Rotator Cuff Tears Pathway
Posted: 7/31/2022
ID: (C102073)
Critical Concepts in Shoulder & Elbow Surgery
2023 Critical Concepts in Shoulder & Elbow Surgery
Irreparable Rotator Cuff Tear in 53M
PRESENTATION
6
POLLS
3,835
OUTCOMES
14
VIDEOS
6
EVIDENCE
67
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:
Pre-procedure VIDEOS:
POLLS
OB Community
CASE OUTCOMES
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PROCEDURE 1:
Left lower trapezius tendon transfer with Achilles allograft
POLL#
SURGEON CHOICE
1
In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Yes - MRI scan of the shoulder (MRI)
2
Would you use a classification system to guide your management of this patient?
Yes - a combination of those named above
3
How would you definitively manage this patient?
Operative
4
If you choose Nonoperative management, how long would you attempt physical therapy?
5-6 weeks
5
If you choose Operative management, what surgery would you perform?
RCR + TT
7
If you choose a Tendon Transfer, what tendon would you transfer?
Lower Trapezius (TRAP)
8
If you choose Lower Trapezius Tendon transfer, would you do this arthroscopically or open?
Arthroscopic-assisted
9
If you choose Lower Trapezius Tendon transfer, how would you position the patient?
Beach-chair
10
If you choose Lower Trapezius Tendon transfer, how long would you immobilize the patient in a sling post-operatively?
5-6 weeks
11
If you choose Lower Trapezius Tendon transfer and would immobilize the patient, what type of sling would you utilize?
Sling with external rotation pillow
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Intra-procedure P1
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Post-procedure P1
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EVIDENCE (67)