Dr. Ramesh Dalwai sends a case for discussion
This a 55 yr old gentleman ( rt. hand dominant) with H/O fall 5 months back. Sustained injury to Rt shoulder and was treated by a bone setter. Presented to His OPD with difficulty in overhead activities and ADL:
Gross wasting,ROM- Flexion upto 60 degrees,No Extension or External rotation, Abd -40 degrees. All movements associated with terminal pain only.No neuro-vascular deficits.
Any comments or tips on management
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if affordable I would do an MRI to check the head vascularity( negative predictive value only) as well as check for cuff tears. If both are fine I would go through a deltopectoral approach, mobilise the greater tuberosity. osteotomise the corocoid after elevating the P. minor, do a Latarjet to increase the glenoid arc and prevent further dislocation. Fix the the fracture with the philos plate. If avascular and cuff deficient a reverse shoulder is the method of choice.
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