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Case Reports
. 2016 Jan-Feb;49(1):53-5.
doi: 10.1590/0100-3984.2013.0011.

Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

Paulo Moraes Agnollitto  1 , Marcio Wen King Chu  2 , Mario Muller Lorenzato  3 , Salomão Chade Assan Zatiti  4 , Marcello Henrique Nogueira-Barbosa  5
Affiliations
Case Reports

Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

Paulo Moraes Agnollitto et al. Radiol Bras. 2016 Jan-Feb.

Abstract
in English, Portuguese

The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

O objetivo deste trabalho é relatar um caso com os achados de imagem característicos da lesão traumática do manguito rotador com interposição de múltiplos cotos de tendões do manguito rotador entre a glenoide e o úmero, confirmada cirurgicamente. Esta condição é uma rara complicação do trauma do ombro. Em geral ocorre no trauma de alta energia, frequentemente associada com luxação da articulação glenoumeral. No caso em questão não houve documentação de luxação franca da articulação glenoumeral. As radiografias mostraram aumento do espaço articular, rotação interna do úmero e fratura do coracoide. Nas imagens de ressonância magnética, além das alterações observadas nas radiografias, foi identificada ruptura massiva do manguito rotador com interposição dos cotos dos tendões do supraespinal, do infraespinal e do subescapular no interior da articulação glenoumeral. Foi realizado tratamento cirúrgico confirmando a lesão e a interposição dos cotos do manguito. É importante que radiologistas e ortopedistas estejam familiarizados com esta entidade, que, pela sua raridade, pode ser negligenciada no atendimento do trauma do ombro.

Keywords: Interposition; Magnetic resonance imaging; Rotator cuff; Shoulder; Tear; Trauma.

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Figures

Figure 1
Figure 1
Radiography of right shoulder. Anteroposterior view showing glenohumeral joint space widening (continuous arrows). The humerus presented with internal rotation. The dashed arrow indicates fracture of the coracoid process.
Figure 2
Figure 2
MRI. Axial sections images acquired with intermediate weighting demonstrates rotator cuff stumps interposition (arrows) between the glenoid and the humerus, explaining the blockage and the joint space widening.
Figure 3
Figure 3
MRI, coronal section, intermediate weighting. The arrows identify rotator cuff stumps interposition between the glenoid and the humerus. The white arrow indicates the supraspinatus tendon and the black arrow shows the subscapularis tendon.
Figure 4
Figure 4
A: Intraoperative finding demonstrating uncovered humeral head (continuous arrow) and retracted and interposed rotator cuff stumps in the glenohumeral joint (dashed arrow). B: Intraoperative finding demonstrating rotator cuff (continuous arrows), repaired by surgical thread (dashed arrow) coursing up to the site of insertion of the greater humeral tuberosity.
See this image and copyright information in PMC

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