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Rotator Cuff Tears
Posted: Feb 7 2024 #(C102409)
A

Large Rotator Cuff Tear in 71M

;
Large Rotator Cuff Tear in 71M

HPI

A 71-year-old male, retired active male, RHD, presents with left shoulder pain of 3-month duration. The pain is worse with forward elevation, in which he reports it is a 10 out of 10. He reports difficulty sleeping at night due to shoulder pain. He is an avid pickleball player and is unable to play due to the pain in his shoulder. He is taking Motrin and Tylenol with minimal pain relief. He has attempted physical therapy and one cortisone injection with no significant and lasting pain relief. His cortisone injection was done 9 weeks ago.

PMH

His past medical history is significant for Type 2 DM and hypertension.

PE

On physical exam, he has full active elevation with pain. There is positive but minimal, atrophy of supraspinatus and infraspinatus. He has 5- out of 5 strengths in Jobe’s and Empty-can tests. He has 5 out of 5 strength to external rotation. Active external rotation at his side to 60 degrees. His provocative tests are negative for the lift-off sign and Napoleon sign, Hornblower's sign, and Popeye's sign. His neurovascular exam is normal. There is no tenderness to palpation over the AC joint.

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
5%
35/602
    • Additional radiographic views (aXR)
    0%
    4/602
    • CT scan of the shoulder (CT)
    1%
    7/602
    • MRI scan of the shoulder (MRI)
    79%
    481/602
    • aXR + CT
    0%
    1/602
    • aXR + MRI
    6%
    41/602
    • CT + MRI
    3%
    19/602
    • aXR + CT + MRI
    0%
    6/602
    • Outside my area of expertise - best if I don't vote
    1%
    8/602
    • PROCEDURE #1

    Rotator Cuff Repair Augmented with Acellular Dermal Matrix Mechanical Allograft

    Intra-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)
    5
    If you choose Rotator cuff repair, how would you prepare the footprint to enhance the healing of your cuff repair?
    Lightly decorticate with burr (decorticate)
    6
    If you choose Rotator Cuff Repair, what technique would you perform?
    Double-Row Repair
    7
    If you choose Rotator Cuff Repair, would you use the Rotator Cuff Healing Index (RoHI) to determine if you will augment the repair?
    Yes - I would use RoHI to determine if I will augment the repair
    8
    If you choose Rotator cuff repair, would you augment it with a biologic and/or mechanical graft augment?
    Augment with Mechanical Graft Alone
    9
    If you choose Rotator cuff repair with a Mechanical Augment Graft, which one would you use?
    Allograft - Acellular Dermal Matrix (ex. ArthroFlex)
    10
    If you choose Rotator cuff repair with a Mechanical Augment Graft, how would you integrate the graft into your repair?
    I would integrate into cuff repair
    11
    If you choose Rotator cuff repair with a cellular biologic, which one would you use?
    I would not choose Rotator cuff repair with a biologic
    12
    If you choose Operative Management with the Procedure shown, how long would you immobilize the patient in a sling post-operatively?
    5-6 weeks
    13
    If you choose operative management with the procedure shown, when would you begin Strengthening exercises?
    11-12 weeks
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