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Rotator Cuff Tears
Posted: May 24 2020 #(C101474)
A

Acute Massive Rotator Cuff Tear in a 43M

HPI

A 43-year-old male presents with left shoulder pain after a fall from mountain bike 4 days prior to evaluation. The pain is exacerbated by overhead activities. He has difficulty reaching above the waist and has nighttime pain.

PMH

His past surgical history is significant for a previous left clavicle fracture that was treated with nonoperative management 13 years prior.

PE

On physical exam, there is no gross deformity. He has tenderness over the greater tuberosity. The range of motion exam shows: - active/passive terminal elevation 45/170 degrees - active/passive external rotation 15/60 degrees - internal rotation to T6 bilaterally. The motor exam shows: - 1/5 supraspinatus - 2/5 infraspinatus - 5/5 subscapularis The neurovascular exam is intact.

Poll
1 of 10
1. How would you manage this injury?
Nonoperative (physical therapy, possible injection)
6%
91/1419
Operative
91%
1302/1419
Outside my area of expertise - best if I don't vote
1%
26/1419
2. If you choose Nonoperative management, how long would you attempt physical therapy?
I would not choose Nonoperative management
75%
979/1294
3-4 weeks
5%
68/1294
5-6 weeks
7%
103/1294
7-8 weeks
2%
30/1294
9-12 weeks
4%
56/1294
>12 weeks
2%
27/1294
Outside my area of expertise - best if I don't vote
2%
31/1294
3. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
12/1374
Rotator cuff repair
90%
1244/1374
Superior capsular reconstruction
3%
45/1374
Tendon transfer
1%
21/1374
Reverse total shoulder replacement
0%
8/1374
Outside my area of expertise - best if I dont vote
3%
44/1374
4. If you choose Rotator cuff repair, what technique would you use?
I would not choose Rotator cuff repair
0%
10/1358
Arthroscopic
77%
1057/1358
Mini-open
13%
181/1358
Open
5%
72/1358
Outside my area of expertise - best if I don't vote
2%
38/1358
5. If you choose Arthroscopic rotator cuff repair, how would you position the patient?
I would not choose Arthroscopic rotator cuff repair
3%
41/1329
Lateral decubitus
22%
303/1329
Beach chair
70%
934/1329
Outside my area of expertise - best if I don't vote t
3%
51/1329
6. If you choose Arthroscopic rotator cuff repair, what technique would you use?
I would not choose Arthroscopic rotator cuff repair
2%
36/1314
Single-row repair
12%
160/1314
Double-row repair
80%
1054/1314
Outside my area of expertise - best if I dont vote
4%
64/1314
7. If you choose Arthroscopic rotator cuff repair, would you medialize the footprint?
I would not choose Arthroscopic rotator cuff repair
2%
34/1280
No - never
10%
140/1280
Yes - only if mobility is limited following releases
72%
925/1280
Yes - I always medialize the footprint
5%
70/1280
Outside my area of expertise - best if I don't vote
8%
111/1280
8. If you choose Arthroscopic rotator cuff repair, would you include a subacromial decompression?
I would not choose Arthroscopic rotator cuff repair
1%
22/1274
No - never
3%
48/1274
Yes - only if there is subacromial spurring
59%
754/1274
Yes - always
31%
403/1274
Outside my area of expertise - best if I don't vote
3%
47/1274
9. If you choose Arthroscopic rotator cuff repair, would you address the biceps?
I would not choose Arthroscopic rotator cuff repair
1%
22/1262
No - never
1%
23/1262
Yes - only if there is clinical biceps tendonitis
19%
252/1262
Yes - only if there is gross pathology on arthroscopic evaluation
64%
818/1262
Yes - always
8%
104/1262
Outside my area of expertise - best if I don't vote
3%
43/1262
10. If you performed Arthroscopic double-row rotator cuff repair and attained the construct shown in the images below, how long would you immobilize the patient post-operatively?
No immobilization - immediate early ROM
3%
48/1238
Sling x 2 weeks
11%
144/1238
Sling x 4 weeks
23%
293/1238
Sling x 6 weeks
51%
640/1238
Sling x 8 weeks
4%
56/1238
Sling x 12 weeks
0%
12/1238
Sling >12 weeks
0%
3/1238
Outside my area of expertise - best if I don't vote
3%
42/1238
PROCEDURE #1

Arthroscopic Rotator Cuff Repair

Intra-procedure P1
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