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Failed Acromioplasty / Rotator Cuff Surgery


- Discussion:
    - recurrent rotator cuff tear:
         - ref: Mode of failure for rotator cuff repair with suture anchors identified at revision surgery
    - deltoid injury:
         - may occur from axillary nerve palsy or from avulsion of deltoid off the acromion;
         - consider EMG to determine whether the injury is an neuropraxia or neurotmesis;
         - detached deltoid:
                - detached anterior deltoid may be diagnosed by careful palpation on physical exam;
                - look for a defect at the origin of the deltoid from the acromion and a prominence of the deltoid distal to the defect that is accentuated by active elevation of the arm;
                - MRI should help confirm the diagnosis;
    - superior migration of the humeral head:
         - is more apt to occur w/ massive rotator cuff tears;
         - may occur due to excision of CA ligament and excessive acromioplasty;
    - missed diagnosis
         - nerve palsy:
              - w/ failed rotator cuff surgery, consider obtaining an MRI of the shoulder, to evaluate for space occupying lesion causing suprascapular nerve palsy;
              - also consider EMG
         - occult instability (anterior or multi-directional)
         - biceps tendonitis
         - AC joint arthrosis
         - os acromiale
              - ref: Os acromiale: anatomy and surgical implications.
         - recurrent impingement
         - cervical spondylosis
         - reflex sympathetic dystrophy
         - thoracic outlet syndrome
         - glenohumeral osteoarthritis

- Management Suggestions:
    - revision acromioplasty in worker's compensation patients is unlikely to improve symptoms;
    - if a specific diagnosis can be made (either recurrent impingement or other), then a second operation may be indicated;

Failed Repair of the Rotator Cuff. Evaluation and Treatment of Complications

Superior Humeral Dislocation: A Complication Following Decompression and Debridement for Rotator Cuff Tears.

Operative Treatment of failed repairs of the rotator cuff.

Failed anterior acromioplasty. A review of 51 cases.

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