#10563
Stephen Bird
Keymaster

Hi Amanda,

this is a great question with a long answer.

I have a nice post op shoulder lecture and I will record it into a webinar for the website as this will answer your questions plus other things that are important.

To answer your questions before the webinar is loaded up:

The long head of biceps tendon is often absent in the area of the rotator cuff interval and may look thin in the bicipital groove. This is not pathological, but rather a normal post op appearance as the surgeon often performs a biceps tenodesis.

The AC joint may also be vert wide if they have had a mumford procedure.

The CA ligament is often busy, hypo echoic and not tight as it has been disconnected from the acromiale ens as part of an acromioplasty.

Sutures are variable depending on the number of bone anchors used. Look at the x-ray first as if the anchors are red-opaque you can see how many there are and the locations. If you can’t see them on the x-ray you can see them on the ultrasound as a divot in the location of the native supraspinatus enthesis on the greater tuberosity. Arising from these anchors you will see the suture material spreading out through the repaired supraspinatus tendon. If the repair is good the sutures will be within the tendon and if the repair has failed you often see sutures running along the bony enthesis and over the humeral head hyaline cartilage. So sutures running along bone is a bad sign. If you see this internally and externally rotate the shoulder while watching the suture(s) in short axis and you will see the sutures moving independent to the overlong soft tissue proving they are no longer in the tendon.

Anchors rarely fall out.

Most re-tears happen at the proximal junction between the sutures and the native tendon. This is called a proximal re-tear.
To see this area you may need to use a full Crass position.

Other things to consider are that adhesive capsulitis is common in the post op shoulder as is bursitis.

There will be more detail in the webinar,

I will get it recorded and loaded up for you.

Steve.

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