A method for the treatment of patients with massive tears of the rotator cuff: a clinical case

Abstract

Background: Rotator cuff tears are the most common cause of shoulder pain and dysfunction in older patients. Tears with the retraction greater than 5 cm or with the involvement of two and more tendons are considered massive. According to the literature, the incidence of massive injuries of the rotator cuff ranges from 10 to 40%. The formation of massive injuries is a long process leading to a pronounced pain syndrome, loss of function and, as a result, to pseudo-paralysis of the affected limb. There is no consensus concerning the treatment of this category of patients. Conservative methods of treatment are applicable for patients with a low activity. Among the surgical methods of treatment, the preference is given to the proximal capsule reconstruction, subacromial balloon arthroplasty, reverse arthroplasty and muscle-tendon transfers. However, today there is no single tactic for the surgical treatment of patients with massive rotator cuff tears. Clinical case description: We propose a new surgical method for this shoulder joint pathology arthroscopically associated transposition of the tendon of the latissimus dorsi muscle using an autograft of the long peroneal muscle tendon. As an illustration of the new method, we present a successful clinical case of the treatment of a patient with a chronic massive rotator cuff injury of the right shoulder and secondary upper subluxation of the right humerus head. Conclusion: This method allows increasing the efficiency of the treatment of a massive tear of the rotator cuff tendons, restoring the correct biomechanics of the shoulder joint, reducing the pain and restoring the function of the affected limb.