A webinar for orthopaedic trainees
A good session with colleagues Michael Fleming and Terry Hammond, taking orthopaedic trainees through cases on shoulder replacement in patients with shoulder arthritis. The trainees performed well and handled all the questions put to them.
What shoulder arthritis is
Arthritis of the shoulder means the smooth cartilage that covers the ball and lines the socket has worn away, so that bone bears against bone. It causes pain, stiffness and a grinding sensation, and it usually progresses slowly over years. A shoulder replacement removes the worn surfaces and replaces them with artificial components. Individual results vary.
How orthopaedic trainees learn
An orthopaedic trainee, or registrar, is a qualified doctor working through a supervised training programme towards specialist qualification. Much of that training happens in theatre and in clinic, but a good deal of it takes the form of case-based teaching of the kind this webinar provided. A case is presented with its history and its imaging, and the trainee has to say what they would do and then defend it against questioning. The point is not to recall a fact but to reason through a decision out loud, which is also how the specialist examinations are conducted.
What trainees are working through
Shoulder replacement for arthritis is a good subject for case-based teaching because the decisions are rarely clear-cut. The questions that recur include whether the rotator cuff is intact and functioning, which largely determines whether an anatomic or a reverse total shoulder replacement is appropriate; how much bone remains in the socket and how it has worn; and whether the patient's age and demands make it reasonable to proceed at all, given that an implant has a finite life.
Equally important is recognising when a replacement is not yet warranted. Many people with shoulder arthritis do well for years with analgesia, activity modification, physiotherapy and occasional injections.
Related information
- Our shoulder arthritis page explains the condition
- Our post on the difference between ATSR and RTSR
- Our anatomic total shoulder replacement page
- Our reverse total shoulder replacement page