A 53-year-old right-hand-dominant farmer presents with a 2-year history of progressive left shoulder pain and weakness. He has failed extensive conservative treatment including physiotherapy, NSAIDs, and subacromial injections. He cannot lift his arm above shoulder height. Clinical examination shows crepitus, tenderness over greater tuberosity, and 3/5 power in abduction and external rotation. Impingement tests are positive.
How do you assess reparability of this rotator cuff tear?
What are the surgical options for a massive irrepairable rotator cuff tear?
Describe the principles of reverse total shoulder arthroplasty.
How do you interpret MRI findings in massive rotator cuff tears?
What rehabilitation protocol would you follow after RTSA for massive irrepairable cuff tear?
What are the complications of RTSA and how would you manage instability?
Opening Statement: This farmer has a massive posterosuperior rotator cuff tear with features suggesting irreparability - Goutallier 3-4 fatty infiltration, retraction to glenoid, and 2-year duration. Treatment options include RTSA, superior capsular reconstruction, or tendon transfer depending on age, activity level, and presence of arthritis.
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