It is presumed that the recent symptoms are a manifestation of an extension of her chronic tear to involve the upper portion of the subscapularis and some displacement of the biceps. In spite of this, she remains able to elevate her arm fully overhead now that the initial inflammation has subsided. We have discussed alternatives including latissimus tendon transfer in conjunction with repair of her subscapularis and centralization of the biceps. However, given her ability to elevate her arm overhead and after discussing what would be involved with the latissimus transfer, a conscious decision was made at this juncture to approach the recent extension of her tear in hopes of recentralizing her biceps and repairing the upper portions of her subscapularis. No effort is going to be made to revise repair of the chronically retracted supraspinatus.
Health otherwise is good.