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A case of Reverse Shoulder Replacement for a 40yr old with Post-traumatic Arthritis of Shoulder

A 40yr old male, Kenyan came to me with complaints of severe pain and stiffness in right shoulder since 10 months. He sustained an injury to right shoulder while playing football in Kenya when he had a direct blow to his shoulder. He neglected the injury and did not take any treatment for the injury. He started developing pain and stiffness in his shoulder for which he visited many doctors in Kenya but they could not offer any treatment and hence he came to India for treatment.

On history, there was no other joint pains, no fever, no infection, appetite was good, no significant weight loss. On examination, his shoulder movements were severely restricted due to pain. Crepitus was present, the Hawkins test was positive, Empty can test was positive, Drop arm test was positive. I advised him to undergo all the blood investigations, X-ray, 3DCt scan and MRI of the shoulder joint. Blood tests were normal.

In Ct scan, large erosion was noted along the superior articular surface of the humeral head, osteophytes and multiple cortical cysts along with the posterolateral humeral head, mild subluxation of the humeral head, large hillsach’s lesion of size 21x25mm. Glenoid: Type A2(Walch classification). Friedman angle: 1.6 degrees.

MRI scan showed that he had severe glenohumeral arthritis with chondromalacia and large erosions, old non-union of coracoid process, complete glenoid labrum tear, supraspinatus and subscapularis tear. He was diagnosed to have Severe post-traumatic Secondary Arthritis of shoulder with Rotator cuff tear. He has advised Reverse Shoulder Arthroplasty surgery.

This surgery was performed under General Anaesthesia and Interscalene block in Beach chair position. Delto-pectoral approach was used. Shoulder joint was severely arthritic which was replaced with Cementless Reverse Shoulder replacement prosthesis from Exactech. Surgery was successful. The patient is given a shoulder sling to be used for 6 weeks and he needs physical therapy and rehabilitation to get back to his daily routine.

In a Reverse Shoulder Replacement, the normal ball-and-socket structure is reversed. An artificial ball is attached to the shoulder blade. An artificial socket is attached to the top of the arm bone. The large deltoid muscle that covers the shoulder is typically able to move the arm.

Dr M. Kaushik Reddy, M.S Ortho Fellow in Shoulder & Elbow Surgery(Japan), (Consultant Orthopaedic Surgeon)

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