Anat Ambar — Health Portal

🦴 Priority — Right Shoulder Surgical Consult

Consulting surgeon: Dr. Edward C. Cheung, MD — UCLA Orthopaedic Sports Medicine & Shoulder Surgery (Santa Monica / Westwood).
Board-certified, fellowship-trained (Brown → UCLA residency → UCSF fellowship). Team physician LA Chargers (NFL), UCLA Bruins. Affiliated with Hospital for Special Surgery.
Purpose: Review both MRIs, discuss operation options for end-stage right glenohumeral (shoulder) osteoarthritis.

Study	Findings on File
MRI #1 Aug 4, 2023 outside facility · reviewed by Dr. Kwak Dec 2025	• Severe glenohumeral (shoulder joint) osteoarthritis • Labrum (fibrocartilage rim) tears — front, back, top, bottom (fraying throughout) • Moderate supraspinatus + infraspinatus tendinosis (rotator cuff) • Mild subscapularis tendinosis • Moderate long head biceps tendinosis + small midgrade attritional tear
MRI #2 Jul 27, 2026 Liberty Pacific, Tarzana · ordered by Dr. Chingkai Lin	• END-STAGE glenohumeral osteoarthritis — Grade 4 = bone-on-bone in multiple areas • Circumferential labral degeneration (entire socket rim, not one spot) • Biceps complex: partial anchor tear + horizontal attenuation + partial split tear • Supraspinatus: small partial-thickness articular-surface tear (Ellman I–II) + mild fatty infiltration • Rotator cuff otherwise relatively preserved (no full-thickness tears) • Moderate joint effusion + synovitis + loose bodies + mild bursitis

Study

Findings on File

MRI #1
Aug 4, 2023
outside facility · reviewed by Dr. Kwak Dec 2025

• Severe glenohumeral (shoulder joint) osteoarthritis
• Labrum (fibrocartilage rim) tears — front, back, top, bottom (fraying throughout)
• Moderate supraspinatus + infraspinatus tendinosis (rotator cuff)
• Mild subscapularis tendinosis
• Moderate long head biceps tendinosis + small midgrade attritional tear

MRI #2
Jul 27, 2026
Liberty Pacific, Tarzana · ordered by Dr. Chingkai Lin

• END-STAGE glenohumeral osteoarthritis — Grade 4 = bone-on-bone in multiple areas
• Circumferential labral degeneration (entire socket rim, not one spot)
• Biceps complex: partial anchor tear + horizontal attenuation + partial split tear
• Supraspinatus: small partial-thickness articular-surface tear (Ellman I–II) + mild fatty infiltration
• Rotator cuff otherwise relatively preserved (no full-thickness tears)
• Moderate joint effusion + synovitis + loose bodies + mild bursitis

📉 3-year progression: "severe" (2023) → "end-stage" (2026), with biceps complex involvement advancing considerably. Intact rotator cuff → likely candidate for anatomic Total Shoulder Replacement (TSR) rather than reverse TSR.

❓ Questions for Dr. Cheung

💡 Print this page (Ctrl+P / ⌘P) to bring to the appointment.

1
Anatomic TSR or reverse TSR — and specifically why, given my rotator cuff status?
2
Given both MRIs (2023 & 2026), is there any less invasive procedure that buys meaningful time (arthroscopic debridement, resurfacing, biologics) — or are we past that window?
3
Biceps tendon: tenotomy or tenodesis? What do you recommend, and what does recovery look like for each? (Tenotomy = higher chance of "Popeye" bulge but no functional loss; tenodesis = cleaner cosmetically, longer recovery.)
4
I'm left-hand dominant — does that change how you approach my right shoulder or the recovery plan?
5
What's realistic function post-op — range of motion, strength, activities I'll get back?
6
Recovery timeline before I can use my right arm for daily tasks?
7
How long do shoulder replacements last, and what happens when one needs revision?
8
What's the complication rate for this procedure — specifically for a patient with my profile?
9
"If this were your shoulder — what would you do?"

📊 Key Health Metrics

HbA1c

6.2 %

Jul 2026 · prediabetes ⚠️ trending up from 5.9

LDL

110 mg/dL

Jul 2026 · was 138 ✅ improved

Triglycerides

37 mg/dL

Jul 2026 · excellent ✅

Total Cholesterol

220 mg/dL

Jul 2026 · was 282 ⚠️ improved

CAC Score

0 Ag

Jun 2022 · no calcified plaque ✅

eGFR (Kidney)

94 mL/min

Jul 2026 · was 67 ✅ improved

Glucose (fasting)

102 mg/dL

Jul 2026 · slightly high ⚠️

TSH (Thyroid)

3.89 mIU/L

Jul 2026 · normal ✅ stable

Right Hip T-score

-1.9

2023 DXA · osteopenia · re-scan due ⚠️

Blood Pressure

137/80 mmHg

Apr 2026 · Stage 1 range ⚠️

Hemoglobin

12.3 g/dL

Jul 2026 · normal ✅

Weight

108 lbs

BMI ~19 · lean/low-normal

💊 Current Medications & Supplements

Venlafaxine (Effexor XR) 225mg

SNRI — depression / anxiety

Daily · max approved dose

Lamotrigine (Lamictal) 50mg

Mood stabilizer / augmentation

Daily · titrating → 100mg target ~Aug 19

Celebrex (celecoxib)

NSAID — shoulder arthritis pain

Dose per prescriber · take with food

Naproxen (Naprosyn) 500mg BID

NSAID — TMJ / joint inflammation

PRN course · with food

Fluticasone (Flonase)

Allergic rhinitis

Nasal spray daily

Fexofenadine (Allegra)

Allergic rhinitis

As needed

Valacyclovir (Valtrex) 500mg

HSV outbreak treatment

BID × 3 days PRN

Vitamin B12 (methyl, 1000mcg)

B12 deficiency (formally listed)

Morning · sublingual

Vitamin D3 + K2 (Thorne)

D insufficiency + bone health (osteopenia)

With biggest meal · 2–4 caps

👁️ Active Watch List

Issue	Status	Next Step
Right shoulder — end-stage OA	SURGICAL	Consult Dr. Cheung (UCLA) · operation options
A1c 5.9 → 6.2%	TRENDING UP	Discuss diet intervention w/ Dr. Azarmehr
Bone density (right hip -1.9)	OSTEOPENIA	DXA re-scan (first since 2020) · check if ≤ -2.5
Blood pressure 137/80	STAGE 1	Confirm home BP monitor · track w/ Dr. Azarmehr
Colonoscopy — strong paternal FHx colon CA	CONFIRM	Last scope + next due date
Mammogram (dense breasts)	CURRENT	BI-RADS 2 benign · next Sep 2026
Shingrix vaccine	CONFIRM	Shingles history — verify if vaccinated
TMJ / orofacial dystonia	ACTIVE	Dr. Newman f/u · Botox first-line option

👥 Care Team

Provider	Role
Dr. Edward C. Cheung, MD	Orthopedic Surgeon — shoulder (UCLA, Santa Monica)
Dr. Yalda Azarmehr, MD	Internist / PCP (Cedars-Sinai)
Dr. Steve K. Kwak, MD	Orthopedic Surgeon — right shoulder (SCOI Van Nuys)
Dr. Frank Petrigliano, MD	Orthopedic Surgeon
Dr. Taaly Silberman	OB-GYN
Dr. Alan Charles Newman, DDS	TMJ / Orofacial Pain (Beverly Hills)

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