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Year |
2001 |
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Question Number |
62 |
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Category |
Select |
Question
62. A 32-year old man has left shoulder pain. Hx reveals that he underwent an open Bankart repair for recurrent shoulder dislocations 3 years ago. Four months after the surgery he fell and sustained a hyper abduction injury of the shoulder. Examination reveals slightly limited shoulder motion, pain with passive external rotation, and he cannot maintain a belly-press maneuver against resistance (Napolean’s sign). An MR-Arthrogram ios shown in figure 12. Because PT has failed to provide relief, treatment should now consist of:
1. arthroscopic Bankart repair
2. an open capsular shift
3. a subscapularis transfer
4. a pectoralis major transfer
5. a pectoralis minor transfer
Figures
Answer (click for answer)
The correct answer is (4) a pectoralis major transfer. The Hx gives the pertinent information that his subscapularis is no longer functioning (or more likely even attached based on the Hx alone). This is given through the positive Napolean sign. The MR-arthrogram reveals a totally retracted subscap—indicating an irreparable traumatic rupture. (1) is incorrect because his problem is no longer a Bankart lesion but rather the subscap rupture. (2) is incorrect for similar reasons. Because the subscap is irreparable from the MR image, a subscap transfer is not an option. A Pectoralis minor transfer is simply not a hearty enough transfer to replace the ruptured subscap to any suitable degree.
Reference: Wirth & Rockwood. Operative Treatment of Irreparable Rupture of the Subscapularis. JBJS. 1997. 79: pp. 722-731.