Case Studies

A woman, 35, of normal height and weight and in generally good health injured her right shoulder while trying to power-up a pull-start lawn mower. She came to see us on referral by her primary-care physician after enduring two weeks of no improvement and unrelieved pain, despite use of nonsteroidal anti-inflammatory drugs.

Our evaluation found that the patient had only 90 degrees of active elevation in the injured shoulder, along with positive impingement signs and – during manipulation testing of her supraspinatus – pain and weakness. X-rays revealed a Type II acromion.

Taken together, the patient exhibited classic symptoms of a damaged rotator cuff. An MRI of the shoulder was ordered; the images confirmed a full-thickness tear of the supraspinatus.

The patient’s age and health status made her a good candidate for outpatient minimally invasive arthroscopic repair of the damaged rotator cuff.

Using standard arthroscopic procedures, we visually confirmed the presence of the rotator cuff tear and verified that no other damage was present. For the repair itself, a double-row suture anchor procedure was performed. The procedure was completed in 90 minutes.

The patient was discharged home that same day. She visited our office 48 hours later for a check of the wound site incisions and to receive instruction in exercises that would help restore full, pain-free use of the repaired shoulder. Sutures were removed on the seventh postoperative day, at which time she began a three-month program of formal physical therapy. (The first six weeks were devoted to passive range-of motion work, followed by six weeks of active range of motion exercise, with the final three months taken up by strengthening.)

The double-row suture anchor procedure resulted in a very solid repair. The patient regained full range of motion, was pain-free and possessed normal strength in the affected shoulder. She was able to resume all previous activities without restriction.

Patients aged 60 and younger who sustain an acute traumatic tear of a rotator cuff are best managed with early surgical intervention. The first six weeks after injury are considered the ideal time for that intervention. This is in contrast to older patients with degenerative, nontraumatic rotator cuff tears; they are typically better managed by trying conservative treatment first.

Rotator cuff repair is among the most painful surgical endeavors. Consequently, we favor use of an interscalene block administered via catheter by the anesthesiologist immediately prior to surgery. This block completely numbs the shoulder and is left in place for the first five postoperative days in order to ensure greater patient comfort. (Our ambulatory surgery center where this case occurred is one of only a handful in Indianapolis capable of providing interscalene blocks.)

An advantage of all-arthroscopic repair is elimination of the need to detach the deltoid muscle. Not having to perform such a detachment minimizes muscle damage and pain while helping maximize speed of recovery. Use of double-row suture anchoring has been shown in the literature to dramatically improve the fixation strength of the rotator cuff repair. The patient was referred to us because of our leading edge expertise in treating shoulder injuries.