Rotator Cuff Arthropathy in 63F

HPI

A 63-year-old female presents with right shoulder pain, worsening over the past 6 months. She has a history of rotator cuff repair in 2015 and revision cuff repair in 2016. Did well until 2020, then had atraumatic gradual onset of pain. She has undergone cortisone injection and attempted PT without relief. She now has difficulty reaching arm to shoulder height and above. Denies any numbness/tingling in the arm. VAS Pain score: 2/10 ASES: 83 Subjective Shoulder Value: 30% Constant: 56

PMH

None

PE

Focused physical examination of the right shoulder reveals well-healed arthroscopic portals without open wounds or abrasions. There is moderate infraspinatus muscle atrophy and mild scapular dyskinesia with repetitive forward flexion in the scapular plane. There is tenderness to palpation over the biceps grove and coracoid. Her ROM is as follows: Range of Motion (Active/Passive): Right Shoulder Forward Flexion (FF) 90/135 degrees External Rotation (ER) 5/10 degrees Internal Rotation (IR) T12 Abduction (ABD) 85/110 degrees Range of Motion (Active/Passive): Left Shoulder Forward Flexion (FF) 160/165 degrees External Rotation (ER) 45/50 degrees Internal Rotation (IR) T7 Abduction (ABD) 155/160 degrees   Strength Testing of the right shoulder reveals weakness of the supraspinatus (3+/5) and a 10-degree external rotation lag. There is 5/5 strength on belly press and bear hug.