Rotator Cuff Tear — ABOS Oral Boards Preparation

A 55-year-old right-hand-dominant male commercial painter presents to your office with a 4-month history of progressive right shoulder pain and weakness. He initially noticed difficulty reaching overhead and night pain that disrupts sleep. He denies any acute injury but does a significant amount of overhead work. He tried a 6-week course of physical therapy with some improvement in pain but persistent weakness. He has no prior shoulder surgery and no medical comorbidities besides hypertension. On exam, active forward elevation is to 140 degrees (170 on the left). External rotation strength is 4/5 compared to 5/5 on the left. Jobe test (empty can) produces pain and weakness. He has a positive lag sign. Hornblower sign is negative. There is no significant atrophy of the supraspinatus or infraspinatus fossae.

MRI of the right shoulder with intra-articular contrast shows a full-thickness tear of the supraspinatus tendon measuring 2.5 cm in the anteroposterior dimension with 1.5 cm of retraction to the level of the glenoid face. There is Grade 1 fatty infiltration of the supraspinatus (Goutallier). The infraspinatus and subscapularis are intact. The long head of the biceps tendon is subluxated medially. The acromion is Type II (Bigliani). There is moderate subacromial bursitis.

After discussion of options, you performed arthroscopic rotator cuff repair with suture bridge technique (double-row equivalent) along with biceps tenodesis and subacromial decompression. The tendon quality was good, and the repair was performed without excessive tension. Post-operatively, the patient was placed in an abduction sling for 6 weeks with pendulum exercises only, followed by progressive strengthening.