Reverse Shoulder Arthroplasty Pathway Posted: 1/1/2022 ID: (C101924) Critical Concepts in Shoulder & Elbow Surgery

Charcot Shoulder in 58F

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EVIDENCE

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CASE DESCRIPTION

AGE	58 / Female
CC	Left shoulder pain
HPI	A 58-year-old retired teacher presents for evaluation of chronic left shoulder. She reports that her motion has significantly worsened over the years. She has tried multiple cortisone injections in the past. No prior surgical intervention on the shoulder. No reported trauma or history of infection. Recent ultrasound-guided aspiration of the shoulder revealed 553 WBC with no crystals and no growth on cultures after 14 days. Labs revealed unremarkable WBC, ESR and CRP. An MRI of the cervical spine was obtained which showed no intrinsic cord pathology or syrinx. Non-smoker. No EtOH use. No history of steroid use.
PMH	Left shoulder adhesive capsulitis in 2017 which improved without surgery, Parkinson's disease (diagnosed in 2019) and is on multiple medications for this.
PE	Focused examination of the left shoulder reveals an active and passive forward elevation of 50 and 60 degrees, respectively. External rotation to neutral. Internal rotation to the back pocket. Strength is 4/5 with forward elevation and 4/5 for abduction, external and internal rotation. Crepitus is appreciated in the shoulder. Patient has severe pain at the end range of motion

AGE/GENDER:

58 / Female

CHIEF COMPLAINT:

Left shoulder pain

HISTORY OF PRESENT ILLNESS:

A 58-year-old retired teacher presents for evaluation of chronic left shoulder. She reports that her motion has significantly worsened over the years. She has tried multiple cortisone injections in the past. No prior surgical intervention on the shoulder. No reported trauma or history of infection. Recent ultrasound-guided aspiration of the shoulder revealed 553 WBC with no crystals and no growth on cultures after 14 days. Labs revealed unremarkable WBC, ESR and CRP. An MRI of the cervical spine was obtained which showed no intrinsic cord pathology or syrinx. Non-smoker. No EtOH use. No history of steroid use.

PAST MEDICAL HISTORY:	Left shoulder adhesive capsulitis in 2017 which improved without surgery, Parkinson's disease (diagnosed in 2019) and is on multiple medications for this.
PHYSICAL EXAM:	Focused examination of the left shoulder reveals an active and passive forward elevation of 50 and 60 degrees, respectively. External rotation to neutral. Internal rotation to the back pocket. Strength is 4/5 with forward elevation and 4/5 for abduction, external and internal rotation. Crepitus is appreciated in the shoulder. Patient has severe pain at the end range of motion
DIAGNOSIS:	Charcot Shoulder in 58F