Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report

Figures

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  Figure 1. Preoperative image of the right shoulder compared with the contralateral side. Presents swelling and hematoma in the proximal third of the arm.

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  Figure 2. Initial radiographs (anteroposterior view).

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  Figure 3. Preoperative dynamic right shoulder ultrasound, with stress maneuvers against resistance in rotations and abduction. Demonstration of complete rupture with retraction of subscapularis (A), supraspinatus (B), posterosuperior humeral head bare due to complete infraspinatus rupture (C), medial dislocation of the biceps (red line) below avulsed bone fragments (arrow) (D) and, teres minor myotendinous junction with avulsed bone fragments (E). Retraction of supraspinatus tendon (F).

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  Figure 4. Conventional computed tomography of the shoulder was performed to assess the probable cause of soft-tissue interposition in the glenohumeral joint.

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  Figure 5. Subscapularis tear. (A and B) Medial dislocation of the biceps (circle) below avulsed bone fragments of lesser tuberosity (arrow). View from posterior portal. (C) Medial dislocation of the biceps and bare humeral head (triangle). View from anterosuperior portal.

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  Figure 6. (A) Interposition of supraspinatus and infraspinatus at the glenohumeral joint. Rotator cuff stumps interposition (arrow) with avulsion of humeral head (triangle). (B) Supraspinatus and infraspinatus tendon repair. View from the lateral portal.

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  Figure 7. View from the posterior portal. (A) Subscapularis tear and dislocation of long head of the biceps tendon. (B) Removal of hematoma and resection of the rotator interval (C) Suture anchor repair of the torn subscapularis muscle of the rotator cuff. (D) Subscapularis muscle repair.

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  Figure 8. Range of motion documented 6 months (A) and 24 months (B) after surgery with patient returning to full function.

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  Figure 9. Postoperative dynamic ultrasound of the right shoulder ultrasound with stress maneuvers 24 months after surgery. Integrity of sutures without rupture or retraction and integration of bone fragment of the lesser tuberosity. (A) Bicipital tendon (red line) tenodesis; tenodesis suture (arrow). (B) Subscapular tendon reinserted (red line); avulsed fragment reinserted (arrow). (C) Supraspinatus tendon (red line) repaired. (D) Infraspinatus tendon reinserted. Arrow shows the sutures.