AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Case Presentation #2-Josef K. Eichinger, M.D.

Case Presentation #2-Josef K. Eichinger, M.D.

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This case involves a 58-year-old male with a history of left open rotator cuff repair several years prior, who sustained a motorcycle accident injury to the same shoulder 6 weeks ago. He reports persistent shoulder pain rated 3/10 at rest and up to 7/10 at worst, with a subjective shoulder value (SSV) of 35%. His job as a machinist involves overhead lifting up to 50 lbs. He has a significant smoking history (1 pack/day for 20 years).<br /><br />On physical examination, active forward flexion is 140 degrees but painful, and passive forward flexion is limited to 80 degrees. Positive clinical signs include a drop arm test, impingement signs (Hawkins and Neer), and tenderness over the anterior biceps groove, indicating rotator cuff pathology. The Hornblower and belly-press tests are negative, suggesting intact teres minor and subscapularis. The Jobe test shows weakness (3/5 strength) with pain, consistent with supraspinatus involvement, while other upper extremity muscle groups are normal at 5/5 strength.<br /><br />MRI findings (details not specified here) presumably confirm rotator cuff re-tear or pathology. Treatment options considered include conservative management with injections and physical therapy, as well as surgical options such as revision arthroscopic rotator cuff repair, superior capsular reconstruction (SCR), patch augmentation, tendon transfer, or reverse total shoulder arthroplasty (RTSA).<br /><br />The patient underwent surgery—details of the intraoperative procedure are not provided—but postoperatively reports minimal pain and significant functional improvement, with a subjective shoulder value improving to 90%. This highlights successful management of a complex rotator cuff re-injury in a physically active patient with prior repair and significant occupational demands.

Keywords

rotator cuff repair

shoulder injury

motorcycle accident

shoulder pain

rotator cuff re-tear

shoulder physical examination

MRI shoulder

shoulder surgery

superior capsular reconstruction

reverse total shoulder arthroplasty