Page 44 - Hoag Orthopedic Institute 2018 Outcomes Report
P. 44

 EDUCATION AND RESEARCH CONTINUED
CASE STUDY: ROTATOR CUFF REPAIR
Robert C. Grumet, MD
Back to the Gridiron
An 18-year-old, right-hand-dominant high school football player injured his right arm in a game while attempting to make a tackle. He fell onto his outstretched right arm, felt a “pop,” and the immediate sense of a “dead arm.” He was seen at a local urgent care and told he likely sustained a shoulder subluxation. He completed his
senior football season; however, he reinjured his shoulder while snowboarding, about six weeks prior to being seen in the office. He again fell onto his right arm with it extended.
When examined, the patient had significant pain and weakness while testing his rotator cuff.
He was unable to lift weights or do any activity overhead or away from his body due to pain.
His MRI revealed a large tear in his rotator
cuff. Although quite a common condition in the general population, rotator cuff injury is rather unusual for a high school athlete. Due to the
fact that rotator cuff tissue has a poor blood supply and limited healing potential and given the patient’s young age, we elected to proceed with surgical repair of the torn tendon. The challenge in this case is the fact that the tendon tear is
not complete. The tear can only be seen when looking inside the shoulder joint (Figure 1, below left). This is called a PASTA (partial articular sided tendon avulsion) injury.
Surgical Repair
The repair is initiated by removing the frayed tissue and preparing the “bed” to repair the tendon back to the bone (Figure 2).
Anchors are then placed into the bone and the sutures are passed systematically through the tendon tissue (Figure 3).
Finally, the sutures are tied on the outer side of the tendon tissue and crossed to compress the rotator cuff tendon. This arrangement will afford additional strength to the repair and promote healing of the tissue (Figure 4).
Conclusion
This patient was placed in a sling for four weeks, followed by progressive physical therapy. He
is now about a year past his surgery and has regained full, pain-free range of motion and strength. He has resumed playing football at a local junior college.
       Rotator Cuff Tear
MRI
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