J Korean Orthop Assoc.  2012 Jun;47(3):236-241. 10.4055/jkoa.2012.47.3.236.

Reverse Shoulder Arthroplasty with Tendon Transfer Using Single Incision for Massive Rotator Cuff Tear with Loss of External Rotation

• Lee BG
• Oh JH
• Choi YH
• Rhee YG

• KMID: 2106655
• DOI: http://doi.org/10.4055/jkoa.2012.47.3.236

Abstract

In patients with massive rotator cuff tears, operative treatment is considered if there is no improvement after conservative treatment. Reverse shoulder arthroplasty is an option among several treatments. However, in cases of massive rotator cuff tears that extend to the teres minor with combined loss of active elevation and external rotation, reverse shoulder arthroplasty alone might not restore the active external rotation. As a consequence, patients continue to feel inconvenienced in performing activities of daily living. Reverse shoulder arthroplasty, with latissimus dorsi and teres major transfer, can restore functional range of motion in forward flexion and in external rotation. Herein, we report a case of massive rotator cuff tear with literature review.

Keyword

latissimus dorsi; teres major; massive rotator cuff tear; reverse shoulder arthroplasty; tendon transfer

MeSH Terms

Activities of Daily Living
Arthroplasty
Humans
Range of Motion, Articular
Rotator Cuff
Shoulder
Tendon Transfer
Tendons

Figure

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  Figure 1 Pre-operative clinical photographs. (A) Pseudoparalysis: the patient could not elevate her arm at all. (B) Positive drop sign: the patient could not keep external rotation of her arm in 90 degree abduction.

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  Figure 2 Pre-operative radiograph shows typical appearance of cuff tear arthropathy; decreased acromio-humeral interval (white arrow) and superior migration (white triangle).

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  Figure 3 Magnetic resonance images. (A) Rotator cuff is retracted to glenoid margin (white arrow). (B) Cuff tear extends to posteroinferior portion of rotator cuff and teres minor muscle is also involved (black asterisk).

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  Figure 4 Intra-operative photographs. (A) Severe loss of cuff tissue includes external rotators. (B) Harvested common tendon of latissimus dorsi and teres minor (white arrow) was passed around the posterior aspect of humeral diaphysis and transferred to lateral aspect of humerus. (C) The transferred tendon was reattached to the lateral aspect of the humerus (white triangle) and the subscapularis (white asterisk) to anterior aspect of bone cutting margin with transosseous sutures.

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  Figure 5 Post-operatively 1 year radiograph shows mild scapular notching (white arrow) but component loosening is not observed.

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  Figure 6 Clinical photographs 1 year after surgery show improvement of forward flexion (A) and external rotation of right shoulder (B).

Reference

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