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Updated: Jun 5 2021

Deltoid Rupture

  • Summary
    • Deltoid ruptures are very are injuries that generally occur secondary to massive rotator cuff tears, repeat corticosteroid injections into the deltoid, or acute trauma. 
    • Diagnosis is made clinically with depression over the deltoid in acute ruptures with deltoid strains and partial ruptures presenting with localized tenderness and ecchymosis.
    • Treatment of partial tears is rest, NSAIDs and observation. Early surgical repair is indicated for complete tears.
  • Epidemiology
    • Incidence
      • rare
    • Risk factors
      • repeated corticosteroid injections about the shoulder
      • rotator cuff tear
      • trauma
  • Etiology
    • Pathophysiology
      • mechanism
        • secondary to repeated corticosteroid injections about the shoulder
        • massive rotator cuff tear
          • proximal migration of the humeral head leads to compression/abrasion of undersurface of deltoid by greater tuberosity
        • iatrogenic injury
          • during open rotator cuff repair
        • trauma
          • sudden deltoid contracture
          • shoulder contusion
    • Associated conditions
      • rotator cuff tear
  • Anatomy
    • Deltoid anatomy
  • Presentation
    • Symptoms
      • shoulder pain
    • Physical exam
      • inspection
        • depression over deltoid
        • soft tissue mass distal to depression (contracted muscle)
  • Imaging
    • Radiographs
      • recommended views
        • shoulder radiographs
      • findings
        • associated with cuff tear arthropathy
        • proximal humeral head migration
    • Ultrasound
      • indications
        • noninvasive method of detection
      • findings
        • shows deltoid gap with intact surrounding fibers
    • MRI
      • indications
        • differentiate partial vs complete deltoid tears
        • associated rotator cuff pathology
      • findings
        • deltoid defect
        • associated rotator cuff tear
  • Treatment
    • Nonoperative
      • observation only
        • indications
          • chronic injuries in elderly patients
    • Operative
      • early surgical repair
        • indications
          • complete rupture
      • deltoplasty with mobilization and anterior transfer of the middle third of the deltoid
        • indications
          • iatragenic injury during rotator cuff repair
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