AANA/SOMOS Enduring Shoulder Program 2024-Discussion/Case Presentations: Complex Shoulder Pathology

Video Transcription

Video Summary

The discussion focused on two complex shoulder cases with challenging management issues. The first was a 19-year-old nonverbal autistic male with recurrent anterior shoulder dislocations linked to seizure disorder and significant bone defects. Despite surgeries including open bone grafting, rim plissage, and immobilization with a shoulder spica cast, the patient continued dislocating, culminating in a fracture and failed fixation. Options debated included aggressive reconstructive surgery, glenohumeral arthrodesis (fusion), or resection arthroplasty. Due to difficulties controlling seizures and post-op compliance, the team opted for resection arthroplasty, which ultimately satisfied the family by eliminating recurrent ER visits. The second case was a 42-year-old fit female triathlete with post-fracture shoulder pain, stiffness, rotator cuff atrophy, and low-grade infection (osteomyelitis). After hardware removal and antibiotics, she underwent humeral head replacement and subsequently a reverse shoulder arthroplasty due to nonfunctional cuff. She experienced stem loosening from trauma and repeated infections, requiring multiple revisions, antibiotic spacers, and eventually a hybrid glenoid implant to manage bone loss and persistent infection. The panel emphasized the complexity of managing infected shoulder arthroplasties, the challenges of diagnosing low-grade infections like Cutibacterium acnes, and the importance of multidisciplinary approaches. They noted cautious use of bone-preserving implants in younger patients, infection vigilance, and tailored postoperative care to optimize outcomes in these difficult scenarios.

Asset Caption

Moderators: Jennifer Smith, M.D., Andrew J. Sheean, M.D., Larry D. Field, M.D., FAANA
Panel: Jeanne C. Patzkowski, M.D., FAANA, Felix (Buddy) H. Savoie III, M.D., Daniel J. Song, M.D., FAANA, William J. Ciccone II, M.D., FAANA, Kyong Su Min, M.D., Alan S. Curtis, M.D., FAANA, Michael A. Donohue, M.D.

Keywords

shoulder dislocation

seizure disorder

resection arthroplasty

rotator cuff atrophy

osteomyelitis

reverse shoulder arthroplasty

Cutibacterium acnes infection