Surena Namdari1, R Frank Henn, Andrew Green. 1. Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Abstract
BACKGROUND: Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than posterosuperior tears and are rarely discussed in the literature. The purpose of this study was to identify the unique features of this injury and to assess the outcome of operative treatment. METHODS: Thirty consecutive patients, with a mean age of fifty-seven years (range, forty-three to seventy-three years), had an open repair of a traumatic anterosuperior rotator cuff tear. Twenty-four patients (80%) were male. Sixteen patients (53%) had involvement of the dominant shoulder, twenty-three (77%) had a biceps tendon disorder, and sixteen (53%) had a positive lift-off maneuver prior to surgery. Surgical approaches included an isolated superior deltoid-splitting approach in twenty patients, an isolated deltopectoral approach in five patients, and a combined approach in five patients. Open repair was performed at a mean of 4.5 months after the injury or the onset of symptoms. The final outcomes were determined with a physical examination and patient self-assessed outcome tools. RESULTS: At a mean follow-up of fifty-six months, twenty-one of the thirty patients were satisfied with their symptoms, and twenty-nine would have the surgery again. The mean pain score on the visual analog scale improved from 6.2 to 1.2 (p < 0.001). The mean score on the Disabilities of the Arm, Shoulder and Hand questionnaire improved from 41.7 to 12.2 (p < 0.001). The mean percentage of functions that patients were able to perform on the Simple Shoulder Test improved from 36.4% to 82.8% (p < 0.001). The mean age and sex-adjusted Constant score was 93.4 postoperatively. The mean elevation, external rotation, and internal rotation of the involved shoulders were 97%, 109%, and 97%, respectively, of those of the contralateral side. The mean strength of elevation, external rotation, and internal rotation were 85%, 93%, and 101%, respectively, of those of the contralateral side. Infraspinatus involvement (p = 0.04), the extent of the supraspinatus tear (p = 0.03), and a Workers' Compensation claim (p = 0.03) were associated with worse outcomes and decreased satisfaction. CONCLUSIONS: Patients with a traumatic anterosuperior rotator cuff tear present with internal rotation weakness, and they usually have a biceps tendon disorder. While larger tears involving greater portions of the supraspinatus and extending into the infraspinatus are associated with poorer outcomes, early recognition of this injury and open repair can reliably restore shoulder function to near normal levels.
BACKGROUND: Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than posterosuperior tears and are rarely discussed in the literature. The purpose of this study was to identify the unique features of this injury and to assess the outcome of operative treatment. METHODS: Thirty consecutive patients, with a mean age of fifty-seven years (range, forty-three to seventy-three years), had an open repair of a traumatic anterosuperior rotator cuff tear. Twenty-four patients (80%) were male. Sixteen patients (53%) had involvement of the dominant shoulder, twenty-three (77%) had a biceps tendon disorder, and sixteen (53%) had a positive lift-off maneuver prior to surgery. Surgical approaches included an isolated superior deltoid-splitting approach in twenty patients, an isolated deltopectoral approach in five patients, and a combined approach in five patients. Open repair was performed at a mean of 4.5 months after the injury or the onset of symptoms. The final outcomes were determined with a physical examination and patient self-assessed outcome tools. RESULTS: At a mean follow-up of fifty-six months, twenty-one of the thirty patients were satisfied with their symptoms, and twenty-nine would have the surgery again. The mean pain score on the visual analog scale improved from 6.2 to 1.2 (p < 0.001). The mean score on the Disabilities of the Arm, Shoulder and Hand questionnaire improved from 41.7 to 12.2 (p < 0.001). The mean percentage of functions that patients were able to perform on the Simple Shoulder Test improved from 36.4% to 82.8% (p < 0.001). The mean age and sex-adjusted Constant score was 93.4 postoperatively. The mean elevation, external rotation, and internal rotation of the involved shoulders were 97%, 109%, and 97%, respectively, of those of the contralateral side. The mean strength of elevation, external rotation, and internal rotation were 85%, 93%, and 101%, respectively, of those of the contralateral side. Infraspinatus involvement (p = 0.04), the extent of the supraspinatus tear (p = 0.03), and a Workers' Compensation claim (p = 0.03) were associated with worse outcomes and decreased satisfaction. CONCLUSIONS:Patients with a traumatic anterosuperior rotator cuff tear present with internal rotation weakness, and they usually have a biceps tendon disorder. While larger tears involving greater portions of the supraspinatus and extending into the infraspinatus are associated with poorer outcomes, early recognition of this injury and open repair can reliably restore shoulder function to near normal levels.