Chronic Massive Rotator Cuff Tear in 69M

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PRESENTATION
12
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POLLS
10,492
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OUTCOMES
5
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VIDEOS
8
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EVIDENCE
33
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Comments
25
CASE DESCRIPTION
AGE 69 / Male
CC Right shoulder pain
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.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101749/d5db0e33-5974-4c86-89b0-7282302c5e01_b3e5e94f-60ab-4a57-a0db-005144ebd039_xr1..jpg https://upload.orthobullets.com/cases/101749/472e438b-a44d-4fb2-a2d5-b75afd6f68ab_58517196-fb54-461f-80f0-c3a72b063791_xr2..jpg https://upload.orthobullets.com/cases/101749/896641e9-a645-4b7b-87e6-0cd29a588fdc_78bd069e-5f3f-454b-bfb0-7c6a8da75053_t2_coronal_mri..jpg https://upload.orthobullets.com/cases/101749/43af5439-6a8c-474e-b8d1-fd6b59f51366_fe376829-dbbb-48fd-b888-0385c13167eb_t1_coronal_mri..jpg https://upload.orthobullets.com/cases/101749/91686b68-42e3-4723-832d-30cb60446c0d_95c4ad1e-9494-415b-a903-fbc0815b768b_mr1..jpg https://upload.orthobullets.com/cases/101749/da9cd604-189c-4af8-b032-3509e7eecd6a_22c53577-a474-4ffc-b015-b3c2d1670cea_mr2..jpg https://upload.orthobullets.com/cases/101749/7b66f037-845c-4a36-bdd5-2ed8f8d676f6_7c68234d-c66b-48e4-9a05-0a8610fc1990_t2_axial_mri..jpg https://upload.orthobullets.com/cases/101749/21d2246d-b3c2-410a-a578-e3262e02f993_952c6ad4-5ad6-43c4-9e08-4d471b9bd13a_mr5..jpg https://upload.orthobullets.com/cases/101749/c81e503e-409c-4419-b9af-244c6a4ca62f_mri6..jpg https://upload.orthobullets.com/cases/101749/a0657ec6-2751-46f2-bd72-cf94897a3f42_11e74b37-ed27-4eeb-b016-07bcb2d8e22c_mr3..jpg https://upload.orthobullets.com/cases/101749/927b4aee-456e-443c-a278-c6dceb41d08f_d2153c88-776e-4eb6-ae22-d6db70606a17_mr4..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?
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3) How would you definitively manage this patient?
Other
4) If you choose Operative treatment, what would you recommend?
Other
5) If you choose Rotator cuff repair (partial or complete) what primary repair technique would you perform?
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6) If you choose Rotator cuff repair and are successful in achieving a repair, would you augment with a biologic?
Other
7) If you choose a Tendon Transfer, what tendon would you transfer?
Other
8) If you choose Superior capsular reconstruction (SCR), what graft would you use?
Other
9) If you choose a Reverse total shoulder arthroplasty (RSA), would you repair the subscapularis tendon and what would be your primary repair method?
Other
10) If you choose Subacromial balloon spacer, where would you perform this procedure?
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11) If you choose Subacromial balloon spacer, how long would you keep the patient immobilized in a sling?
Other
12) If you choose a treatment other than Subacromial balloon spacer, what is the primary reason you did not choose it?
Other
CASE OUTCOMES
PROCEDURE 1: Subacromial balloon spacer
DOP: 1/15/2022
Intra-procedure P1
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Post-procedure P1
17 days Post-procedure P1
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VIDEOS & PODCASTS (8)
EVIDENCE (33)
EXPERT COMMENTS