Persistent Anterior Shoulder Pain Following Rotator Cuff Repair in a 51-Year-Old Male

Abstract

Rotator cuff repairs are among the most common orthopedic procedures performed in the United States, and their incidence is on the rise. Repairs have been reported with excellent outcomes; however, complications still exist. Some common complications include rotator cuff tear recurrence, acromioclavicular joint pain, suprascapular or axillary nerve injury, infection, and stiffness. In the setting of anterior shoulder pain following rotator cuff tear, the differential diagnosis will include pathologies both intrinsic and extrinsic to the shoulder such as AC joint arthrosis, subcoracoid impingement, glenohumeral instability, glenohumeral arthritis, rotator cuff pathology, adhesive capsulitis, biceps pathology, and cervical radiculopathy. Biceps tendon pathology is often a clinical diagnosis made with anterior shoulder pain, clicking, bicipital groove tenderness, and positive provocative testing such as Yergason’s, Speed’s, and O’Brien’s tests. Imaging is not always reliable though an MRI, showing increased T2 signaling around the biceps tendon or displacement of the tendon from the groove, may aid in diagnosis. Treatment options include tenotomy alone or tenodesis via an arthroscopic suprapectoral or open subpectoral technique. Results have been excellent, and treatment decision should be based on patient factors such as age, activity, lifestyle, and medical comorbidities. Concomitant procedures are sometimes necessary to treat co-pathologies affecting the shoulder.