Portal de Periódicos da CAPES

Open reduction and rotator cuff repair of irreducible traumatic shoulder dislocation with sleeve-avulsion and glenohumeral interposition of the cuff: a case report and review of the literature

2022; Elsevier BV; Volume: 2; Issue: 3 Linguagem: Inglês

10.1016/j.xrrt.2022.04.011

2666-6391

Florian Frank, Kata Papp, Felix Toft,

Trauma Management and Diagnosis

Traumatic dislocation of the glenohumeral joint is a common injury16Leroux T. Wasserstein D. Veillette C. Khoshbin A. Henry P. Chahal J. et al.Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada.Am J Sports Med. 2014; 42: 442-450https://doi.org/10.1177/0363546513510391Crossref PubMed Scopus (128) Google Scholar,35Zacchilli M.A. Owens B.D. Epidemiology of shoulder dislocations presenting to emergency departments in the United States.J Bone Joint Surg Am. 2010; 92: 542-549https://doi.org/10.2106/JBJS.I.00450Crossref PubMed Scopus (388) Google Scholar seen in the predominantly young, male, and active population. Among females, elderly women are most likely to suffer a shoulder dislocation after minor trauma.28Shah A. Judge A. Delmestri A. Edwards K. Arden N.K. Prieto-Alhambra D. et al.Incidence of shoulder dislocations in the UK, 1995-2015: a population-based cohort study.BMJ Open. 2017; 7e016112https://doi.org/10.1136/bmjopen-2017-016112Crossref Scopus (32) Google Scholar Anterior dislocation makes up 95% of all dislocations.20McBride T. Kalogrianitis S. Dislocations of the shoulder joint.Trauma. 2012; 14: 47-56https://doi.org/10.1177/2F1460408611413837Crossref Scopus (0) Google Scholar Associated injuries occur frequently and include avulsion of the anterior labrum, fracture of the glenoid, rotator cuff tears, proximal humeral shaft fractures, fractures of tuberosities, and impaction fracture of the humeral head.2Atef A. El-Tantawy A. Gad H. Hefeda M. Prevalence of associated injuries after anterior shoulder dislocation: a prospective study.Int Orthop. 2016; 40: 519-524https://doi.org/10.1007/s00264-015-2862-zCrossref PubMed Scopus (44) Google Scholar,8Emond M. Le Sage N. Lavoie A. Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation.Acad Emerg Med. 2004; 11: 853-858https://doi.org/10.1111/j.1553-2712.2004.tb00768.xCrossref PubMed Scopus (0) Google Scholar,26Robinson C.M. Shur N. Sharpe T. Ray A. Murray I.R. Injuries associated with traumatic anterior glenohumeral dislocations.J Bone Joint Surg Am. 2012; 94: 18-26https://doi.org/10.2106/JBJS.J.01795Crossref PubMed Scopus (114) Google Scholar,36Zarins B. McMahon M.S. Rowe C.R. Diagnosis and treatment of traumatic anterior instability of the shoulder.Clin Orthop Relat Res. 1993; : 75-84PubMed Google Scholar When occurring in patients older than 60 years, 80% of patients with shoulder dislocation present with concomitant rupture of the rotator cuff.22Neviaser R.J. Neviaser T.J. Neviaser J.S. Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.J Bone Joint Surg Am. 1988; 70: 1308-1311Crossref PubMed Scopus (196) Google Scholar Females over the age of 60 years were most likely to suffer a torn rotator cuff after minor low-energy falls. Healing and clinical outcome of traumatic rotator cuff tears are known to be favorable when treated early.10Gutman M.J. Joyce C.D. Patel M.S. Kirsch J.M. Gutman B.S. Abboud J.A. et al.Early repair of traumatic rotator cuff tears improves functional outcomes.J Shoulder Elbow Surg. 2021; 30: 2475-2483https://doi.org/10.1016/j.jse.2021.03.134Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar In general, reduction of the shoulder is easily achieved, but interposed soft or bony tissue may hinder successful reduction, necessitating open reduction and removal of obstructions. This phenomenon was first described by Herbert in 1946.11Herbert J.J. Irreducible dislocation of the shoulder and tubercle fractures.Rev Orthop Chir Appar Mot. 1946; 32: 63-67PubMed Google Scholar We report on a rare case of rotator cuff interposition in the glenohumeral joint after a minor fall in a 71-year-old woman who was successfully treated with open reduction and rotator cuff repair. In addition, a review of the current literature was