There is great current interest in the ream and run, the pyrocarbon humeral head and B type glenoids. A recent publication, B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty, reports a series of 41shoulders (in 35 patients, mean age of 57.9 years) that had a ream and run (glenoid reaming and humeral hemiarthroplasty without a prosthetic glenoid component) using a pyrocarbon humeral head. This procedure was offered to healthy young and/or active individuals (heavy workers or athletes ..read more

Overview Understanding loss of internal rotation after reverse shoulder arthroplasty: a narrative review of current literature Functional internal rotation after RSA is optimized by maximizing impingement-free arc of motion and subscapularis repair in patients with mobile scapulothoracic joints, adequate preoperative humerothoracic extension, and low body mass index. Do internal rotation and global range of motion affect patient outcomes? Internal rotation limitation is prevalent following modern reverse shoulder arthroplasty and negatively affects patients' subjective rating of the pr ..read more

Getting the best result from shoulder arthroplasty depends not only on the diagnosis and the excellence of the surgery, but also on the condition of the patient. As presented in Patient's Guide to Optimal Recovery there is much we can do to help the patient in optimizing their outcome. What other non-surgical factors should we consider prior to performing elective shoulder arthroplasty? One area of focus is preemptively identifying and managing comorbidities, such as anemia, cardioopulmonary conditions, kidney disease and depression.  Another set of high impact factors are the o ..read more

Deconflicting use of the term "subluxation".  Most orthopaedic surgeons use the word subluxation to refer to separation of the surfaces of a joint, as in patello-femoral subluxation In this classic article, Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis,   the authors defined subluxation of the shoulder in a manner consistent with the standard use of the term:  decentering of the humeral head with respect to the perpendicular bisector of the plane of the glenoid face. Thus, this humeral head is not subluxated. Neither is this one where ..read more

 The B2 glenoid is characterized by posterior decentering of the humeral head on a biconcave glenoid. This pathoanatomy can be managed by anatomic total shoulder (without or with an augmented glenoid component) or by a reverse total shoulder arthroplasty. However, neither of these options may be suitable for active individuals who wish to avoid the risks and limitations of a prosthetic glenoid component.  Here are two such cases. Case 1 - A 64 year old active carpenter with shoulder pain, stiffness and symptoms of posterior instability. His preoperative axillary "truth" view demonstr ..read more

 Preparing for Elective Shoulder Surgery Most shoulder surgeries are elective, including operations for arthritis, rotator cuff problems, and dislocation. This gives patients the opportunity to bring their best, most healthy, and most prepared self to the operating room. Here are some recommendations for you to consider. Please discuss them with your surgeon and primary provider. A. Get Comfortable with the Surgery and Recovery Discuss with your surgeon: 1.    The planned procedure, including likely benefits and possible risks 2.    Surgical and n ..read more

Dwight D. Eisenhower, our 34th President, said “the plan is nothing, planning is everything”, meaning that while specific plans may change, the act of planning itself is crucial because it prepares us to anticipate, adapt and respond effectively. Thus, while there are important qualities of each patient’s arthritic shoulder that are only be revealed once the osteophytes have been removed and the contracted soft tissues are released, we can anticipate some elements of the surgery with consideration of the patient’s pre surgical anatomy as seen on plain radiographs and the pr ..read more

Acromial stress fractures (ASFs) and scapular spine stress fractures (SSFs) are important complications of reverse total shoulder arthroplasty, limiting patient comfort and function and creating difficult surgical challenges for open reduction and internal fixation.  Acromial stress fractures and scapular spine stress fractures are related primarily to unmodifiable patient risk factors: (1) poor bone density (osteoporosis, female sex, older age, and inflammatory arthritis) and (2) diagnoses of rotator cuff deficiency (cuff tear arthropathy and massive rotator cuff tear). These factor ..read more

 Preoperative planning is helpful in anticipating what might be needed to reconstruct an arthritic shoulder; however the final choice of implants is determined at the time of surgery. A 43 year old man presented with pain and stiffness of his left shoulder. He had a prior CT scan showing an arthritic humeral head centered on a somewhat retroverted glenoid. We obtained our standard set of plain radiographs: an AP in the plane of the scapula and an axillary "truth" view taken with the arm in a functional arm position of elevation. The truth view showed posterior decentering of the humeral ..read more

 Owl you need is love.  Superb owl photo I took during Super Bowl You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link Follow on twitter/X: https://x.com/RickMatsen Follow on facebook: https://www.facebook.com/shoulder.arthritis Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/ Here are some videos that are of shoulder interest Shoulder arthritis - what you need to know (see this link). How to x-ray the shoulder (see this link). The ream and run proc ..read more