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Case of the Month - June 2020

Repair of Massive and Retracted Rotator Cuff Tear

Patient Testimonial: "I suffered a severe tear of rotator cuff tendons and partial tear of the bicep tendon after a fall on ice while traveling. Dr. Ziegler initiated consultation with the Swiss physician and radiologist who first treated me after my accident. Within a few weeks of my return, Dr. Ziegler performed extensive repair surgery. Following his recovery and therapy protocol, I have regained, after 6 months, complete mobility and strength continues to improve. I am grateful for Dr. Ziegler's thoroughness & skills and have no reservation recommending him."

Three months post-op after arthroscopic rotator cuff repair. Full range of motion and strength with no pain.

Case: 70 year old male who fell onto his Left shoulder while skiing in Europe. Immediate onset pain and weakness. He could not lift his arm. He was evaluated by an orthopaedic surgeon in Europe and diagnosed with a large rotator cuff tear based on examination and advanced imaging. Upon returning to the USA, he was promptly evaluated by my team and I. Given his functional goals and active lifestyle, arthroscopic rotator cuff repair was recommended.

A rotator cuff tear is a common cause of pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of a rotator cuff problem.

A torn rotator cuff will weaken your shoulder. This means that many daily activities may become painful and difficult to do. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear.

Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age, from repetitive stress, poor blood supply and bone spurs. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder even if you have no pain in that shoulder.

Tears can also occur acutely such as after a fall or when lifting something too heavy with a jerking motion.

Signs that surgery may be a good option:

- Symptoms have lasted 6 to 12 months

- Large tear (more than 3 cm) and good quality tissue

- Significant weakness and loss of function

- Tear was caused by a recent, acute injury

CT arthrogram obtained shortly after injury (patient could not have MRI). Picture on Left shows a retracted, full thickness rotator cuff tear. Picture on Right shows good muscle volume with no evidence of atrophy suggesting acute injury and good muscle quality.

Arthroscopic photos of massive, full thickness tear of the supraspinatus extending into the infraspinatus. Picture on Left shows a completely bare rotator cuff footprint on humeral head (ball side of joint). Picture on Right shows rotator cuff retracted to the glenoid (socket side of joint).

Arthroscopy photos showing rotator cuff repair with suture anchors and high strength suture.

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