Shoulder Rotator Cuff Pathology: Common Problems and Solutions

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Key points

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    There are many patient factors and technical factors which may increase the risk for retear.

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    Dermal allograft augmentation or reverse total shoulder arthroplasty provide options for irreparable failed rotator cuff repairs.

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    Always consider other sources of shoulder pain when evaluating a rotator cuff tear in order to rule out other pathology

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    Infection should be considered in patients who have persistent pain postoperatively with no obvious source.

Case Example

A 63-year-old right-hand-dominant man presented to clinic with 1 year of right shoulder pain after no inciting incident. His examination was notable for limited forward flexion and reduced strength on both supraspinatus and infraspinatus testing. MRI showed a full-thickness supraspinatus tear with retraction to the level of the acromion and mild fatty atrophy and a partial thickness subscapularis tear (Fig. 1A). He subsequently underwent arthroscopic repair of both the supraspinatus and

Case Example

A 54-year-old woman presented to the clinic with years of right shoulder pain. She had positive impingement and empty can signs on examination with mildly reduced cuff strength. MRI showed a full-thickness supraspinatus tear measuring 15 mm in the anteroposterior (AP) plane with minimal retraction. She subsequently underwent a knotless suture bridge repair with 2 medial and 2 lateral anchors (Fig. 2A and B).

The patient regained full motion postoperatively but had continued pain and subjective

Case Example

A 52-year-old woman presented to the authors’ clinic with several years of worsening right shoulder pain. Imaging showed a full-thickness supraspinatus tear with minimal retraction. She subsequently underwent arthroscopic repair with 2 medial and 2 lateral row anchors. Her initial postoperative course was uncomplicated, but she failed to make progress with range of motion. At the 6-month follow-up, her active and passive forward flexion was limited to 90°. This flexion was significantly worse

Case Example

A 33-year-old woman presented to the clinic after a motor vehicle accident with anterior and lateral shoulder pain. An MRI at that time showed a high-grade supraspinatus articular-sided tear; she underwent arthroscopy with PASTA repair, with the rotator cuff tear and subsequent repair seen in Fig. 4A, B, respectively. The long head biceps tendon at that time did not show any pathology (Fig. 4C). She was recovering and regaining her strength but continued to have anterior shoulder pain after

Case Example

A 62-year-old right-hand-dominant man presented to the authors’ clinic with left shoulder pain and dysfunction after a mini-open rotator cuff repair 3 months prior. His medical history was notable for congestive heart failure (CHF) and hypertension. After his cuff repair, he was hospitalized for CHF exacerbation. He then noticed redness and warmth over the anterior portal site, which improved with 10 days of cephalexin. The redness then returned with chronic drainage (Fig. 5A). His examination

Summary

Rotator cuff repair is perhaps the most common shoulder surgery performed today. Despite advances in technique, complications are not infrequent and continue to limit the success of this procedure. There are many patient and technical factors that increase the risk for retear or failure to heal. Most of the time, revision repair can be performed for smaller retears. Larger-sized retears may require allograft augmentation or even reverse total shoulder arthroplasty. Stiffness is perhaps the most

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    • There are no personal conflicts of interests to disclose in the writing or publishing of this article.

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