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It might be worth a diagnostic injection to determine if pain is his primary restriction to his motion. If so, a debridement with a biceps tempting or tenodesis may be adequate. Otherwise, I would lean towards a reverse as definitive management.
I think we would be remiss to not enter the risk of acromial fracture with RSA into the conversation. At 5% incidence, and with inferior outcomes compared to non-fractured patients, it truly is one of the greatest downsides of a modern RSA, otherwise an outstanding treatment with a low risk of complications that is proving more durable than we thought. In a 69 year old male who has been a laborer his whole life, I would say he has a lower risk of acromial fx, so RSA would be great. Excluding cost, the subacromial balloon spacer would also be a great option and has little downside for this patient, has a clinical success rate of 85-90%, and has very little morbidity with a fast recovery.Same MRI in a 69 yo small-statured caucasian female with osteoporosis has a major risk of acromial fx, so I would do a balloon in 2021.
Totally agree with George Athwal that we need X-rays and saggital scan to determinate the fatty inflitration. In case of no OA and active patient I'll go for partial repair with LHBT augmentation ( if LHBT will be preserved with good quality) or just partial repair maybe with additional ballon. For active patient I prefer partial repair or SCR. RverseTSA is good for partial repair or screw which fail