This 49-year-old male presents to our clinic with a one-year history of progressive left shoulder pain. He has been seen and evaluated by Dr. Reginald Hall who ordered an MRI as part of the workup and this demonstrated severe degenerative arthritis of the shoulder with loose bodies and a full fitness subscapularis tear. The patient notes mainly shoulder stiffness and does not necessarily perceive a lot of weakness. He wants restoration of function and to a lesser extent wants restoration of his pain.
REVIEW OF SYSTEMS
Negative.
PHYSICAL EXAMINATION
On exam, this is a well nourished male in no acute distress. The mood and affect is normal. The gait is normal. Cervical spine moves well. Cranial nerves are intact. This shoulder abducts to about 120 degrees, …show more content…
PLAN
I had a long detailed discussion with the patient and told him that years from now a reverse shoulder arthroplasty would be an option, certainly at this point, I would strongly advise not getting a shoulder replacement. We went over the complications of this procedure and he agrees that right now it is not in his best interest. We discussed the subscapularis tear seen on MRI and I told the patient that clinically he had functional internal rotation motion and therefore, I would not recommend a subscapularis repair. I also pointed out to the patient with his severe degenerative arthritis and already restricted range of motion that a subscapularis repair might create a severe internal rotation contracture and would prevent him from performing activities of daily living such as reaching the arm out and into an external rotation such as changing a radio or driving a car. These activities could be severely compromised given his current situation. I also pointed out that years from now when he does get a shoulder replacement he will probably want a reverse shoulder replacement and in that case the subscapularis as well as supraspinatus as
REVIEW OF SYSTEMS
Negative.
PHYSICAL EXAMINATION
On exam, this is a well nourished male in no acute distress. The mood and affect is normal. The gait is normal. Cervical spine moves well. Cranial nerves are intact. This shoulder abducts to about 120 degrees, …show more content…
PLAN
I had a long detailed discussion with the patient and told him that years from now a reverse shoulder arthroplasty would be an option, certainly at this point, I would strongly advise not getting a shoulder replacement. We went over the complications of this procedure and he agrees that right now it is not in his best interest. We discussed the subscapularis tear seen on MRI and I told the patient that clinically he had functional internal rotation motion and therefore, I would not recommend a subscapularis repair. I also pointed out to the patient with his severe degenerative arthritis and already restricted range of motion that a subscapularis repair might create a severe internal rotation contracture and would prevent him from performing activities of daily living such as reaching the arm out and into an external rotation such as changing a radio or driving a car. These activities could be severely compromised given his current situation. I also pointed out that years from now when he does get a shoulder replacement he will probably want a reverse shoulder replacement and in that case the subscapularis as well as supraspinatus as