AANA Lab Course 912 - Arthroscopic Shoulder Solutions-A Cuff Tear-Michael H. Amini, MD

A Cuff Tear-Michael H. Amini, MD

Pdf Summary

This case involves a 50-year-old female patient presenting with a six-month history of shoulder pain and weakness following trauma, with no prior shoulder symptoms. Initially, she was on hydrocodone 5mg twice daily and smoked one pack per day; at her first visit, she had discontinued hydrocodone but was smoking 3-4 cigarettes daily and attempting to quit. Conservative treatment including injections and physical therapy provided minimal relief, with her symptoms worsening.<br /><br />Clinical examination revealed limited shoulder range of motion (forward elevation 60° actively, improving passively to 130°; external rotation strength 5/40 degrees; internal rotation to the buttock) and decreased strength (4/5 strength in external rotation with a notable lag and 4/5 strength on belly press test). Imaging and additional assessments were not described in the provided text.<br /><br />The case raises several treatment considerations for managing a rotator cuff tear in this patient with ongoing symptoms and functional deficits. Key questions include whether to proceed with reverse shoulder arthroplasty (RSA), or opt for less invasive options such as superior capsular reconstruction (SCR) or latissimus tendon transfer (LTT). Other considerations involve whether to perform isolated or combined acromial resurfacing and management strategies if the subscapularis tendon is not reparable. The discussion also notes the possibility of parachute or double tendon transfers and the potential for staged treatment, such as an initial surgery followed by balloon implantation if failure occurs.<br /><br />Overall, the case exemplifies the challenges in treating complex rotator cuff tears with poor tissue quality or irreparable components and highlights a need to balance surgical options with patient-specific factors including functional demands and comorbidities.

Keywords

rotator cuff tear

shoulder pain

shoulder weakness

reverse shoulder arthroplasty

superior capsular reconstruction

latissimus tendon transfer

acromial resurfacing

subscapularis tendon

tendon transfer

balloon implantation