Complex Repair: Case Report #1

Many of our patients ask us for a video of their surgery and with this article we are starting a case series approach where the video of a particular patient’s surgery will be posted along with some highlights of the case to hopefully serve an educational purpose.

This case report is about a 59 year old professor from Virginia who first contacted us for a second opinion and consultation regarding a shoulder problem he felt had been an issue throughout his life. He noted that he always felt that he had to throw a baseball either side-arm or directly overhead to protect his shoulder. He had tried extensive conservative management and his physical therapist encouraged him to seek out a shoulder specialist for further evaluation. He did have an MRI of his shoulder performed along with several evaluations and opinions closer to home. 

Click here to watch a video about Anterior Superior Rotator Cuff Repair.

He made the trip to Indiana for a detailed evaluation and we discussed with him that it appeared he may have initially developed some tightness in his posterior inferior capsule that altered his throwing mechanics and with the resultant increased stress superiorly, with time had developed a large posterior superior zone labrum tear that eventually progressed to a prominent anterior superior rotator cuff tear involving the subscapularis and supraspinatus components of the rotator cuff. We also recommended further electrodiagnostic testing which revealed evidence of suprascapular nerve involvement and some mild chronic cervical radicular involvement at C5-C6 and C7-T1.

After completing the evaluation, our comprehensive solution to rebalance the shoulder and provide him with the best chance at long term functional restoration and pain relief included arthroscopic massive rotator cuff repair with reinforcement graft, labrum repair, biceps tenodesis, acromioplasty, suprascapular nerve decompression, and capsulotomy. Just as the breakdown of his shoulder function had occurred in a gradual stepwise progression, we discussed with him that we feel it’s important to address not only the affect but also the root cause for the best chance at an excellent outcome. In this particular instance, the capsulotomy/ capsular release helped not only restore shoulder range of motion but also relieved stress and tension at the rotator cuff to provide the patient a better chance at primary healing and much lower risk of shoulder stiffness after surgery. 

Author
Vivek Agrawal, MD

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