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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 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
Pre-procedure IMAGES:
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Pre-procedure VIDEOS:
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POLLS
OB Community
1) In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
Other
2) Would you use a classification system to guide glenoid management?
Other
3) What do you think is contributing to this patient's advanced joint destruction?
Other
4) How would you manage this patient?
Other
5) If you choose Operative management, what technique would you use?
Other
6) If you choose Arthroplasty, what procedure would you perform?
Other
7) If you choose Arthroplasty, would you use a planning software to guide management?
Other
8) If you choose Arthroplasty, how would you manage the subscapularis?
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 use patient-specific instrumentation (PSI) for glenoid management?
Other
11) If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
Other
12) If you choose Reverse Total Shoulder Arthroplasty (RSA) with subscapularis repair, what would be your immediate postoperative motion restrictions?
Other
CASE OUTCOMES
PROCEDURE 1: Reverse total shoulder arthroplasty
Intra-procedure P1
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Post-procedure P1
https://upload.orthobullets.com/cases/101924/895349ca-e262-420e-9145-de0334852866_postop_xray_1.jpg https://upload.orthobullets.com/cases/101924/0dbf57ca-307c-4f80-9368-1f138825fb13_postop_xray_2.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (12)
EXPERT COMMENTS