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PRESENTATION
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POLLS
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OUTCOMES
15
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VIDEOS
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EVIDENCE
25
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Comments
18
CASE DESCRIPTION
AGE 67 / Male
CC Right Shoulder Pain
HPI A 67-year-old male, electrician, presents with a 1-year history of atraumatic right shoulder pain. His pain is worse with overhead and behind-the-back activities. He had an ultrasound-guided PRP injection and course of physical therapy 3 months ago with only minimal relief. He presents with persistent symptoms and disability.
PMH Gall Stones Left Shoulder Rotator Cuff Repair
PE A focused physical examination of the right shoulder reveals tenderness at the anterolateral bursa. His shoulder range of motion is: ER in neutral abduction to 45 degrees, IR in neutral abduction to L2, forward flexion to 165 degrees. His cervical spine range of motion is full. On strength testing: 4/5 supraspinatus, 5/5 subscapularis, 5/5 infraspinatus, and 5/5 biceps. Provocative tests reveal a positive Speeds, Hawkins and Neer's test. He is distally neurovascular intact.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101520/screen shot 2020-08-07 at 1.58.18 pm.jpg https://upload.orthobullets.com/cases/101520/aafa71da-838d-4831-826c-32a0e332bdd1_screen_shot_2020-08-05_at_6.42.31_am.jpg https://upload.orthobullets.com/cases/101520/7e830f02-9420-4a3d-ab51-e534f79727df_screen_shot_2020-08-05_at_6.42.53_am.jpg https://upload.orthobullets.com/cases/101520/5383834c-4667-4b51-b003-1f2c36cf8ada_screen_shot_2020-08-05_at_6.44.59_am.jpg https://upload.orthobullets.com/cases/101520/0ceae252-9921-404e-9b7d-de902d8896ff_screen_shot_2020-08-03_at_3.16.13_pm.jpg https://upload.orthobullets.com/cases/101520/d6e41861-6b0e-4776-b0f7-03dd52e6c177_screen_shot_2020-08-03_at_3.16.46_pm.jpg https://upload.orthobullets.com/cases/101520/5032ebd5-c7fe-46a8-b3da-45292e3585f3_screen_shot_2020-08-03_at_3.20.28_pm.jpg https://upload.orthobullets.com/cases/101520/e38590d5-0ba6-4cc9-9824-4cda2c45a455_screen_shot_2020-08-03_at_3.18.55_pm.jpg https://upload.orthobullets.com/cases/101520/21357755-7b0d-443e-88e8-a3338d2abfcf_screen_shot_2020-08-03_at_3.21.01_pm.jpg
Pre-procedure VIDEOS:
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POLLS
OB Community
1) In addition to the MRI provided, would you obtain any further imaging to guide your treatment?
Other
2) Would you use a classification system to guide your management of this patient?
Other
3) How would you manage the patient at this time?
Other
4) If you choose Nonoperative management and would offer an injection, what type of injections would you perform?
Other
5) If you choose Operative management, how long would you wait after the last injection to perform surgery?
Other
6) If you choose Operative treatment, what would you recommend?
Other
7) If you choose Operative management with Rotator Cuff Repair (RCR), what treatment would you plan on performing?
Other
8) If you choose In situ rotator cuff repair (INSITU-RCR), what approach would you use?
Other
9) If you choose In situ rotator cuff repair (INSITU-RCR), what construct would you perform?
Other
10) If you choose In situ rotator cuff repair (INSITU-RCR), would you perform an acromioplasty?
Other
11) If you choose In situ rotator cuff repair (INSITU-RCR), would you augment your repair with biologics?
Other
12) If you choose Operative management and attained the construct shown below, when would you discontinue the sling post-operatively?
Other
13) If you choose Operative management and attained the construct shown below, when would you begin active range of motion of the shoulder?
Other
CASE OUTCOMES
PROCEDURE 1: Small Partial Thickness Degenerative Rotator Cuff Repair - Arthroscopic
Intra-procedure P1
https://upload.orthobullets.com/cases/101520/93216d9c-a16a-4937-9b33-073a5ffe7d6b_rc_articular_side..jpg https://upload.orthobullets.com/cases/101520/f5eb3a31-1846-4432-9c63-12fc3cea12d6_biceps..jpg https://upload.orthobullets.com/cases/101520/17da4f7f-bf4a-49a3-99ab-1da4c718fc6c_ca_lig..jpg https://upload.orthobullets.com/cases/101520/df26bcb6-6cf7-41aa-91a7-e8412ff4980d_spur..jpg https://upload.orthobullets.com/cases/101520/b2a6e8e7-3a3f-4ede-bd64-452090a0209b_rc_bursal_2..jpg https://upload.orthobullets.com/cases/101520/86092a85-f6f7-40bc-b664-c0c09a59198d_rc_post_debride..jpg https://upload.orthobullets.com/cases/101520/76072876-42b0-44d2-a082-22ad7c6d1f3e_vents..jpg https://upload.orthobullets.com/cases/101520/53cc036a-2922-4859-aef0-ef40081828c2_single_row_repair_2..jpg
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Post-procedure P1
https://upload.orthobullets.com/cases/101520/30928fd5-1637-4cdd-bc5a-20e75fced211_screen_shot_2020-08-03_at_3.13.55_pm.jpg https://upload.orthobullets.com/cases/101520/7178ef47-003d-4c07-be35-38c70f66f6f5_screen_shot_2020-08-03_at_3.14.02_pm.jpg
VIDEOS & PODCASTS (4)
EVIDENCE (25)
EXPERT COMMENTS