In the recent years there has been discussion about the indications and contra-indications of repair of degenerative tears of the rotator cuff. Cost analysis studies have been published in major orthopaedic journals (JBJS) and the treatment algorithms continue to evolve. A recent study demonstrated that postoperative aggressive physical therapy is equally effective to conservative or slow rehab treatment with no negative impact on shoulder function, patient satisfaction and re tear rate. A few years ago studies demonstrated that rotator cuff repair without or with acromioplasty have the same outcome.
Although there is a debate on the treatment of degenerative rotator cuff tears and while the indications for treatment continue to be explored, there is general agreement among orthopaedic surgeons that traumatic rotator cuff tears that result in loss of motion or strength to the rotator cuff need to be addressed surgically if the patient has no contra-indications to surgery. Timing is important as scarring, retraction and atrophy develop with time. Generally, the sooner are repaired the better the chances for successful healing and treatment.
The following case is a patient who is in his 30s and presented in the office 2 months after a traumatic dislocation of his shoulder which resulted in weakness in shoulder abduction, forward elevation of the shoulder to 90 degrees with pain and no instability. He already had an MRI by another orthopaedic provider that indicated a ruptured biceps, Hill Sachs lesion and a torn retracted rotator cuff. The XRs after the dislocation and MRI after reduction of the dislocation are shown below:
 |
| Scapular Y XR demonstrates anterior dislocation of the shoulder |
 |
| AP Xray shows the dislocation |
 |
| MRI without contrast shows the retracted tear of the rotator cuff |