performed. A 71-year-old female was referred to our clinic 10 days after sustaining a traumatic anterior shoulder dislocation in a simple fall, most likely caused by a syncopal episode. Immediate reduction had been performed at a local emergency department. After reduction, pain was eliminated, but the patient complained about significant loss of function. At presentation, active and passive range of motion (ROM) of the shoulder were equally limited (forward flexion [FFL] 40°, external rotation [ER] 10°, and internal rotation [IR] to the greater trochanter). Initial Constant score was 27. X-rays taken upon presentation to our clinic revealed persistent anterior-inferior subluxation of the humeral head, which was easily missed on the initial anteroposterior postreduction x-rays (Fig. 1). A complementary magnetic resonance imaging (MRI) arthrography had been obtained on the day of the accident and confirmed glenohumeral interposition of the upper two-third of the subscapularis (SSC) muscle and tendon in a total rotator cuff avulsion injury from the humeral head. Only the teres minor tendon was still partially attached to the humerus. The biceps tendon wound posteriorly around the head. The cuff itself remained in continuity. Morphologic appearance of the tendons and musculature as well as the glenohumeral joint status was good to excellent (Fig. 2). Lastly, a potential bony Bankart lesion was suspected (Fig. 3).Figure 3MRI showing bone marrow edema at the anterior glenoid (left) as indicated by the red circles. Possible glenoid fracture (right). MRI, magnetic resonance imaging.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Surgery was performed 17 days after the incident or 7 days after referral to our clinic. Using a standard deltopectoral approach, dissection was carried out to the level of the clavipectoral fascia. The humeral head partially perforated the fascia and stretched the anterior structures. After completing the fascial incision and freeing the humeral head, the extent of the rotator cuff tear was evaluated after mobilization of the conjoint tendon. In addition, the dislocated long head of the biceps tendon (LHBT) was identified at the inferior sulcus intertubercularis, running posteriorly around the humeral head. As seen on MRI results, the upper two-third of the SSC was interposed between the humeral head and the glenoid with a remnant of the muscular part at the minor tuberosity. The tendons of the upper two-third of the SSC, the supraspinatus, infraspinatus, and part of the teres minor were completely avulsed en bloc from the tuberosities and located behind the humeral head. It appeared that the humerus had dislocated through the muscular-tendinous junction of the lower SSC muscle, resembling a “diving injury” underneath the tendinous part of the SSC, with the cuff and LHBT resting in the normal position (Fig. 4). First, both tuberosities were prepared for later rotator cuff repair, and a medial row of suture anchors was placed (1 × 5.5 mm Titan Corkscrew (Arthex, Naples, FL, USA) minor tuberosity, 3 × 5.5 mm Titan Corkscrew greater tuberosity). Next, reduction was attempted by introducing a “De Quervain” Elevatorium (Ulrich, St. Gallen, Switzerland) through the SSC tear into the glenohumeral space to lift the torn cuff including the biceps tendon over the dislocated head, reversing the traumatic “dive” mechanism. After several failed attempts, the LHBT was tenotomized, and the muscular remnant of the lower SSC at the minor tuberosity was released to reduce overall tension and eliminate the LHBT as a potential factor impeding successful reduction. With these measures, en bloc reduction of the humeral head back into the sleeve was achieved by lifting the interposed SSC tendon up and manipulating the humeral head back into the joint, putting the torn cuff sleeve back in place. The bony Bankart lesion proved stable and nondisplaced. Therefore, no additional measures were necessary. Rotator cuff repair was then completed with a double-row suture bridge technique (SSC/ supraspinatus/infraspinatus/teres minor). All sutures from the medial row were secured laterally with two 