Chief Complaint/Injury

75 year-old female presents with right shoulder pain 10 years after successful arthroscopic rotator cuff repair of her opposite left non-dominant shoulder. She is a painter and has significant shoulder pain and functional limitations that are preventing her from engaging in activities of daily living, obtaining restful sleep at night, and pursuing her love of painting. Conservative management is selected initially due to her age of 75 and our collective desire to avoid surgery.

Workup/Images

Despite a corticosteroid injection, oral anti-inflammatory medication and tailored physical therapy with a specific rotator cuff protocol, she returns with significant pain and an MRI which demonstrates a large, full-thickness tear of the supraspinatus and infraspinatus tendons with retraction and very early, mild atrophy. Due to persistent pain and functional limitation despite physiotherapy, we discuss the potential role of arthroscopic repair and possible biceps tenotomy with which she is quite familiar given her surgery on the opposite shoulder ten years earlier. We explain that her age, tear size, and the degenerative nature of the tear make this one that is less likely to heal and have an optimal result. She and her husband indicate their understanding and explain that she is unable to enjoy her life and feels very limited (especially without the ability to pursue her love of painting). Given that she has had a thorough course of appropriate non-operative management and understands the risks, benefits, and alternatives of surgery the patient makes a collaborative decision with her husband and surgeon to pursue arthroscopic repair.

Surgery

Her right shoulder surgery took place in January of 2017. She underwent an outpatient arthroscopic rotator cuff repair with biceps tenotomy at Sibley Memorial Hospital. The procedure went well with an uneventful anatomic double-row arthroscopic repair of her rotator cuff under combined regional and general anesthesia.  She began physical therapy at approximately 4 weeks and discontinued her sling at 6 weeks.  At 6 months she began to paint again and had complete resolution of her pain with functional restoration.

Result

“It has been a little over a year since I had surgery on the rotator cuff of my right arm.  At first Dr. Rudzki recommended no surgery because of the severity of the tear, my age and some degeneration in the shoulder from arthritis. But, he also let me know that he would perform the surgery if I wanted to go through with it.  I tried physical therapy first but I soon realized, after consultation with my physical therapist, that just physical therapy would not have restored full mobility, which I need as an artist to be able to paint my large canvases. I already had surgery on the rotator cuff of my left arm and I knew that with post-operative physical therapy and faithfully doing my home exercises, I would have a good chance to regain my mobility.

Following a successful surgery, Dr. Rudzki prescribed physical therapy with a tailored protocol and daily home exercises. It has all been worthwhile.  I am now able to paint my large canvasses and to place objects on high shelves without any difficulty.”- patient’s testimonial March 14th, 2018