A method for the treatment of patients with massive tears of the rotator cuff: a clinical case

Background: Rotator cuff tears are the most common cause of shoulder pain and dysfunction in older patients. Tears with the retraction greater than 5 cm or with the involvement of two and more tendons are considered massive. According to the literature, the incidence of massive injuries of the rotator cuff ranges from 10 to 40%. The formation of massive injuries is a long process leading to a pronounced pain syndrome, loss of function and, as a result, to pseudo-paralysis of the affected limb. There is no consensus concerning the treatment of this category of patients. Conservative methods of treatment are applicable for patients with a low activity. Among the surgical methods of treatment, the preference is given to the proximal capsule reconstruction, subacromial balloon arthroplasty, reverse arthroplasty and muscle-tendon transfers. However, today there is no single tactic for the surgical treatment of patients with massive rotator cuff tears. Clinical case description: We propose a new surgical method for this shoulder joint pathology — arthroscopically associated transposition of the tendon of the latissimus dorsi muscle using an autograft of the long peroneal muscle tendon. As an illustration of the new method, we present a successful clinical case of the treatment of a patient with a chronic massive rotator cuff injury of the right shoulder and secondary upper subluxation of the right humerus head. Conclusion: This method allows increasing the efficiency of the treatment of a massive tear of the rotator cuff tendons, restoring the correct biomechanics of the shoulder joint, reducing the pain and restoring the function of the affected limb.