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HPI

A 69-year-old male, with a history of prior right rotator cuff repair in 2001, presents with progressive right shoulder pain. He worked as a carpenter for 40 years before retiring earlier this year. For the past 2 years, he has had progressive worsening of right shoulder pain with associated weakness and difficulty with overhead activities. A trial of NSAIDS and physical therapy did not improve his symptoms.

PMH

Hypertension Prior rotator cuff repair (2001)

PE

1. Tenderness to palpation laterally below the acromion and anteriorly over the bicipital groove. 2. Right shoulder range of motion reveals - active/passive abduction to 80/120 - forward elevation to 110/160 - external rotation at side to 30/50 - internal rotation to L5 vertebra 3. There is a positive Jobe's test with a negative belly press test. 4. He is neurovascularly intact.

Poll
1 of 12
1. In addition to the MRI provided, would you obtain any further imaging to guide your treatment?
No - current MRI is sufficient
49%
542/1102
Yes - radiographs (XR)
27%
307/1102
Yes - CT scan
7%
85/1102
Yes - MRI arthrogram
3%
39/1102
Yes - XR + CT
5%
63/1102
Yes - XR + MRI arthrogram
1%
21/1102
Yes - CT + MRI arthrogram
0%
8/1102
Yes - XR + CT + MRI arthrogram
0%
6/1102
Outside my area of expertise - best if I don't vote
2%
31/1102
2. Would you use a classification system to guide your management of this patient?
No - a classification system would not help me
37%
374/1004
Yes - Goutallier
25%
255/1004
Yes - Hamada
9%
92/1004
Yes - Thomazeau
0%
4/1004
Yes - Cofield (size of tear)
3%
32/1004
Yes - Gerber (# of tendons)
1%
11/1004
Yes - a combination of those named above
13%
139/1004
Yes - other described Classification
0%
8/1004
Outside my area of expertise - best if I don't vote
8%
89/1004
3. How would you definitively manage this patient?
Nonoperative
9%
103/1059
Operative
86%
920/1059
Outside my area of expertise - best if I don't vote
3%
36/1059
4. If you choose Operative treatment, what would you recommend?
I would not choose Operative treatment
2%
22/1064
Rotator cuff debridement only
2%
31/1064
Rotator cuff repair (partial or complete)
24%
257/1064
Subacromial balloon spacer
7%
75/1064
Superior capsular reconstruction (SCR)
10%
110/1064
Tendon transfer
3%
41/1064
Reverse total shoulder arthroplasty (RSA)
44%
474/1064
Other
0%
3/1064
Outside my area of expertise - best if I don't vote
4%
51/1064
5. If you choose Rotator cuff repair (partial or complete) what primary repair technique would you perform?
I would not choose Rotator Cuff Repair
39%
369/924
Partial Repair Only
8%
76/924
Single-Row Repair
7%
67/924
Double-Row Repair
37%
351/924
Other
0%
9/924
Outside my area of expertise - best if I don't vote
5%
52/924
6. If you choose Rotator cuff repair and are successful in achieving a repair, would you augment with a biologic?
I would not choose Rotator Cuff Repair
35%
321/898
No - I would not augment with a biologic
26%
235/898
Yes - PRP
6%
62/898
Yes - Dermal allograft (DA)
15%
141/898
Yes - Bone Marrow Aspirate (BMA)
2%
23/898
Yes - Adipose derived cells (ADC)
0%
5/898
Yes - Resident Bursal stem cells (RBSC)
1%
9/898
Yes - DA + BMA
1%
13/898
Yes - PRP + DA
2%
21/898
Yes - Other combination of above
1%
11/898
Outside my area of expertise - best if I don't vote
6%
57/898
7. If you choose a Tendon Transfer, what tendon would you transfer?
I would not perform Tendon transfer
55%
483/865
Lower Trapezius (TRAP)
8%
70/865
Latissimus (LAT)
21%
182/865
Pectoralis Major (PM)
2%
24/865
TRAP + LAT
1%
13/865
TRAP + PM
0%
3/865
LAT + PM
0%
6/865
TRAP + LAT + PM
0%
2/865
Outside my area of expertise - best if I don't vote
9%
82/865
8. If you choose Superior capsular reconstruction (SCR), what graft would you use?
I would not choose SCR
53%
449/846
Dermal allograft
21%
181/846
Tensor fascia lata
10%
89/846
Long head biceps tendon
5%
49/846
Bovine Achilles allograft
1%
9/846
Other
0%
4/846
Outside my area of expertise - best if I don't vote
7%
65/846
9. If you choose a Reverse total shoulder arthroplasty (RSA), would you repair the subscapularis tendon and what would be your primary repair method?
I would not choose Reverse total shoulder arthroplasty (RSA)
13%
114/854
No - I would not repair subscapularis
15%
129/854
Yes - Soft tissue repair with sutures only
25%
220/854
Yes - Bone tunnels
24%
213/854
Yes - Suture anchors
13%
112/854
Yes - Cortical buttons
0%
7/854
Outside my area of expertise - best if I don't vote
6%
59/854
10. If you choose Subacromial balloon spacer, where would you perform this procedure?
I would not choose Subacromial balloon spacer
62%
506/807
Independent Ambulatory Surgery Center
7%
60/807
Hospital Associated Ambulatory Surgery Center
8%
68/807
Hospital affiliated operating room
13%
106/807
Outside my area of expertise, best if I do not answer
8%
67/807
11. If you choose Subacromial balloon spacer, how long would you keep the patient immobilized in a sling?
I would not choose Subacromial balloon spacer
56%
452/799
I would not place the patient in a sling (allow immediate range of motion)
6%
51/799
< 2 weeks (< 14 days)
12%
103/799
2-4 weeks (14-28 days)
11%
89/799
5-6 weeks (29-42 days)
4%
32/799
> 6 weeks (>42 days)
0%
4/799
Outside my area of expertise, best if I do not answer
8%
68/799
12. If you choose a treatment other than Subacromial balloon spacer, what is the primary reason you did not choose it?
I choose treatment with a Subacromial balloon spacer
10%
77/732
Because I have never heard of Subacromial balloon spacer
12%
94/732
Because we don't have enough quality evidence yet to support Subacromial balloon spacer
39%
290/732
Because we have quality evidence but outcomes are not superior to other treatment methods
11%
82/732
Because I don't feel I am experienced enough to perform the procedure
5%
41/732
Because it is too expensive
4%
31/732
Because it is not approved in my hospital system
4%
34/732
Outside my area of expertise - best if I don't vote
9%
68/732
Because there is no reimbursable code yet
2%
15/732
PROCEDURE #1 DOP: 1/15/2022

Subacromial balloon spacer

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OUTCOMES
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