The following case is an example of a similar clinical condition. This patient is in her seventies and presented with symptoms of pain and popping of the glenohumeral joint of the left shoulder. On radiographs of the shoulder, as seen below, there is a large anterior inferior acromial spur and a significant size spur at the footprint of the rotator cuff.
During surgery we found that the acromial spur was not eroding into the rotator cuff muscles and for this reason was left intact. The rotator cuff footprint bone spur was within the intact supraspinatus fibers and for this reason was left intact to avoid damage to rotator cuff from potential surgical removal. As it is well known one of the main reasons of failure of the total shoulder arthroplasty is rotator cuff denegeration and tearing. Removing the footprint "bone spur" would have caused damage to the rotator cuff and failure of the glenoid component in the long run.
The patient was seen in the office at 3 years postoperatively. She had no pain and active forward elevation of the shoulder to 170 degrees. Xrays are shown below
Although this is a case report (Level 5 of evidence) it highlights the need to think twice before saying to patients that "bone spurs in the shoulder = shoulder pain". Generalization and false analogy are common mistakes performed by scientists and physicians including myself.
Hippocrates was the first to introduce the concept of 'physis' and to transform hieratic or theocratic medicine into rational medicine. Correct use of new scientific knowledge, individualized management with a Hippocratic holistic approach and compassionate sympathy for the patient who suffers, should be considered in the years to come for maintaining the level of medical profession.
