massive rotator cuff tears - decision making 2015
Post on 22-Jul-2015
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• Boutonniere • Loss of suspension
bridge (force couple) • LHB subluxes • Subscap tears • muscles atrophy • fixed instability • bone softens
Massive Cuff Tear (>5cm)
IRREPERABLE CUFF TEARS
Loss of Teres Minor - Postero-inferior Cuff:
1. +ve Hornblower’s Sign
2. MRI (fatty infiltration & retraction???)
3. Arthroscopy (subjective)
TREATMENT OPTIONS
1. Deltoid Rehabilitation
2. Partial Repair
3. Debridement - Humeroplasty, ASD, Biceps Tenotomy
4. Tendon Transfers
5. Synthetic Patches
6. Reverse Arthroplasty
7. Superior Capsular Reconstruction
8. InSpace Balloon
CONSIDERATIONS
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
DECISIONS
Deltoid Rehab Painless Need DeltoidCompliant Patient
Debridement + Deltoid Rehab
Pain Need Deltoid, Compliant Patient
Partial Repair PainNeed Deltoid,
Compliant Patient Long rehab & recovery
Tendon Transfer Painabove +
risk of open surgery
Synthetic Augmentation
Function (? Pain)
above +Cost vs. Benefit?
Xenograft/Allograft Risks
Reverse Arthroplasty
Pain +Function
Predictable Results? Long-term
DELTOID REHAB
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
DEBRIDEMENT
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
LAT DORSI TRANSFER
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
REVERSE ARTHROPLASTY
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
INSPACE BALLOON
PAIN FUNCTIONAGE
SMOKINGCOMORBID
STIFFNESS HORN-BLOWER
EXAM
RETRAC-TION
FATTYATROPHY
MRI
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