|
Year |
2007 |
|---|---|
|
Question Number |
162 |
|
Category |
Shoulder and Elbow |
Question
Figure 58 shows the radiograph of a 75-year-old patient who has severe shoulder pain and is unable to elevate the arm. Nonsurgical management consisting of corticosteroid injections and 3 months of physical therapy has failed to provide relief. Treatment should now consist of
1- latissimus dorsi transfer.
2- arthroscopic debridement with possible rotator cuff repair.
3- hemiarthroplasty.
4- reverse shoulder arthroplasty
5- total shoulder arthroplasty.
Figures
Answer (click for answer)
The correct answer is 4- reverse shoulder arthroplasty
This patient has severe glenohumeral arthritis w/evidence of a massive, irreparable rotator cuff tear evidenced by the high-riding humeral head and his inability to elevate his arm. He has failed conservative mgmt and would benefit from surgical intervention. The best option for him is a reverse shoulder arthroplasty which does not rely on the rotator cuff and instead utilizes the deltoid for shoulder motion.
#1, #2, #3 are wrong as they have been shown to have poor results either in pain relief and/or function.
#5 is wrong as TSA are associated with a high rate of failure due to glenoid loosening.
Reference: Rittmeister M, Kerschbaumer F: Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg 2001;10:17-22.
Werner CM, Steinmann PA, Gilbart M, et al: Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005;87:1276-1486.
