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HPI

A 64 year-old male presents for evaluation of left shoulder pain. Patient reports a 3-year history of progressive shoulder pain that worsens at night. He is having difficulty with basic ADLs. He has been on NSAIDs and has had 4 cortisone injections over the last 2 years with the last 2 injections not providing much relief. No prior surgeries in the left shoulder

PMH

PMH: Hypertension. Gout. GERD SH: Patient is a retired teacher and is married with good support. Occasional EtOH, no smoking. He enjoys kayaking, pickleball and fishing.

PE

Focused examination of the left shoulder reveals active and passive FE to 120 deg & active and passive ER to 10 deg. IR to left buttock. There is crepitus noted throughout his range of motion. He has 5/5 strength in external and internal rotation. Patient is neurovascularly intact.

Poll
1 of 10
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
4%
22/542
Yes - additional radiographic views (aXR)
1%
10/542
Yes - CT scan of the shoulder (CT)
42%
232/542
Yes - MRI scan of the shoulder (MRI)
13%
75/542
Yes - aXR + CT
9%
50/542
Yes - aXR + MRI
1%
9/542
Yes - CT + MRI
18%
102/542
Yes - aXR + CT + MRI
5%
28/542
Outside my area of expertise - best if I don't vote
2%
14/542
2. How would you manage this patient?
Nonoperative
2%
12/510
Operative
95%
488/510
Outside my area of expertise - best if I don't vote
1%
10/510
3. If you choose Operative treatment, what treatment would you recommend?
I would not choose Operative treatment
0%
1/513
Arthroscopic debridement (i.e. CAM procedure)
2%
15/513
Arthroplasty
94%
485/513
Arthrodesis
0%
3/513
Other
0%
0/513
Outside my area of expertise - best if I don't vote
1%
9/513
4. 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
0%
2/506
No
22%
115/506
Yes
72%
368/506
Outside my area of expertise - best if I don't vote
4%
21/506
5. If you choose Arthroplasty with CT scan based pre-operative templating software program to plan for this surgery, would you order patient-specific guides to assist in the case?
I would not choose Arthroplasty with CT scan based pre-operative templating
6%
33/498
Yes
45%
228/498
No
40%
203/498
Outside my area of expertise - best if I don't vote
6%
34/498
6. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
0%
0/507
Hemiarthroplasty (HA)
2%
11/507
Ream and Run (non-prosthetic glenoid)
1%
8/507
Anatomic total shoulder arthroplasty (TSA)
58%
296/507
Reverse total shoulder arthroplasty (RSA)
35%
179/507
Other
0%
2/507
Outside my area of expertise - best if I don't vote
2%
11/507
7. If you choose anatomic Total shoulder arthroplasty (TSA), what type of glenoid component would you use?
I would not choose TSA
9%
45/486
Standard all poly glenoid
26%
128/486
Augmented glenoid
42%
205/486
Inlay glenoid
4%
23/486
Metal-backed glenoid
10%
50/486
Outside of my area of expertise - best if I don't vote
7%
35/486
8. If you choose Reverse Total Shoulder Arthroplasty (RSA), what would be your technique for implanting your glenoid component?
I would not choose RSA
28%
137/484
Standard baseplate in normal version along glenoid center line (Matsen’s line)
13%
64/484
Standard baseplate in anteversion engaging the alternate spine line
5%
28/484
Standard baseplate with posterior bone graft
7%
34/484
Posteriorly augmented baseplate
31%
154/484
High-side Reaming
3%
15/484
Other
0%
2/484
Outside my area of expertise - best if I don't vote
10%
50/484
9. If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
I would not choose RSA
21%
100/474
No
14%
70/474
Yes
60%
288/474
Outside my area of expertise - best if I don't vote
3%
16/474
10. If you choose Reverse Total Shoulder Arthroplasty (RSA) with subscapularis repair, what would be your immediate postoperative motion restrictions?
I would not choose RSA
16%
78/465
I would not have repaired the subscapularis
3%
18/465
No restriction
2%
13/465
Pendulums only
21%
101/465
Passive/active-assisted range of motion without limitations
5%
25/465
Passive/active-assisted range of motion without any external rotation passed neutral
38%
177/465
Sling on at all times (no active/passive shoulder ROM)
6%
30/465
Other
0%
4/465
Outside my area of expertise - best if I don't vote
4%
19/465
PROCEDURE #1

Left Reverse Total Shoulder Arthroplasty

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OUTCOMES
Post-procedure P1
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