肩峰偽関節を伴った cuff tear arthropathy の 1 例

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In a massive rotator cuff tear (mRCT), the shoulder function may be maintained by intact deltoid muscle, even if there is the arthropathy. We report a case of mRCT combined with pseudoarthrosis of the acromion, which had remarkable shoulder dysfunction.<BR>The patient was a 70-year-old man, whose right shoulder pain developed three years previously without injury. He had received an intra-articular injection of steroid, several times. At examination, he had supraspinatus and infraspinatus muscle atrophy, and biceps muscle deformity, and active shoulder elevation was limited to 30°. Image inspections showed ascent of the humeral head with rounding of the greater tuberosity, pseudoarthrosis of the thinned acromion, and mRCT with biceps tendon rupture(BTR). An operation was performed by acromion-splitting approach through pseudoarthrosis. The rotator cuff tear was repaired by tissue augmentation, and the pseudoarthrosis was fixed by tension band method using iliac bone graft. The pain was relieved and his active shoulder elevation improved to 120° at one year, postoperatively.<BR>It is thought that a possible cause of pseudoarthrosis is a stress fracture of the thinned acromion due to cuff tear arthropathy. Both impaired dynamic stabilizer due to the mRCT with BTR and loss of deltoid function due to the moveable acromion caused remarkable shoulder dysfunction.