ICJR CASES: Thinking Through the Right Treatment for 3 Shoulder Patients

    A 72-year-old patient has had right shoulder pain for 7 years, but now the pain has worsened and no longer responds to cortisone and anti-inflammatory drugs.

    A 64-year-old patient with rheumatoid arthritis has been experiencing significantly deteriorating shoulder function after 6 years of progressively worsening shoulder pain.

    A 69-year-old patient who underwent total shoulder arthroplasty has had increasing pain and decreasing shoulder function since feeling a sharp pain in the operated shoulder nearly a decade after the procedure.

    At ICJR’s 8th Annual Shoulder Course, Guido Marra, MD, shared these 3 cases from his practice and challenged a panel of experienced shoulder surgeons to review the physical exam and radiographic findings and then – on the spot – comment on how they would manage the patients.

    RELATED: Register for ICJR’s 9th Annual Shoulder Course, October 15-17

    Taking on this challenge were the following panel members:

    • April D. Armstrong, MD
    • Mark A. Frankle, MD
    • John M. Itamura, MD
    • Evan S. Lederman, MD
    • Grant E. Garrigues, MD
    • Mark D. Lazarus, MD
    • Thomas W. Quin Throckmorton, MD

    Below are more details of the cases. To hear more, click the image above.

    Case 1

    • 72-year-old, right hand-dominant male patient
    • Right shoulder pain for 7 years, managed with cortisone and anti-inflammatory drugs
    • Pain has worsened over the past 6 months
    • Forward elevation 120°, external rotation -15°, internal rotation to back pocket
    • Strength: 5/5 on elevation and external rotation, but painful
    • Positive belly compression test

    Case 2

    • 64-year-old right hand-dominant male patient
    • Diagnosed with rheumatoid arthritis at age 21; taking etanercept (Enbrel) and methotrexate
    • Left shoulder pain for 6 years, but becoming more painful with less function
    • Forward elevation 60°, external rotation 10°, internal rotation to anterior thigh
    • Strength: 3+/5 with pain

    Case 3

    • 69-year-old right hand-dominant male patient
    • Underwent left total shoulder arthroplasty in 2002
    • Was functioning well until he reached out and felt a sharp pain in 2012
    • Pain with decreasing function since then
    • Forward elevation 90°, external rotation 0°, internal rotation to back pocket
    • Strength: 4-/5 on elevation; 4/5 on external rotation
    • Positive belly compression test