Thursday, June 25, 2020

Irreparable rotator cuff tear -operative management

There is great current interest in the management of functionally irreparable rotator cuff tears.
Here is an informative case demonstrating the utility of two conservative surgical procedures.

A commercial truck (18 wheeler) driver presented two years ago with a painful left shoulder. His x-rays are shown here


His MRI demonstrated a severely retracted supraspinatus and infraspinatus with a detached subscapularis. In spite of this his left shoulder showed active elevation to 120 degrees.

Because of the heavy physical nature of his work, he elected to have a CTA arthroplasty (seee this link).  At surgery, he had retracted irreparable subscapularis, supraspinatus, and subscapularis tendons and severe cuff tear arthropathy.

Three months after surgery he had a comfortable functional shoulder and returned to work. Here are his x-rays at two years after surgery.


                              

                              

Two years later he presented with right shoulder pain. His images at that time are shown below











Because he had minimal glenohumeral arthritis and retained active elevation of 130 degrees, he elected to proceed with a smooth and move procedure (see this link). At surgery, he had retracted irreparable subscapularis, supraspinatus, and subscapularis tendons and mild cuff tear arthropathy.

Less than 24 hours after surgery, he had the shoulder function shown below.





He will return to driving his rig two weeks after his surgery.

This case illustrates the utility of conservative surgical procedures in shoulders with retained active elevation. 

Of note is the fact that neither the CTA or the smooth and move procedures are associated with complications and both allow for more aggressive procedures in the unlikely event that they prove unsuccessful.





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We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

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You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'