Frank A. Petrigliano, MD

Patients with Parkinson’s disease who undergo reverse total shoulder arthroplasty may experience more complications and revisions than neurologically healthy patients, according to published results.

The patient is a 35-year-old right-hand dominant woman with 2 years of chronic right shoulder pain. She previously sustained a cerebral hemorrhage related to postpartum hypertension, which resulted in right-sided hemiparesis 2 years prior to presentation. At baseline, she had right upper extremity paresis that was worse than her right lower extremity paresis. She was able to walk short distances around the house, but her shoulder pain impaired her ability to take care of her three children. Her complaints were centered around shoulder pain that occurred while trying to use her arm. She currently uses her right hand as a helping hand to post objects that she then lifts with her left hand, but she cannot grasp or lift independently with the right upper extremity.

A 70-year-old right-hand-dominant man presented to the orthopedic clinic with 3 months of worsening left shoulder pain after having undergone total shoulder arthroplasty for primary glenohumeral arthritis 1.5 years earlier at an outside hospital. The patient denied any history of trauma but noted new areas of redness and skin discoloration over his left shoulder. He denied any systemic signs of illness including fevers, chills or night sweats, but did note increasing difficulty with range of motion secondary to pain. The patient attempted 3 months to 6 months of organized physical therapy, but experienced worsening disability and pain with his activities of daily living. The patient was a non-smoker with no significant medical history. On exam, the patient’s left shoulder showed a well-healed deltopectoral incision with small areas of blotchy erythema surrounding the incision. Range of motion (ROM) was 90° forward elevation (FE), 45° external rotation (ER) and internal rotation (IR) to S1. The motor exam demonstrated weakness in FE and IR, but neurologic examination was normal.