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PRESENTATION
11
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POLLS
1,644
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OUTCOMES
13
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VIDEOS
8
0%
EVIDENCE
51
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Comments
36
CASE DESCRIPTION
AGE 63 / Female
CC Right shoulder pain
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.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102072/e323fabd-ec44-41b5-b6fc-746b9d327d2c_preop_1.jpg https://upload.orthobullets.com/cases/102072/1fd8c321-4bd9-47f0-95e6-fb679756b76c_preop_2.jpg https://upload.orthobullets.com/cases/102072/315235b7-3616-4ace-8840-0db65a166274_preop_3.jpg https://upload.orthobullets.com/cases/102072/d47c26f2-ca43-413c-bb36-e2c28b41c29f_ct_1.jpg https://upload.orthobullets.com/cases/102072/b1b1ca47-872e-483d-92ed-590fd5cf676b_ct2.jpg https://upload.orthobullets.com/cases/102072/e93d0ef3-ab9a-4283-984b-f2c9133078ac_ct3.jpg https://upload.orthobullets.com/cases/102072/a96ad6da-0628-4404-bf5d-a303846dcd70_ct4.jpg https://upload.orthobullets.com/cases/102072/805f62e5-8f9f-4cda-8018-a661698ed53e_ct5.jpg https://upload.orthobullets.com/cases/102072/a767058a-e341-4e2e-b227-1a450927de7a_preop_plan1.jpg https://upload.orthobullets.com/cases/102072/bd7e9734-1529-44de-9b8c-e6959920b9b3_preopplan2.jpg https://upload.orthobullets.com/cases/102072/2b69eee3-1689-48d0-9eea-2403b2ca6e53_preopplan_3.jpg
POLLS
OB Community
1) In addition to the plain AP and LAT radiographs, would you obtain any additional imaging studies to guide?
Other
2) Would you use a classification system to guide your management of this patient?
Other
3) If you choose Reverse total shoulder arthroplasty (RSA), would you use neuromonitoring for this case?
Other
4) If you choose Arthroplasty, what procedure would you perform?
Other
5) If you choose Arthroplasty, would you use a CT scan based pre-operative templating software program to plan for this surgery?
Other
6) If you choose Reverse total shoulder arthroplasty (RSA), would you use patient-specific guides?
Other
7) If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
Other
CASE OUTCOMES
PROCEDURE 1: Reverse Total Shoulder Arthroplasty
POLL#
SURGEON CHOICE
1
In addition to the plain AP and LAT radiographs, 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
Intra-procedure P1
https://upload.orthobullets.com/cases/102072/57d80212-cba0-48e7-9cc7-102c85ad5cda_nerve_monitoring.jpg https://upload.orthobullets.com/cases/102072/b4ce8b46-4596-47be-9650-cd56440b7a71_intraop1.jpg https://upload.orthobullets.com/cases/102072/cec90655-8cde-46a6-b2d7-2f1794257be9_intraop2.jpg https://upload.orthobullets.com/cases/102072/e72d693a-b8a0-49eb-9532-0649665df75c_intraop3.jpg https://upload.orthobullets.com/cases/102072/c96fd110-2375-43ea-b642-cf6d4f71eda9_intraop4.jpg https://upload.orthobullets.com/cases/102072/3aa37ff3-1480-4da1-856c-af707c74f9ea_intraop5.jpg https://upload.orthobullets.com/cases/102072/1c612e19-711e-4a2b-8612-f544c74dfcf5_intraop6.jpg https://upload.orthobullets.com/cases/102072/244d2b8e-89f7-4cbf-bd95-92ee4f3967f3_intraop7.jpg https://upload.orthobullets.com/cases/102072/d7c96dac-fe36-40b8-8b14-5170e7165ea7_intraop8.jpg https://upload.orthobullets.com/cases/102072/49667101-2f51-4c27-97d3-e62f3ceaf769_intreaop9.jpg https://upload.orthobullets.com/cases/102072/a371130f-9216-492a-8b9c-56671f27234b_fluoro1.jpg https://upload.orthobullets.com/cases/102072/1303d66b-6e2c-4a7a-9891-6926e80a375c_fluoro3.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/102072/dae13f5a-a506-4756-914b-76c6c05e39fa_postop2.jpg
VIDEOS & PODCASTS (8)
EVIDENCE (51)
EXPERT COMMENTS