Indications and Considerations of Shoulder Replacement in Posttraumatic Conditions
Posttraumatic degeneration of the shoulder is one of the more difficult categories with which to deal when considering replacement surgery. On the whole, these patients tend to be young, they are disabled at an active and productive time in their lives, and the demands and stresses they will subsequently place on the prosthesis will be greater and of longer duration than those anticipated for the older osteoarthritic and the less active rheumatoid groups. The dominant arm will be involved more frequently, and there will usually have been previous surgery. In addition, these patients are more likely to have partial or complete nerve palsy (especially axillary) as well as bone loss or deformity (e.g., malunion or nonunion). The presence of these complicating factors requires a thorough preoperative assessment including multiple radiographic views or techniques and often electromyographic evaluation. Postinjury pain and scar may mask a partial axillary nerve palsy picked up on electromyography, which could alter the prognosis or the timing of any reconstructive surgery.
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