Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder.

Abstract

Introduction:This report describes a case of irreparable massive rotator cuff tear and axillary nerve palsy associated with shoulder dislocation successfully treated by arthroscopic superior capsule reconstruction (ASCR), with a favorable post-operative outcome.Case Report:A 76-year-old man, injured from a fall while walking, presented to another hospital with right shoulder pain and a limited range of motion (ROM) 3 days after the injury. Given a diagnosis of right shoulder dislocation, he received manual reduction followed by immobilization with a sling. He continued to experience difficulty in performing active ROM exercises of the shoulder and underwent magnetic resonance imaging, which revealed an irreparable extensive rotator cuff tear involving the supraspinatus and infraspinatus muscles. He was then referred to our hospital 2 months after the injury. Examination revealed atrophy of the supraspinatus and infraspinatus muscles, atrophy of the deltoid muscle and hypoesthesia, likely due to axillary nerve palsy, and a marked limitation of active ROM with flexion, abduction and lateral rotation angles of 10°each. ASCR was considered for treating the irreparable rotator cuff tear. Since the technique is not indicated for patients with deltoid paralysis, the operation was delayed until signs of improved axillary nerve palsy were observed at 6 months after the injury. The patient started passive ROM training the day after the operation while wearing a shoulder abduction orthosis for 3 weeks, followed by immobilization with a sling for 2 weeks. Thereafter, he started active exercise. The axillary nerve palsy was almost completely resolved 3 months after the operation. He achieved a ROM comparable to that of the unaffected side at 1 year after operation. He has had an uneventful post-operative course for 2 years after operation.Conclusion:We encountered a rare, difficult-to-treat case of irreparable extensive rotator cuff tear with axillary nerve palsy after a shoulder dislocation. ASCR, although not indicated for patients with deltoid muscle dysfunction, provided a favorable post-operative outcome when performed after confirmation of signs of improved palsy.