Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

Abstract

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and  40  % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In  the  treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.