Glenoid Fracture = Adhesive Capsulitis?

[adamd9]

Hi All,

For those of you who followed this thread and suspected some sort of impingement due to the placement of the remaining screw (just outside the glenoid joint space), I found an interesting article that gives that theory a lot more merit. I was seaching for "glenoid fracture internal fixation mechanical impingement" and found a research article titled Arthroscopic screw fixation of large anterior glenoid fractures, which mentioned "In one case, removal of the screw was necessary due to mechanical impingement."

What was interesting was the CT image that indicated the position of the impinging screw:



The article talks about a lack of internal rotation due to the screw placement. The lack of ROM was resolved with the removal of the screw.

From the article: "In the first treated case of this series, damage to the cartilage was observed in the anterior region of the humeral head due to mechanical impingement with the screw head. Implant removal became unavoidable because of pain and restricted internal rotation and was carried out 54 months after arthroscopic screw fixation. Clinical suspicion, based on complaints and physical exam, was complemented by a CT-scan, which revealed moderate sticking out of the screw head (Fig. 7). Meticulous study of the postoperative radiographs led us to believe that the screw was initially placed too close to the cartilage. After this first case, no implant complication occurred any more"................................."The serious problem of screw impingement with intra-articular damage could not be ignored. The implant-related complication had occurred in the first case of this series and was related, retrospectively, to the technical fault of setting the screw too close to the glenoid cartilage."

...which makes my first surgeon's causal response to the CT a little more interesting: "The screw might be protruding 8mm, but it's buried in the cartilage, so it's ok".

Even though my problem is mostly external rotation, I'm now more confident that the screw is more likely to be a primary factor of my lack of external rotation, especially given the more agressive angle of my screw:



I'd be interested in your thoughts...

[adamd9]

Hi All,

Just thought I'd post here to round off this discussion with some good news. A few weeks back I arranged to have a CT scan done while in external rotation and I finally got my report back:

Clinical Notes: Limited external rotation. ? screw impingement from prior surgery.

Findings: The patient was scanned in external rotation. Comparison is made to the prior
study from June 23, 2011. In fact it does appear that the protruding screw limits the
degree of external rotation. The humeral head lies immediately adjacent to the screw.

Conclusion: External rotation does appear limited by the anteriorly positioned screw as the humeral
head abuts the screw when compared to the prior study which was performed in neutral
position.

So, I now have all the justification I need to ask my surgeon to take that screw out as soon as he thinks it's a good idea to go in (bearing in mind it will probably be an open surgery).

Thanks for all your contributions!

Adam

[physiobob]

Also a big thanks from me Adam for continuing to keep us informed of your progress. I'd like to thank all for their contributions and hopefully you can let us know the results once the screw is out. You can link to youtube videos in your posts so it would be great to see a range of motion video before and after the removal. Best of luck with a speedy progress.