Kanji Furuya, Naoya Nishinaka, Taishi Uehara, Hiroaki Tsutsui
Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital1-30, Fujigaoka, Aoba-Ku, Yokohama, Japan.
Showa University Research Institute for Sport and Exercise Sciences2-1-1, Fujigaoka, Aoba-Ku, Yokohama, Japan.
J Orthop Case Rep. 2018 Mar-Apr;8(2):100-103. doi: 10.13107/jocr.2250-0685.1070.
This report describes a case of irreparable massive rotator cuff tear and axillary nerve palsy associated with shoulder dislocation successfully treated by arthroscopic superior capsule reconstruction (ASCR), with a favorable post-operative outcome.
A 76-year-old man, injured from a fall while walking, presented to another hospital with right shoulder pain and a limited range of motion (ROM) 3 days after the injury. Given a diagnosis of right shoulder dislocation, he received manual reduction followed by immobilization with a sling. He continued to experience difficulty in performing active ROM exercises of the shoulder and underwent magnetic resonance imaging, which revealed an irreparable extensive rotator cuff tear involving the supraspinatus and infraspinatus muscles. He was then referred to our hospital 2 months after the injury. Examination revealed atrophy of the supraspinatus and infraspinatus muscles, atrophy of the deltoid muscle and hypoesthesia, likely due to axillary nerve palsy, and a marked limitation of active ROM with flexion, abduction and lateral rotation angles of 10°each. ASCR was considered for treating the irreparable rotator cuff tear. Since the technique is not indicated for patients with deltoid paralysis, the operation was delayed until signs of improved axillary nerve palsy were observed at 6 months after the injury. The patient started passive ROM training the day after the operation while wearing a shoulder abduction orthosis for 3 weeks, followed by immobilization with a sling for 2 weeks. Thereafter, he started active exercise. The axillary nerve palsy was almost completely resolved 3 months after the operation. He achieved a ROM comparable to that of the unaffected side at 1 year after operation. He has had an uneventful post-operative course for 2 years after operation.
We encountered a rare, difficult-to-treat case of irreparable extensive rotator cuff tear with axillary nerve palsy after a shoulder dislocation. ASCR, although not indicated for patients with deltoid muscle dysfunction, provided a favorable post-operative outcome when performed after confirmation of signs of improved palsy.
本报告描述了一例与肩关节脱位相关的不可修复的巨大肩袖撕裂和腋神经麻痹病例，通过关节镜下上关节囊重建术（ASCR）成功治疗，术后效果良好。
一名76岁男性，行走时摔倒受伤，受伤3天后因右肩疼痛和活动范围受限（ROM）就诊于另一家医院。诊断为右肩关节脱位，接受了手法复位，随后用吊带固定。他在进行肩部主动ROM锻炼时仍有困难，并接受了磁共振成像检查，结果显示肩袖广泛撕裂，累及冈上肌和冈下肌，无法修复。受伤2个月后，他被转诊至我院。检查发现冈上肌和冈下肌萎缩、三角肌萎缩以及感觉减退，可能是由于腋神经麻痹所致，主动ROM明显受限，屈曲、外展和外旋角度均为10°。考虑采用ASCR治疗不可修复的肩袖撕裂。由于该技术不适用于三角肌麻痹患者，手术推迟至受伤6个月后观察到腋神经麻痹有所改善的迹象时进行。患者术后第一天开始佩戴肩部外展矫形器进行3周的被动ROM训练，随后用吊带固定2周。此后，他开始进行主动锻炼。术后3个月，腋神经麻痹几乎完全恢复。术后1年，他的ROM与未受伤侧相当。术后2年，他的术后过程顺利。
我们遇到了一例罕见的、难以治疗的肩关节脱位后不可修复的广泛肩袖撕裂伴腋神经麻痹病例。ASCR虽然不适用于三角肌功能障碍患者，但在确认麻痹有所改善的迹象后进行手术，术后效果良好。
