Round Table Discussion of Minimally Invasive Surgery Upper Extremity Cases
Dr. Flatow: This first case is a 55-year-old, right hand-dominant ex-police detective who was injured in a motor vehicle accident in 1978. We don’t have the initial films of the shoulder fracture, but he was evidently treated with olecranon-pin traction for 5 weeks. We first saw him in 1988, when he was virtually ankylosed and had moderate pain. The pain became gradually worse over the ensuing 18 years, and is now unbearable (requiring narcotic pain medications). He is also frustrated with the stiffness: he has elevation of 90°, external rotation to negative 10°, and internal rotation with the hand reaching the buttocks posteriorly. Dr. Parsons, are there any joint-sparing options for this patient?
Dr. Parsons: Joint-sparing procedures such as arthroscopic capsular release and osteoplasty, or open debridement procedures, are options in cases of glenohumeral arthritis in patients with mild arthrosis without substantial articular deformity. These types of procedures can be very helpful in decreasing pain and improving motion in properly selected patients, especially patients who are too young or too physically active to undergo shoulder replacement. Gerry Williams has had success with open debridement and a biological resurfacing of the glenoid with capsular tissue in carefully selected patients; younger, more active patients with primary glenohumeral osteoarthritis. However, once there are extensive arthritic changes, especially in posttraumatic arthritis where significant deformity exists, the success of these options is less predictable. In a patient such as this, I would offer two main options: continuing to live with the shoulder the way it is or considering replacement arthroplasty.