AANA/SOMOS Enduring Shoulder Program 2024-38 y/o Space Force Captain with a Chronic Minimally Retracted 50% Partial Thickness Cuff Tear

38 y/o Space Force Captain with a Chronic Minimally Retracted 50% Partial Thickness Cuff Tear

Video Transcription

Video Summary

The panel discusses acute third-degree acromioclavicular (AC) separations, common sports injuries involving ligament tears around the shoulder. Dr. Buddy Savoie advocates for nonoperative treatment using specialized braces combined with injections to reduce deformity and allow early return to play, citing high complication rates and variable outcomes with surgery. Surgical options are complex with over 28 techniques described; complications occur in about 20-35% of cases, and randomized trials show no significant long-term benefit over nonoperative care for type III injuries. Dr. Andy Sheehan emphasizes considering associated injuries like rotator cuff tears, advanced imaging, and distinguishing type 3A versus 3B (with horizontal instability), which may benefit more from surgery. Surgical techniques involve arthroscopic-assisted fixation with grafts to stabilize vertical and horizontal instability, with caution about timing and complexity. Overall, most type III AC separations are best managed nonoperatively unless persistent horizontal instability or associated injuries warrant surgery, stressing careful patient counseling on risks and outcomes.

Asset Caption

Trans-Tendon (Jeanne C. Patzkowski, M.D., FAANA) vs. Scaffold (Richard K.N. Ryu, M.D.)
Discussion, moderated by David J. Tennent, M.D.
Technique Video: Trans-Tendon (Aaron E. Barrow, M.D.)

Keywords

third-degree acromioclavicular separation

nonoperative treatment

surgical complications

rotator cuff tears

arthroscopic-assisted fixation

horizontal instability