There is conflicting information as to whether or not she had previous
surgery on this shoulder, her other shoulder, or both.
I cannot reach the doctor or the patient, I have tried.
At the risk of being stupid….is this a chronic high grade partial
thickness suprapsinatus tear, or has there been a superior capsular
reconstruction?
I have seen so few…so I need help!
The coronals look almost graft-like, but I don’t see anchors, and I’m not
convinced I see sutures (though a colleague seems to be hallucinating
suture artifact…I’m not convinced).
[image: 1.jpg]
[image: 2.jpg]
[image: 3.jpg]
I received Many comments on this case.
I have to say, several were certain that this was post-operative related to
Superior Capsualr Reconstruction (saying that anchors can be bioabsorbable
and no longer visible) and others were certain this is a chronic, high
grade partial cuff tear.
Tear did outweigh post-surgical.
I discussed this with Dr. Ticker (see the inaugural OCAD lecture on
Subscapularis in the video archive, ocadmsk.com)…who told me it could not
be SCR, because we should see the 4 anchors in the medial and lateral
greater tuberosity; there is 1 anchor in the superior glenoid in the Cor PD
image.
I thought it was odd that the tear was as medial to the insertion as it
is—-I can’t remember seeing that….and I see alot of shoulder MRI.
Dr. Ticker mentioned other patch procedures (eg. Regeneret) but thought we
should see the sutures….plus, it’s supposed to thicken the cuff
substance—and this is certainly not thick.
I finally got a cell contact for the referring orthopedist.
He operated her opposite shoulder in 2018 and last saw her in 2019.
He said that she had surgery on This shoulder at another institution in
2013…she claims “cuff surgery” (maybe very limited subacromial
decompression???), but he doesn’t know details.
He said: “I would really doubt if they were using any sort of patch or
biologic at Saint Joseph’s in 2013. The rotation medical augmentation patch
was not in the market then. And it would’ve been in the very early days for
any sort of superior capsule reconstruction”
So there we have it.
****For those of you who missed it, today’s Case Presentation, Focus on
Infection, was absolutely FABULOUS. It should be available by next week in
the video section of our website.
It was, by the way, the one year anniversary of our first collaborative
Case Presentaion Series between OCAD and the Radiology Society of Rio de
Janeiro…..quite a big deal!
As a result, we have a vibrant and continually growing OCAD community in
Brazil….it’s really fantastic.
[gallery]
Hello,
Here is how failed graft looks like. In our institute- surgeons don’t like any of these grafts- they think they all fail- that’s my opinion too with meniscus transplants and RC grafts.
Our surgeons are doing more and more reverse shoulders in patients above 50 and biceps tenodesis-even at 30 yrs of age.
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>
http://www.utsouthwestern.edu<http://www.utsouthwestern.edu/>
________________________________
Sent: Friday, October 29, 2021 2:52 PM
EXTERNAL MAIL
I received Many comments on this case.
I have to say, several were certain that this was post-operative related to Superior Capsualr Reconstruction (saying that anchors can be bioabsorbable and no longer visible) and others were certain this is a chronic, high grade partial cuff tear.
Tear did outweigh post-surgical.
I discussed this with Dr. Ticker (see the inaugural OCAD lecture on Subscapularis in the video archive, ocadmsk.com<ocadmsk.com>)…who told me it could not be SCR, because we should see the 4 anchors in the medial and lateral greater tuberosity; there is 1 anchor in the superior glenoid in the Cor PD image.
I thought it was odd that the tear was as medial to the insertion as it is—-I can’t remember seeing that….and I see alot of shoulder MRI.
Dr. Ticker mentioned other patch procedures (eg. Regeneret) but thought we should see the sutures….plus, it’s supposed to thicken the cuff substance—and this is certainly not thick.
I finally got a cell contact for the referring orthopedist.
He operated her opposite shoulder in 2018 and last saw her in 2019.
He said that she had surgery on This shoulder at another institution in 2013…she claims “cuff surgery” (maybe very limited subacromial decompression???), but he doesn’t know details.
He said: “I would really doubt if they were using any sort of patch or biologic at Saint Joseph’s in 2013. The rotation medical augmentation patch was not in the market then. And it would’ve been in the very early days for any sort of superior capsule reconstruction”
So there we have it.
****For those of you who missed it, today’s Case Presentation, Focus on Infection, was absolutely FABULOUS. It should be available by next week in the video section of our website.
It was, by the way, the one year anniversary of our first collaborative Case Presentaion Series between OCAD and the Radiology Society of Rio de Janeiro…..quite a big deal!
As a result, we have a vibrant and continually growing OCAD community in Brazil….it’s really fantastic.
There is conflicting information as to whether or not she had previous surgery on this shoulder, her other shoulder, or both.
I cannot reach the doctor or the patient, I have tried.
At the risk of being stupid….is this a chronic high grade partial thickness suprapsinatus tear, or has there been a superior capsular reconstruction?
I have seen so few…so I need help!
The coronals look almost graft-like, but I don’t see anchors, and I’m not convinced I see sutures (though a colleague seems to be hallucinating suture artifact…I’m not convinced).
[1.jpg]
[2.jpg]
[3.jpg]
[gallery]