The Sports Medicine blog reviews and adds clinical perspective to sports medicine cases and reviews of recently published case-based studies.

BLOG: We present the uncommon case of an atraumatic rotator cuff tear in a young patient

Atraumatic rotator cuff tear is an uncommon entity in young patients. There are few clinical studies available in the English literature to guide treatment. Payne and colleagues reported on 29 patients with atraumatic rotator cuff tears. All patients were overhead throwing athletes who had insidious unset of pain and weakness.

We present the case of a young patient who presented to our clinic with symptomatic atraumatic rotator cuff tear.

Sylvester Youlo 

Case presentation    

A 34-year-old man presented with right shoulder pain and severe weakness. His symptoms began after he cleaned his new apartment for a few hours and transferred light-weight trash into a nearby garbage dump. After cleaning, he stepped into his shower. As he reached overhead, he noted severe shoulder pain, immediate weakness and inability to lift his arm. The following day, his primary care physician ordered an MRI, which showed a 1-cm supraspinatus tear.

The patient presented to our clinic 2 weeks later in a sling. His exam showed pain, 3+ strength and atrophy of the supraspinatus. His medical history was unremarkable, and he did not play sports.

The patient was taken to surgery. As can be seen in the arthroscopic photos below, the rotator cuff appears normal when viewed from the articular side. Viewed from the subacromion space and probed, it is clear that the rotator cuff is torn and had tried to heal unsuccessfully.

Final repair images are also shown. The patient continues to regain full strength, and his muscle atrophy is resolving.

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Figure 1. MRI taken 2 days after injury. The T2-weighted sagittal and FSE coronal are shown.

Scott Mair, MD

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Figure 2. Intra-articular view of the rotator cuff is shown.

Scott Mair, MD

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Figure 3. Subacromion view after tagging with PDS suture is shown.

Scott Mair, MD


 
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Figure 4. The view after minimal debridement and synovectomy is shown.

Scott Mair, MD

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Figure 5. Final repair is shown.

Scott Mair, MD


Reference:

Payne LZ, et al. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. Am J Sports Med. 1997;25(3):299-305.

Sylvester Youlo, MD, is a fellow in sports medicine at the University of Kentucky.

Disclosure: Youlo reports no relevant financial disclosures.

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