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Worsening shoulder pain, external rotation weakness may signal rare musculotendinous infraspinatus rupture

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LAS VEGAS — International shoulder specialists who studied 19 cases of infraspinatus musculotendinous rupture presented the first-ever report of this condition here at the American Academy of Orthopaedic Surgeons 76th Annual Meeting.

Musculotendinous (MT) ruptures tend to occur in the lower extremities relative to sports injuries. Based on these patients’ outcomes at 48 months after surgical or conservative treatment, Gilles Walch, MD, of Lyon, France, presented some key findings and treatment recommendations at the meeting.

“We should try to diagnose them as soon as possible,” ideally in the acute phase, he said.

Re-tensioning the infraspinatus and quickly operating on these patients also seems to help them, Walch noted. He treated many of these cases arthroscopically at about 3 months after the symptoms developed.

“All 19 ruptures were isolated,” Walch said. They occurred in patients who had a previous trauma or chronic shoulder pain that worsened; the average patient age was 48 years.

The ruptures were always complete, although has since seen some partial ones, he said.

Investigators examined the patients, recorded Constant scores and performed MRIs with T2 fat saturation sequences in the acute phase to detect fluid collection, edema and MT retraction. Constant scores improved from 53 points to about 67 points. The majority of patients were treated operatively, although by the last follow-up they did no better than the patients treated conservatively, Walch said.

All patients later presented with stage 4 fatty infiltrations (FI), which may account for the presence of FI in patients with intact rotator cuffs, according to the study abstract.

Reference:

• Walch G, Lunn JV, Tavernier T, Barthelemy R. Musculotendinous (MT) ruptures of the infraspinatus: Diagnosis and treatment for about 19 cases. #558. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.