Irreparable cuff tear in a 62 year old woman.

A recent American Shoulder and Elbow Surgeons journal club (link) discussed some options for the management of symptomatic refractory irreparable rotator cuff tears. The faculty discussed the a variety of surgical options, their cost and their effectiveness.

Our approach to patients with irreparable cuff tears has remained consistent for the last three decades: starting with a good trial of directed Jackins rehabilitation exercises to first optimize shoulder flexibility 

and next to gradually build strength.

we continue to be impressed with the effectiveness of this program, irrespective of the size of the cuff defect.

For patients who have active elevation of the arm above 90 degrees but who continue to have limiting stiffness and pain, we consider the simple, low cost, low risk procedure known as the "smooth and move" . A recent example of the rapid return of function following of this procedure can be seen here.

Here's another recent example of an irreparable cuff tear in a 62 year old woman.

After a trial of the Jackins exercise program she had regained motion her her shoulder, but still had painful, function-limiting crepitus of the shoulder.

With this result from her Simple Shoulder Test

She asked to proceed with a smooth and move procedure at which time we found an irreparable supraspinatus tear with a large lateral flap, intact biceps tendon, intact subscapularis and infraspinatus and smooth undersurface of her coracoacromial arch.

We debrided her hypertrophic bursa and the flap, smoothed her tuberosity, preserved her biceps tendon and performed a manipulation under anesthesia. No patches or bioactive agents were used. 

She resumed her active motion and strengthening exercise program immediately after surgery = minimal down time.

At six weeks after surgery she returned for a post op check and demonstrated strong full and comfortable elevation of her arm, reporting that she had returned to work.

Comments welcome at shoulderarthritis@uw.edu

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).