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Rotator Cuff Tears
Posted: Jul 31 2022 #(C102073)
A

Irreparable Rotator Cuff Tear in 53M

;
Irreparable Rotator Cuff Tear in 53M

HPI

A 53-year-old male, right-hand dominant, presents for generalized left shoulder pain over the past 20 years. He reports his pain as a 4/10 that worsens with activity. The patient works as a manual laborer building tractors. He has undergone 3 prior rotator cuff repairs on the involved shoulder, with the most recent repair being 7 years prior. He is taking hydrocodone for pain.

PMH

PMH: Type II DM (Hgb A1c of 8.0)

PE

A focused physical examination of the left upper extremity reveals well-healed arthroscopic incisions. His active shoulder range of motion is forward elevation 165, abduction 90, external rotation 40, and internal rotation L1. He demonstrates weakness with the bear hug maneuver and in abduction with the empty can test. He has 3/5 weakness in external rotation with no external rotation lag sign. He is neurovascularly intact distally.

Poll
1 of 1
1. In addition to the standard radiographs of the shoulder, what additional imaging studies would you get to guide treatment?
None - standard radiographs of the shoulder are sufficient
2%
11/410
    • Additional radiographic views (aXR)
    0%
    0/410
    • CT scan of the shoulder (CT)
    4%
    17/410
    • MRI scan of the shoulder (MRI)
    72%
    299/410
    • aXR + CT
    0%
    2/410
    • aXR + MRI
    7%
    29/410
    • CT + MRI
    8%
    35/410
    • aXR + CT + MRI
    1%
    6/410
    • Outside my area of expertise - best if I don't vote
    2%
    11/410
    • PROCEDURE #1

    Left lower trapezius tendon transfer with Achilles allograft

    Intra-procedure P1
    icon
    OUTCOMES
    Post-procedure P1
    POLL#
    Surgeon's Choices
    1
    In addition to the standard radiographs of the shoulder, what additional imaging studies would you get to guide treatment?
    MRI scan of the shoulder (MRI)
    2
    Would you use a classification system to guide your management of this patient?
    Yes - a combination of those named above
    4
    If you choose Nonoperative management, how long would you attempt physical therapy?
    5-6 weeks
    7
    If you choose a Tendon Transfer, what tendon would you transfer?
    Lower Trapezius (TRAP)
    8
    If you choose Lower Trapezius Tendon transfer, would you do this arthroscopically or open?
    Arthroscopic-assisted
    9
    If you choose Lower Trapezius Tendon transfer, how would you position the patient?
    Beach-chair
    10
    If you choose Lower Trapezius Tendon transfer, how long would you immobilize the patient in a sling post-operatively?
    5-6 weeks
    11
    If you choose Lower Trapezius Tendon transfer and would immobilize the patient, what type of sling would you utilize?
    Sling with external rotation pillow
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