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Massive rotator cuff tears - decision making 2015

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Massive rotator cuff tears - decision making 2015
www.shoulderdoc.co.uk

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Massive rotator cuff tears - decision making 2015

  1. 1. Lennard Funk
  2. 2. • Boutonniere • Loss of suspension bridge (force couple) • LHB subluxes • Subscap tears • muscles atrophy • fixed instability • bone softens Massive Cuff Tear (>5cm)
  3. 3. IRREPERABLE CUFF TEARS Loss of Teres Minor - Postero-inferior Cuff: 1. +ve Hornblower’s Sign 2. MRI (fatty infiltration & retraction???) 3. Arthroscopy (subjective)
  4. 4. SURGEON CONCERNS Fatty infiltration Muscle Atrophy Retraction Recurrences Healing
  5. 5. PATIENT CONCERNS PAIN FUNCTION
  6. 6. TREATMENT OPTIONS 1. Deltoid Rehabilitation 2. Partial Repair 3. Debridement - Humeroplasty, ASD, Biceps Tenotomy 4. Tendon Transfers 5. Synthetic Patches 6. Reverse Arthroplasty 7. Superior Capsular Reconstruction 8. InSpace Balloon
  7. 7. CONSIDERATIONS PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  8. 8. REPAIR YOUNG OLD LAT DORSI DEBRIDE DELTOID REHAB REVERSE SCRCBALLOON PAIN WEAK HORN- BLOWERAGE
  9. 9. DECISIONS Deltoid Rehab Painless Need Deltoid Compliant Patient Debridement + Deltoid Rehab Pain Need Deltoid, 
 Compliant Patient Partial Repair Pain Need Deltoid, 
 Compliant Patient
 Long rehab & recovery Tendon Transfer Pain above +
 risk of open surgery
 Synthetic Augmentation Function
 (? Pain) above +
 Cost vs. Benefit?
 Xenograft/Allograft Risks Reverse Arthroplasty Pain +
 Function Predictable Results
 ? Long-term
  10. 10. DELTOID REHAB PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  11. 11. DEBRIDEMENT PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  12. 12. REPAIR PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  13. 13. LAT DORSI TRANSFER PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  14. 14. REVERSE ARTHROPLASTY PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  15. 15. SCRC PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  16. 16. INSPACE BALLOON PAIN FUNCTION AGE SMOKING COMORBID STIFFNESS HORN- BLOWER EXAM RETRAC- TION FATTY ATROPHY MRI
  17. 17. REPAIR YOUNG OLD LAT DORSI DEBRIDE DELTOID REHAB REVERSE SCRCBALLOON PAIN WEAK HORN- BLOWERAGE
  18. 18. THANKYOU @theshoulderdoc

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