4.5-mm PushLock anchors (Arthrex, Naples, FL, USA), creating a “hot air ballon” construct (Fig. 5). Finally, soft-tissue tenodesis of the LHBT was performed, following irrigation and standard wound closure. Postoperative rehabilitation consisted of initial immobilization of the extremity in a neutral wedge brace in 15° of ER and 15° of abduction (ABD) for 6 weeks after surgery. For the first 3 weeks, only passive ROM was allowed with FFL or ABD limited to 60° and IR to 30°. Starting from week 4, assisted mobilization was extended to FFL or ABD up to 90° and IR to 60°. No active ER was permitted until week 6. Because of the LHBT tenodesis, no active elbow flexion or supination was allowed before week 5. This was followed by free ROM and coordination exercises until 12 weeks after surgery. By 3 months after the surgery, incremental load-bearing and strengthening exercises were undertaken. An initial weakness of the delta muscle visible as inferior eccentricity of the humeral head at 6 weeks subsided at the follow-up at 3 months with x-rays indicating a centered humeral head. Early shoulder movement was limited as expected following this extended surgical procedure with shoulder stiffness in the early months. This proved to be almost completely reversible over the course of the first year. Active ROM reached near-normal values with FFL up to 160°, ABD of 150°, ER 30°, and IR reaching L3. All movements were performed without any pain (Fig. 6). Imaging, consisting of x-rays (Fig. 7) and sonography after 6 months as well as an MRI arthrography after 12 months (Fig. 8), confirmed intact rotator cuff repair, without muscular atrophy or fatty infiltration.Figure 8Arthro-MRI of the left shoulder at 12 months postoperatively. (A) Shows intact supraspinatus tendon () with centered humeral head. (B) Shows intact subscapularis () and teres minor tendon (). (C) Presents intact supraspinatus and infraspinatus tendon (). Quality and trophy of the muscles of the rotator cuff are still well maintained as shown on (D). MRI, magnetic resonance imaging.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Function was evaluated using the Constant score with excellent results as the score steadily improved from 27 preoperatively via 50 after the surgery up to 79 at 24 months of follow-up. This case report describes the radiological and functional outcomes after successful open reduction and rotator cuff repair of an elderly woman with a rare injury pattern sustained after traumatic shoulder dislocation following minor trauma. This type of injury is predominantly seen in younger males and usually associated with high-energy trauma, as outlined in the following literature review. Early presentation of the patient and feasibility of reconstruction made a complete repair worth a try. Due to the completely disturbed anatomy as shown on the preoperative MRI, arthroscopic surgery was considered to be technically demanding. With the lack of a capsuled joint space, the surrounding soft-tissue envelope was prone to rapid and extensive swelling, possibly hampering arthroscopic and potential later open surgeries, even in the case of early transition. Reduction was only achieved with substantial effort during the open approach, making it even less likely for arthroscopic approaches to succeed in a rational time frame. Therefore, open surgery seemed to be the best treatment option with an expected reasonable outcome. Withholding surgery would have rendered the woman’s arm useless for any future activity.15Kim J.H. Park J.W. Heo S.Y. Noh Y.M. Magnetic resonance imaging analysis of rotator cuff tear after shoulder dislocation in a patient older than 40 years.Clin Shoulder Elb. 2020; 23: 144-151https://doi.org/10.5397/cise.2020.00227Crossref PubMed Google Scholar Even though it was tempting to try to visualize this particular injury pattern arthroscopically, the authors suggest arthroscopic repair may not be possible. When advanced imaging techniques are unavailable or surgery is performed before further diagnostics are obtained, an injury of similar extent must be suspected in cases of failed closed reduction combined with