management of this patient?
No - a classification system would not help me
3
If you choose Reverse total shoulder arthroplasty (RSA), would you use neuromonitoring for this case?
Yes
4
If you choose Arthroplasty, what procedure would you perform?
Reverse total shoulder arthroplasty (RSA)
5
If you choose Arthroplasty, would you use a CT scan based pre-operative templating software program to plan for this surgery?
Yes
6
If you choose Reverse total shoulder arthroplasty (RSA), would you use patient-specific guides?
No
7
If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
No
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