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OUR PHYSICIANS:
- Kirk D. Clifford, MD
- Mary Beth Deering, MD
- Michael P. Dohm, MD
- Michael Dolecki, MD
- David P. Fisher, MD
- Robert L. Frazho, MD
- James S. Gebhard, MD
- Steven J. Heil, MD
- Michael J. Huang, MD
- Waqqar Khan-Farooqi, MD
- Mark G. Luker, MD
- Jeffrey M. Nakano, MD
- Richard J. Price, MD
- Michael T. Reeder, DO
- Michael D. Rooks, MD
- James K. Weaver, MD
- Thea A. Wojtkowski, MD
CASE STUDY: Reverse Total Shoulder Arthroplasty for Failed Rotator Cuff Repair
By Michael J. Huang, MD
June, 2009
Patient History:
68 year old right hand dominant male with 2 years of increasing right shoulder pain. Previous open rotator cuff repair in 2001. Complains of inability to reach over shoulder height as well as weakness when lifting objects heavier than five pounds. Pain located along lateral shoulder radiating to lateral elbow and now has night pain. Denies any neurologic symptoms.
Past medical history otherwise unremarkable.
Family history non-contributory
Evaluation:
Active range of motion limited to forward elevation of 80 degress (passive to 130 degrees). External rotator at the side to 60 degrees without lag. Positive Neer and Hawkins impingement signs. Weakness noted in the rotator cuff with supraspinatus testing at 4/5 strength and external rotator strength also at 4/5 strength. Patient able to perform lift of test. Positive drop arm test and negative extensor lag and negative hornblower’s sign.
Anterosuperior escape of the humeral head noted on active forward elevation.
X-rays confirmed severe degenerative joint disease of the glenohumeral joint with proximal humeral head migration (image 1).
Image 1
CT and MRI scans confirmed supraspinatus tear with significant retraction and fatty infiltration of the muscle belly (image 2 and 3).
Image 2
Image 3
Lengthy discussion with patient regarding options including continued non-operative therapy versus arthroscopic debridement versus another rotator cuff repair versus reverse total shoulder arthroplasty. Patient was treated with non-operative management for another 3 months without benefit. Patient elected to proceed forward with reverse total shoulder.
The Treatment Plan:
The patient underwent right reverse total shoulder arthroplasty (image 4).
Image 4
Outcome:
1.5 years after arthroplasty, patient continues to report no pain and significantly increased function (images 5,6,7).
Image 5
Image 6
Image 7
Follow-up clinical discussion of Reverse Total Shoulder Arthroplasty for Failed Rotator Cuff Repair will appear in November, 2009.