AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Case Presentation #1-Josef K. Eichinger, M.D.

Case Presentation #1-Josef K. Eichinger, M.D.

Pdf Summary

This case involves a 52-year-old left-handed male machinist experiencing recurrent shoulder pain due to a rotator cuff tear. He originally injured his shoulder during boxing 20 years ago and underwent a rotator cuff repair with good results. However, two years prior to presentation, he developed atraumatic recurrent pain. He then had a revision rotator cuff repair and biceps tenodesis at an outside hospital. Despite treatment, he reports severe intermittent pain rated 9/10 with activity, significant weakness during overhead motion, impaired sleep, and difficulty working. His subjective shoulder value (SSV) is 30%, and he relies on oxycodone to continue working. He now presents requesting a reverse total shoulder arthroplasty.<br /><br />Physical examination reveals positive Neer’s, Hawkins, and Drop Arm tests indicating rotator cuff pathology. Belly Press and external rotation lag tests are negative. Strength testing shows supraspinatus and infraspinatus at 3/5, while subscapularis remains strong at 5/5. Active forward elevation ranges between 100 to 130 degrees, external rotation is 40 degrees bilaterally, and internal rotation reaches L5.<br /><br />Radiographs and CT arthrograms have been performed but specific findings are not provided.<br /><br />Treatment options under consideration include corticosteroid injections, physical therapy, revision surgery potentially employing graft augmentation, or proceeding with reverse total shoulder arthroplasty.<br /><br />The document references intraoperative images and postoperative follow-ups at 5 days, 1 week, 6 weeks, and 1 year, suggesting surgical intervention was performed. Long-term outcomes at 1 year postoperative are included though not detailed.<br /><br />In summary, this patient with a complex history of rotator cuff tears and prior repairs presents with severe functional limitation and pain. Evaluation points toward advanced shoulder pathology potentially suited for reverse total shoulder arthroplasty with consideration of grafting techniques during revision surgery.

Keywords

rotator cuff tear

shoulder pain

revision rotator cuff repair

biceps tenodesis

reverse total shoulder arthroplasty

shoulder strength testing

Neer's test

Hawkins test

shoulder rehabilitation

graft augmentation