AOSSM/AANA Specialty Day 2020-Handout - DEBATE_ SCR_ 52-Year-Old Male with a Massive Cuff Tear

Handout - DEBATE_ SCR_ 52-Year-Old Male with a Massive Cuff Tear

Pdf Summary

The AANA AOSSM Specialty Day 2020 Session III focused on complex shoulder cases, with a spotlight on a challenging rotator cuff scenario—"The Good, The Bad, and The Ugly." The case involved a 57-year-old right-hand dominant retired firefighter with chronic shoulder pain, who suffered an ATV accident leading to weakness and pain. Eleven weeks post-injury, examination revealed limited forward flexion (50-60 degrees), pseudo-paresis, and moderate external rotation weakness (4/5), alongside a weak belly-press test. MRI showed a massive, retracted tear involving the supraspinatus (SST), infraspinatus (IS), and subscapularis (SSc) tendons, medial biceps dislocation, and advanced Goutallier stage 2-3 fatty changes in the IS muscle.<br /><br />The main treatment question centered on managing irreparable rotator cuff tears, with options including partial repair, tendon transfer, superior capsule reconstruction (SCR), reverse shoulder arthroplasty, interposition grafting, or balloon implantation. Two expert opinions were debated: Dr. Savoie advocated fixing what is repairable and advised avoiding SCR due to concerns over outcomes, while Dr. Tokish supported SCR, citing justifiable results with this method.<br /><br />The operative video showcased attempts at repair of the subscapularis and infraspinatus tendons, noting that the supraspinatus remained irreparable. Postoperative follow-up at five months demonstrated reversal of pseudoparesis, indicating functional improvement with partial repair despite incomplete restoration of all cuff tendons. This session highlighted the complexity in decision-making for massive rotator cuff tears and the evolving role of newer procedures like SCR, emphasizing individualized treatment planning for optimal outcomes.

Keywords

AANA AOSSM Specialty Day 2020

complex shoulder cases

rotator cuff tear

irreparable rotator cuff

partial repair

superior capsule reconstruction (SCR)

reverse shoulder arthroplasty

massive rotator cuff tear

pseudoparesis reversal

tendon transfer