Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormali... more Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.
HISTORY: A 30-year-old right-hand dominant male was playing in a softball game when he ran into a... more HISTORY: A 30-year-old right-hand dominant male was playing in a softball game when he ran into another player with his left anterior chest while going to catch a ball. He had immediate onset of pain in his left shoulder and chest and had to retire from the game. He had no SOB or palpitations or parasthesias or sense of instability. He did not seek attention right away but presented at our clinic two weeks later complaining of a painful lump at his sternoclavicular joint and also laterally near the top of his shoulder joint. His pain was keeping him awake at night and preventing him from exercising. PHYSICAL EXAMINATION: The patient was alert and in no acute distress. He had swelling at this sternoclavicular joint and also at his acromioclavicular (AC) joint. He had full ROM of his fi ngers, wrist and elbow but his shoulder elevation was decreased due to pain. He had mild scapular dyskinesis with elevation but no winging. He was entirely neurologically intact for sensation and motor...
HISTORY: A 61-year-old male who had no previous problems with his shoulders was playing in a seni... more HISTORY: A 61-year-old male who had no previous problems with his shoulders was playing in a seniors softball game and was running to fi rst base after hitting a single when he felt suddenly some tightness in his chest on his right, dominant side. He had not SOB and the pain was non-radiating. He did not fall or stumble. The pain was minimal so he continued to play. He had no pain when swinging the bat or hitting the ball. He did not have any other trauma prior to the game whatsoever and he did not lift weights at home or at the gym. The next day he noticed bruising in his right chest and proximal arm. He saw his primary care who subsequently sent to us for further evaluation and we ordered an MRI of the shoulder and chest. He was not on any anticoagulation and was otherwise healthy. PHYSICAL EXAMINATION: The patient was alert and oriented, was in no acute distress and had no dyspnea. He had resolving ecchymosis on his right chest and proximal upper arm. He had a slight deformity wh...
Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormali... more Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.
HISTORY: A 30-year-old right-hand dominant male was playing in a softball game when he ran into a... more HISTORY: A 30-year-old right-hand dominant male was playing in a softball game when he ran into another player with his left anterior chest while going to catch a ball. He had immediate onset of pain in his left shoulder and chest and had to retire from the game. He had no SOB or palpitations or parasthesias or sense of instability. He did not seek attention right away but presented at our clinic two weeks later complaining of a painful lump at his sternoclavicular joint and also laterally near the top of his shoulder joint. His pain was keeping him awake at night and preventing him from exercising. PHYSICAL EXAMINATION: The patient was alert and in no acute distress. He had swelling at this sternoclavicular joint and also at his acromioclavicular (AC) joint. He had full ROM of his fi ngers, wrist and elbow but his shoulder elevation was decreased due to pain. He had mild scapular dyskinesis with elevation but no winging. He was entirely neurologically intact for sensation and motor...
HISTORY: A 61-year-old male who had no previous problems with his shoulders was playing in a seni... more HISTORY: A 61-year-old male who had no previous problems with his shoulders was playing in a seniors softball game and was running to fi rst base after hitting a single when he felt suddenly some tightness in his chest on his right, dominant side. He had not SOB and the pain was non-radiating. He did not fall or stumble. The pain was minimal so he continued to play. He had no pain when swinging the bat or hitting the ball. He did not have any other trauma prior to the game whatsoever and he did not lift weights at home or at the gym. The next day he noticed bruising in his right chest and proximal arm. He saw his primary care who subsequently sent to us for further evaluation and we ordered an MRI of the shoulder and chest. He was not on any anticoagulation and was otherwise healthy. PHYSICAL EXAMINATION: The patient was alert and oriented, was in no acute distress and had no dyspnea. He had resolving ecchymosis on his right chest and proximal upper arm. He had a slight deformity wh...
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