What's New in Shoulder and Elbow Surgery
Gary M. Gartsman, MD1 and Samer S. Hasan, MD, PhD2
http://www.ejbjs.org/cgi/content/full/88/1/230
1 Texas Orthopedic Hospital, Fondren Orthopedic Group, 7401 South Main Street, Houston, TX 77030. E-mail address: gmg@fondren.com
2 Cincinnati Sportsmedicine and Orthopaedic Center, 12115 Sheraton Lane, Cincinnati, OH 45246
Massive and Irreparable Tears
Warner reported on suprascapular nerve dysfunction in association with massive rotator cuff tears. In that study, four of seven patients who had a chronic massive rotator cuff tear associated with substantial fatty muscle atrophy and an isolated suprascapular nerve injury on electromyography underwent either complete arthroscopic repair or partial arthroscopic repair of the posterior portion of the rotator cuff. Postoperative electromyography demonstrated recovery of suprascapular nerve function. The author proposed that suprascapular nerve injury results from traction on the nerve when the torn rotator cuff tendons retract and resolves following partial or complete rotator cuff repair. Mullett reported on the role of anterior deltoid re-education in patients with chronic massive irreparable rotator cuff tears. Seventeen patients with an age of seventy years or more who had a painful massive rotator cuff tear and resultant deficits in active shoulder elevation were instructed in the use of a home exercise program. The patients were instructed to perform deltoid muscle exercises in the supine position at least three times daily for six weeks and to gradually incline the head of the bed throughout the course of the exercise program. Ninety percent of the participants reported improved upper extremity function following six weeks of treatment.
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