Review Question - QID 1229

With a history of a Putti-Platt procedure with the radiograph, the patient most likely has post-capsulorrhaphy arthropathy.

Post-stabilization procedure arthritis is thought to occur due to changes in contact loading in the shoulder joint due to fixing the joint in an incongruent posistion. It can be severe and debilitating, and lead to arthroplasty as a salvage procedure. The Putti-Platt procedure involves a division of the subscapularis tendon and anterior capsule, and realignment of the lateral tendon stump and capsule sewn into the anterior glenoid neck capsular insertion. The "pants-over-vest" style of repair is then finished by sewing the medial tendon stump into the tuberosity, so that external rotation is significantly limited by the soft tissue imbrication. There is no coracoid transfer for this stabilization procedure.

Bigliani et al. reported on a series of similar patients who developed arthritis following surgery for recurrent glenohumeral dislocation. Authors have theorized that instability repair may excessively tighten the joint in one direction and cause a fixed subluxation in the direction opposite from the side of repair, leading to severe degenerative arthritis due to inappropriate contact loading. 77% of patients following arthroplasty after post-capsulorrhaphy arthropathy had an excellent or satisfactory outcome, with improved pain and range of motion.

Figure A demonstrates severe osteoarthrosis of the affected shoulder, with significant joint space narrowing, periarticular osteophyte formation, and subchondral sclerosis.

Incorrect Answers:
Answers 1, 3, 4, 5: While all of these choices can lead to end-stage arthritis and indications for shoulder arthroplasty, the history given in this question stem indicates Answer 2 as the underlying diagnosis. Of course, the capsulorrhaphy may have been performed for traumatic dislocation, but the best answer choice for this stem is Answer 2.