Case report: Concurrent anterior shoulder dislocation and rotator cuff tear in a young athlete. (2001)

Shoulder dislocation is a common consequence of athletic activity in the younger population, occurring in up to 7% of this population.1 Bankart and Hill-Sachs lesions, where the glenoid fractures or impales the posterolateral humeral head, are frequently seen when the dislocation is anterior.1 Dislocation, more common in males, has not been associated with rotator cuff tears in the younger population.2 However, rotator cuff tears are often seen in shoulder dislocations in patients older than 35 years.2 We present a young athlete with a rotator cuff tear that occurred concurrent with a shoulder dislocation and Bankart lesion. The purpose of this case is to emphasize the need to look for rotator cuff tears when evaluating shoulder dislocations in this population and to detail the management plan that successfully returned him to action.

An 18 year old football player presented to our clinic five days following an initial left anterior shoulder dislocation. He was recovering a fumbled ball when he was struck by two other players and felt his left shoulder dislocate. When on the field reduction was unsuccessful, he was taken to the local ER where reduction was performed under conscious sedation. He noted persistent numbness and tingling in his left hand and over his left deltoid, as well as a significant amount of pain after the reduction. However, at presentation to our clinic 7 days later he was experiencing only occasional paresthesias in the left ring and little finger.

Exam revealed a muscular 315 pound, eighteen year old collegiate football player with minimal left shoulder swelling. His range of motion on the left was significantly decreased, particularly to abduction and external rotation. His supraspinatus was also weak and very painful to strength testing but both anterior and posterior portions of the deltoid were intact. Neurovascular exam revealed no deficits. His shoulder was protected in a sling and he performed limited pendulum exercises for the first six weeks. Preliminary x-rays showed an anterior shoulder dislocation without bony Bankart lesion. An MRI was done to evaluate the patient's rotator cuff and glenoid which showed an anterior labral tear, a supraspinatus tendon tear, and a possible posterior labral tear (Figure 1).



Figure 1



Exam under general anesthesia revealed no shoulder instability, but some crepitus with range of motion. Arthroscopic evaluation showed an extensive detachment of the anterior labrum and a 2 cm full thickness supraspinatus rotator cuff tear, but no evidence of a posterior labral tear or Hill-Sachs lesion. No SLAP lesion was identified. The labral tear was repaired arthroscopically followed by mini-open rotator cuff repair.

Postoperatively, the patient did well with no complications. By the time of the initial follow-up examination there had been an obvious reduction in the level of shoulder pain. His range of motion continued to improve without apprehension but his shoulder girdle muscles did undergo noticeable atrophy. At 12 weeks, the patient progressed through physical therapy from passive to active exercises. At seven months post-op, the patient was back to full strength with a full range of motion except for a mild decrease in external rotation and some residual weakness without pain in his supraspinatus. This continued over the following three months despite an off-season rehabilitation program. The patient was then started on an aggressive PT program for supraspinatus strengthening. At one year post-op, the patient showed no instability, 90-95% supraspinatus strength, full range of motion, and no pain. He was released to resume football practice with a shoulder brace. He completed the entire season with any problems.