Massive rotator cuff tear in an adolescent athlete: a case report

Abstract

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia ("stinger" or "burner"). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.

Keywords: adolescent; athlete; rotator cuff tear.

Figure 1.

Preoperative MRI: A, gradient echo T2-weighted axial image (S = subscapularis muscle). The humeral head is severely subluxed posteriorly. The subscapularis tendon is completely torn and retracted (large black arrowhead). The long head of the biceps tendon (black arrow) is dislocated medially, out of the bicipital groove (small white arrowhead). Extensive, amorphous low-signal tissue in the anterior joint is compatible with hemorrhage. B, fat-saturated T2 oblique coronal image (IS = infraspinatus muscle). The infraspinatus tendon is completely torn and retracted (small white arrowhead). There is also complete rupture of the teres minor with extensive fluid and hemorrhage in its expected position (large white arrowheads).

Figure 2.

Arthroscopic images: A, massive intra-articular hemorrhage and torn tendon edges; B, labrum intact circumferentially.

Figure 3.

Posterior approach. Upon reflecting the deltoid, the articular surface of the humeral head and torn infraspinatus tendon are visualized.

Figure 4.

Postoperative MRI: A, T1-weighted oblique coronal image. Artifact from an anchor is present within the greater tuberosity (arrowhead). Note the intact supraspinatus tendon (arrow). B, gradient echo T2-weighted axial image. The subscapularis (black arrow) and infraspinatus (arrowhead) tendons are intact after repair (white arrow = artifact from anchor).