2024 AANA/ISAKOS Specialty Day All-Access Pass-Debate Introduction: 55-Year-Old Female With Atraumatic Massive Cuff Tear With Pseudoparalysis

Video Transcription

We're going to get the next group of speakers up talking about massive cuff.  At the same time we can bring up our slides to go over the case as we go.  I think Bassam's here somewhere.  So we'll move on to the next section. This is going to have Dr. John Kelly, Tarouh  Mihara and Bassam El-Hassan.  We'll talk about a 55-year-old female with an atraumatic massive cuff tear with pseudoparalysis.  It's been ongoing for two years. History of right shoulder pain as an office manager. Failed all her conservative measurements. Had three  steroid injections, two rounds of physiotherapy, home exercise program. Her pain is worsening. She can't raise her arm.  She's getting pain at night, can't sleep, absolutely wants something done. You can see her physical exam here. This is a right shoulder that we're talking about. Has dyskinesia,  pseudoparesis, cellular atrophy in the fossa.  In terms of range of motion, you can see what she's doing right here, but active forward flexion.  You can see only getting about 45, maybe 90. You can help her up after that, but passively can get her all the way.  She doesn't have frozen shoulder. Passive external rotation, you can see right now. Dr.  O'Brien's here showing about 60 degrees, but really has that lag when having down in adduction.  When she does this, so we're getting about three plus in terms of a  external, sorry, three in terms of an extra rotation, you can hold that neutral. But when you bring her up to abduction of 90 degrees, she is able to external rotate.  So maybe Terry's minor looks okay, but infra is extremely weak. No subscap issues with the belly press.  These are her MRIs. You can see it rotating through here. You got supra, infra, retracted all the way to the lumbar glenoid. You can see the supra is  atrophied about 50%. Infra probably even more than that.  What's the best way? So we're going to have Dr. John Kelly talk about repair is the way.  Mihata talk about SCR and Basam showing us the lower trap. Thank you.

Video Summary

This segment features a 55-year-old female with a significant cuff tear and limited shoulder movement for two years. Despite failed conservative treatments, including injections and physiotherapy, her pain persists and affects her sleep. The physical exam reveals dyskinesia, pseudoparesis, and atrophy. MRIs show significant tendon retraction. The options discussed include repair by Dr. John Kelly, Superior Capsular Reconstruction (SCR) by Tarouh Mihara, and lower trap exercises by Bassam El-Hassan to address the patient's condition.

Asset Caption

Jonathan B. Ticker, M.D., FAANA & Ivan H. Wong, M.D., FAANA

Keywords

cuff tear

shoulder movement

conservative treatments

Superior Capsular Reconstruction

tendon retraction