Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

  • Shon, Min Soo (Department of Orthopedic Surgery, Center for Joint Surgery, National Medical Center, Sungkyunkwan University School of Medicine) ;
  • Bang, Tae Jung (Department of Orthopedic Surgery, Center for Joint Surgery, National Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Jae Chul (Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.02.02
  • Accepted : 2015.02.11
  • Published : 2015.03.30
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Abstract

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.

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References

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