An active 60 year old man had a 7 anchor rotator cuff repair for a massive cuff tear four years prior to presentation. Three years later was climbing out of a truck and slipped off a stair and lost his left hand grip. He held on by his right shoulder and felt like he pulled his arm out of the socket. One year after this he presented with shoulder pain and weakness, but with active elevation to 100 degrees.

His AP radiograph showed superior displacement of an arthritic humeral head.

His axillary truth view showed a centered humeral head centered on the glenoid with loss of the cartilage space

His MRI showed a full-thickness tear of the supraspinatus tendon. The torn tendon end was retracted to the level of the glenoid. There was severe thinning of the nearly absent infraspinatus tendon. There was a full-thickness tear of the subscapularis tendon. Thinned torn tendon end was retracted approximately 1 cm from the lesser tuberosity footprint. Fatty infiltration was seen in all cuff muscles.

Our colleague Philippe Collin requested some a saggital images.

Here they are

After discussion of the alternatives, the patient declined a reverse total shoulder, electing instead to proceed with a CTA arthroplasty (see this link).

At the time of surgery complete irreparable tears of the subscapularis, supraspinatus and infraspinatus were verified along with an arthritic humeral head.

At six months after surgery he had a comfortable stable shoulder with 160 degrees of active elevation.