Rotator Cuff Injuries by Patrick J. McMahon

Author:Patrick J. McMahon
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Figure 11.2Magnetic resonance imaging demonstrating a full-thickness, retracted posterosuperior rotator cuff tear on coronal T2 image (a), with grade 1 atrophy of the supraspinatus, grade 2 atrophy of the infraspinatus, grade 4 atrophy of the teres minor with a normal subscapularis (b)

Diagnosis/Assessment

This patient is presenting with an acute exacerbation of a posterosuperior rotator cuff tear after a minor trauma. The patient’s history, physical exam, and imaging all corroborate this diagnosis. The tear likely propagated anteriorly during the acute exacerbation leaving the supraspinatus with less severe atrophy compared to the infraspinatus and teres minor. While tears and atrophy of the teres minor are rare on presentation, this warranted an electromyographic study (EMG) to evaluate for a neurologic etiology such as a C5 radiculopathy. The EMG was obtained and demonstrated normal testing of the C5 distribution, as well as no evidence of suprascapular nerve or axillary nerve deficit.

While repair of the supraspinatus would likely improve his forward elevation, the chronicity of the posterior component of the tear involving the infraspinatus and teres minor would likely lead these to be less amenable to repair, and less predictable with regard to improving his profound external rotation weakness. For young, active patients with large, irreparable posterosuperior rotator cuff tears with an intact, functional subscapularis, a latissimus dorsi transfer to the greater tuberosity remains a viable, though unpredictable, option for restoring external rotation.

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