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PRESENTATION
6
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POLLS
2,453
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OUTCOMES
14
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VIDEOS
6
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EVIDENCE
52
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Comments
34
CASE DESCRIPTION
AGE 53 / Male
CC Left Shoulder Pain
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.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102073/6e83ee82-5fcd-4841-8ca9-371b8c4095ba_jss_xr_1.jpg https://upload.orthobullets.com/cases/102073/920b005b-97fd-4d99-bd01-795e95100319_jss_xr_2.jpg
Pre-procedure VIDEOS:
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POLLS
OB Community
1) In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Other
2) Would you use a classification system to guide your management of this patient?
Other
3) How would you definitively manage this patient?
Other
4) If you choose Nonoperative management, how long would you attempt physical therapy?
Other
5) If you choose Operative management, what surgery would you perform?
Other
6) If you choose Superior capsular reconstruction (SCR), what graft would you use?
Other
7) If you choose a Tendon Transfer, what tendon would you transfer?
Other
8) If you choose Lower Trapezius Tendon transfer, would you do this arthroscopically or open?
Other
9) If you choose Lower Trapezius Tendon transfer, how would you position the patient?
Other
10) If you choose Lower Trapezius Tendon transfer, how long would you immobilize the patient in a sling post-operatively?
Other
11) If you choose Lower Trapezius Tendon transfer and would immobilize the patient, what type of sling would you utilize?
Other
12) If you choose a treatment other than Subacromial balloon spacer (Balloon), what is the primary reason you did not choose a Balloon?
Other
CASE OUTCOMES
PROCEDURE 1: Left lower trapezius tendon transfer with Achilles allograft
POLL#
SURGEON CHOICE
5
In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Yes - MRI scan of the shoulder (MRI)
6
Would you use a classification system to guide your management of this patient?
Yes - a combination of those named above
7
How would you definitively manage this patient?
Operative
8
If you choose Nonoperative management, how long would you attempt physical therapy?
5-6 weeks
9
If you choose Operative management, what surgery would you perform?
RCR + TT
11
If you choose a Tendon Transfer, what tendon would you transfer?
Lower Trapezius (TRAP)
12
If you choose Lower Trapezius Tendon transfer, would you do this arthroscopically or open?
Arthroscopic-assisted
13
If you choose Lower Trapezius Tendon transfer, how would you position the patient?
Beach-chair
14
If you choose Lower Trapezius Tendon transfer, how long would you immobilize the patient in a sling post-operatively?
5-6 weeks
15
If you choose Lower Trapezius Tendon transfer and would immobilize the patient, what type of sling would you utilize?
Sling with external rotation pillow
Intra-procedure P1
https://upload.orthobullets.com/cases/102073/d59414a4-3a2d-43c5-8239-9d53f2f0f3f4_jss_io_1.jpg https://upload.orthobullets.com/cases/102073/6fd250c0-7e60-482c-bfa7-7224c507a858_jss_io_2.jpg https://upload.orthobullets.com/cases/102073/6ee38451-f130-4277-9cb6-912ded28345f_jss_io_3.jpg https://upload.orthobullets.com/cases/102073/f00605cf-f57f-496c-9006-00a7813f8af4_jss_io_4.jpg https://upload.orthobullets.com/cases/102073/363307d4-cf5f-47be-b003-82a79d507ba2_jss_io_5.jpg https://upload.orthobullets.com/cases/102073/e7717b5b-c688-49c8-9523-0e8a178a1c70_jss_io_6.jpg https://upload.orthobullets.com/cases/102073/ed2d2734-324f-48a9-8e98-b6bc3507e953_jss_io_7.jpg https://upload.orthobullets.com/cases/102073/e17e6c0c-6494-4ffe-98ea-015fdc552255_jss_io_8.jpg https://upload.orthobullets.com/cases/102073/b3a6d028-bc91-4982-ab7c-c70279b73f9a_jss_io_9.jpg https://upload.orthobullets.com/cases/102073/edc1a350-776d-44f1-b038-14eb3aa1924d_jss_io_10.jpg
Post-procedure P1
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VIDEOS & PODCASTS (6)
EVIDENCE (52)
EXPERT COMMENTS