ICJR CASES: How Would You Manage These Shoulder Patients?

    During a session at ICJR’s Shoulder Course last year, moderator Anand Murthi, MD, FRCSC, challenged a panel of experienced shoulder surgeons to view radiographs, MRIs, and CT scans from 6 patients who had presented with significant shoulder issues, listen to the history and physical exam findings, and comment on how they would manage these patients surgically.

    Panel members for this session included:

    • Joseph A. Abboud, MD
    • Mark A. Frankle, MD
    • Mark D. Lazarus, MD
    • Michael J. O’Brien, MD
    • Eric T. Ricchetti, MD,

    Here are the patients they considered:

    Patient 1

    • 82-year-old female with rheumatoid arthritis
    • Had been doing well 2 years after a right reverse total shoulder arthroplasty
    • Began experiencing pain in her left shoulder; VAS pain score of 8/10
    • Uses a wheelchair for mobility

    Patient 2

    • 16-year-old male
    • Quarterback on his school’s football team; injured his shoulder when sacked
    • Pain and crepitus; unknown if the shoulder had dislocated
    • Referred for surgery when he failed conservative therapy (corticosteroid injections, physical therapy)

    Patient 3

    • 67-year-old female
    • Chronic right shoulder pain; VAS pain score 8/10
    • Failed conservative therapy (corticosteroid injections, physical therapy, non-steroidal anti-inflammatory drugs)
    • 80° forward elevation, 20° external rotation, internal rotation to the hip; all painful

    Patient 4

    • 64-year-old female
    • Sales/advertising executive
    • Had undergone a hemiarthroplasty for osteoarthritis about 8 years prior
    • Underwent a second procedure following subscapularis failure; glenoid bone graft and pectoralis major transfer

    Patient 5

    • 83-year-old female
    • 2-year history of prodromal right shoulder pain from glenohumeral osteoarthritis
    • Fell onto her outstretched hand, resulting in complex proximal one third humerus fracture
    • Managed non-operatively, but presented 6 months later with very painful, symptomatic non-union

    Patient 6

    • 34-year-old male
    • Laborer; lays cable all day
    • Presents with significant pain (VAS pain score 6-7/10) and crepitus with range of motion
    • Fails conservative therapy
    • Wants to continue working

    Click the image above to hear what the panel members had to say about managing these patients.

    Disclosures: The faculty have no disclosures relevant to this presentation.