Lennard Funk

• 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)

SURGEON CONCERNS

Fatty infiltration

Muscle Atrophy

Retraction

Recurrences

Healing

PATIENT CONCERNS

PAIN FUNCTION

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

REPAIRYOUNG

OLD

LAT DORSI

DEBRIDE DELTOIDREHAB

REVERSE

SCRCBALLOON

PAIN WEAKHORN-

BLOWERAGE

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

REPAIR

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

SCRC

PAIN FUNCTIONAGE

SMOKINGCOMORBID

STIFFNESS HORN-BLOWER

EXAM

RETRAC-TION

FATTYATROPHY

MRI

INSPACE BALLOON

PAIN FUNCTIONAGE

SMOKINGCOMORBID

STIFFNESS HORN-BLOWER

EXAM

RETRAC-TION

FATTYATROPHY

MRI

REPAIRYOUNG

OLD

LAT DORSI

DEBRIDE DELTOIDREHAB

REVERSE

SCRCBALLOON

PAIN WEAKHORN-

BLOWERAGE

THANK YOU@theshoulderdoc