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31st Annual Tampa Shoulder Course: Arthroplasty & Sports
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Rotator Cuff Tears
Posted: Nov 6 2023 #(C102280)
A

Massive Rotator Cuff Tear​ in 62M Electrician

;
Massive Rotator Cuff Tear​ in 62M Electrician

HPI

A 62-year-old male, electrician, presents with a 2-year history of worsening pain in his left shoulder. He complains of night pain and difficulty with overhead activities. The patient had 1 prior cortisone injection 6 months ago and attempted PT for 3 months with no significant improvement in his symptoms.

PMH

He is active and does not smoke or use drugs. He occasionally drinks alcohol. His past medical history is significant for HTN and GERD. His past surgical history is significant for a prior appendectomy and left knee scope for meniscal debridement.

PE

On physical exam, he has full forward flexion and abduction. He has External rotation to 40 degrees, and Internal Rotation to L5. He has a Positive Neer and Hawkins sign. He has a negative ER lag sign and a negative Hornblowers. There is no tenderness at the AC joint. He has 4/5 strength to FE and ER, 5/5 strength to IR, and a negative lift-off test.

Poll
1 of 1
1. If you choose Operative management, what treatment would you perform? * includes tenodesis or tenotomy if needed
I would not choose Operative Management
3%
22/705
    • Rotator cuff debridement +/- subacromial decompression (D+/-SAD) Alone *
    13%
    92/705
    • Rotator cuff repair (RCR) Alone *
    18%
    129/705
    • Superior capsular reconstruction (SCR) Alone *
    8%
    57/705
    • Subacromial balloon (Balloon) Alone *
    2%
    17/705
    • Tendon transfer (TT) Alone *
    3%
    22/705
    • Biologic Interpositional Tuberosity Graft (Biologic Tuberoplasty) Alone *
    1%
    13/705
    • Arthroplasty
    9%
    66/705
    • RCR + SCR *
    18%
    129/705
    • RCR + TT *
    7%
    54/705
    • RCR + Biologic Tuberoplasty *
    3%
    27/705
    • Other / Other Combination
    3%
    22/705
    • Outside my area of expertise - best if I don't vote
    7%
    55/705
    • PROCEDURE #1 DOP: 10/6/2023

    Arthroscopic Biologic Interpositional Tuberosity Graft

    Intra-procedure P1
    icon
    OUTCOMES
    6 weeks after
    Post-procedure P1
    POLL#
    Surgeon's Choices
    2
    If you choose Operative management, what treatment would you perform? * includes tenodesis or tenotomy if needed
    Biologic Interpositional Tuberosity Graft (Biologic Tuberoplasty) Alone *
    4
    If you choose Biologic Interpositional Tuberosity Graft (Biologic Tuberoplasty) Alone, what graft would you use?
    Allograft - Dermal
    5
    If you choose Biologic Interpositional Tuberosity Graft (Biologic Tuberoplasty) Alone, what anchor/suture fixation construct would you use?
    Suture Cross Bridging over Graft (sutures tied and crossed over graft)
    11
    If you choose Operative Management with the Procedure shown, how long would you immobilize the patient in a sling post-operatively?
    5-6 weeks
    12
    If you choose operative management with the procedure shown, when would you begin Strengthening exercises?
    7-8 weeks
    14
    If you are doing Biologic Interpositional Tuberosity Graft (Biologic Tuberoplasty) Procedures, which of the following statement regarding to Superior Capsular Reconstruction (SCR) is most true in your practice?
    I do SCRs - but have largely replaced it with Biologic Tuberoplasty because it is cheaper with similar outcomes
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