- Discussion:
- recurrent rotator cuff tear:
- ref: Mode of failure for rotator cuff repair with suture anchors identified at revision surgery
- deltoid injury:
- may occur from axillary nerve palsy or from avulsion of deltoid off the acromion;
- consider EMG to determine whether the injury is an neuropraxia or neurotmesis;
- detached deltoid:
- detached anterior deltoid may be diagnosed by careful palpation on physical exam;
- look for a defect at the origin of the deltoid from the acromion and a prominence of the deltoid distal to the defect
that is accentuated by active elevation of the arm;
- MRI should help confirm the diagnosis;
- superior migration of the humeral head:
- is more apt to occur w/ massive rotator cuff tears;
- may occur due to excision of CA ligament and excessive acromioplasty;
- missed diagnosis
- nerve palsy:
- w/ failed rotator cuff surgery, consider obtaining an MRI of the shoulder, to evaluate for space occupying lesion causing suprascapular nerve palsy;
- also consider EMG:
- occult instability: (anterior or multi-directional)
- biceps tendonitis
- AC joint arthrosis:
- os acromiale:
- ref: Os acromiale: anatomy and surgical implications.
- recurrent impingement:
- cervical spondylosis:
- reflex sympathetic dystrophy
- thoracic outlet syndrome
- glenohumeral osteoarthritis;
- Management Suggestions:
- revision acromioplasty in worker's compensation patients is unlikely to improve symptoms;
- if a specific diagnosis can be made (either recurrent impingement or other), then a second operation may be indicated;
Failed Repair of the Rotator Cuff. Evaluation and Treatment of Complications. E.H. Karas MD and J.P. Iannotti MD PH.D. JBJS. Vol 79-A, No 5, May 1997. p. 784-793.
Superior Humeral Dislocation: A Complication Following Decompression and Debridement for Rotator Cuff Tears.
Operative Treatment of failed repairs of the rotator cuff. LU Bigliani et al. JBJS Vol 74-A. 1992. p 1505-1515.
Failed anterior acromioplasty. A review of 51 cases. RJ Hawkins MD et al. CORR. No 243. June, 1989. p 106.
