Case Example 2: Combined Massive Rotator Cuff Tear and Recurrent Shoulder Instability

Abstract

A combination of massive rotator cuff tear and recurrent shoulder instability is uncommon and represents a complex problem to treat. The significant range of shoulder motion is achieved due to the lack of bony constraints which sets the stage for pathologic instability. The balance between shoulder mobility and stability is related to a complex combination of dynamic and static stabilizers around the shoulder joint. One of the main dynamic stabilizers is represented by the rotator cuff, which centers the humeral head in the glenoid fossa through concavity compression mechanism. Disruption of the balance between dynamic and static stabilizers due to their loss of integrity may lead to instability. In patients who complain of pain and weakness for up to 3 weeks after an anterior dislocation a rotator cuff lesion should be suspected and further investigation should be taken. There are no clear guidelines as to whether either the rotator cuff tear or the anterior capsulolabral complex injury or both should be treated surgically if they occur simultaneously in a patient with recurrent anterior shoulder dislocation. A case example of a combined massive rotator cuff and recurrent shoulder instability in a 63-year-old female is presented.