open reduction being hindered by soft-tissue tension. The bare humeral head breaking through the clavipectoral fascia gives another hint on the severity of the soft-tissue injury. We scanned databases (PubMed, Cochrane) for the following queries: “interposed”, “rotator cuff”, “shoulder”, “glenohumeral”, and “dislocation” from 1946 to 2021. After identifying relevant literature, we crosschecked references and were able to retrieve additional literature. We excluded cases in which bony fragments hindered reduction as they are usually identified on plain x-rays. Several case reports and case series have a variety of different injury patterns and causes of persistent subluxation after failed attempts of closed reduction following glenohumeral dislocation. In total, 28 patients could be identified from 1982 to 2021.1Agnollitto P.M. Chu M.W. Lorenzato M.M. Zatiti S.C. Nogueira-Barbosa M.H. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear.Radiol Bras. 2016; 49: 53-55https://doi.org/10.1590/0100-3984.2013.0011Crossref PubMed Scopus (5) Google Scholar,3Bayoumy M.A. Said H.G. Abdelkawi A.F. Fetih T.N. Treatment of Irreducible Traumatic Anterior Shoulder Dislocation Caused by Subscapularis Tendon Interposition.Arthrosc Tech. 2017; 6: e737-e741https://doi.org/10.1016/j.eats.2017.02.003Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 4Bridle S.H. Ferris B.D. Irreducible acute anterior dislocation of the shoulder: interposed scapularis.J Bone Joint Surg Br. 1990; 72: 1078-1079Crossref PubMed Google Scholar, 5Bruce-Brand R.A. O'Connor B.R. Quinn M. Fleming P. Subscapularis tendon interposition after anterior shoulder dislocation and reduction.BMJ Case Rep. 2014; 2014https://doi.org/10.1136/bcr-2014-206320Crossref PubMed Scopus (1) Google Scholar, 6Connolly S. Ritchie D. Sinopidis C. Brownson P. Aniq H. Irreducible anterior dislocation of the shoulder due to soft tissue interposition of subscapularis tendon.Skeletal Radiol. 2008; 37: 63-65https://doi.org/10.1007/s00256-007-0370-yCrossref PubMed Scopus (18) Google Scholar, 7Dodson C.C. Bedi A. Sahai A. Potter H.G. Cordasco F.A. Complete rotator cuff tendon avulsion and glenohumeral joint incarceration in a young patient: a case report.J Shoulder Elbow Surg. 2010; 19: e9-e12https://doi.org/10.1016/j.jse.2009.07.014Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar,9Gudena R. Iyengar K.P. Nadkarni J.B. Loh W. Irreducible shoulder dislocation - a word of caution.Orthop Traumatol Surg Res. 2011; 97: 451-453https://doi.org/10.1016/j.otsr.2011.02.004Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,12Ilaslan H. Bilenler A. Schils J. Ricchetti E.T. Sundaram M. Pseudoparalysis of shoulder caused by glenohumeral interposition of rotator cuff tendon stumps: a rare complication of posterior shoulder dislocation.Skeletal Radiol. 2013; 42: 135-139https://doi.org/10.1007/s00256-012-1478-2Crossref PubMed Scopus (5) Google Scholar, 13Inao S. Hirayama T. Takemitsu Y. Irreducible acute anterior dislocation of the shoulder: interposed bicipital tendon.J Bone Joint Surg Br. 1990; 72: 1079-1080Crossref PubMed Google Scholar, 14Javier J.C. Pablo C.V. Miguel Angel M.A. Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report.JSES Int. 2021; 5: 649-655https://doi.org/10.1016/j.jseint.2021.02.004Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,17Lin C.L. Su W.R. Jou I.M. Chih W.H. Occult interpositional rotator cuff - an extremely rare case of traumatic rotator cuff tear.Korean J Radiol. 2012; 13: 98-101https://doi.org/10.3348/kjr.2012.13.1.98Crossref PubMed Scopus (3) Google Scholar, 18Luenam S. Kosiyatrakul A. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.Musculoskelet Surg. 2013; 97: 273-278https://doi.org/10.1007/s12306-012-0211-6Crossref PubMed Scopus (10) Google Scholar, 19McArthur C. Welsh F. Campbell C. Posterior dislocation of long head of biceps tendon following traumatic anterior shoulder dislocation: imaging and intra-operative findings.J Radiol Case Rep. 2013; 7: 19-26https://doi.org/10.3941/jrcr.v7i9.1516Crossref PubMed Scopus (3) Google Scholar,21Miles Z.E. Gordon R.J. Wilkinson M.P.R. Irreducible Traumatic Anterior Shoulder Dislocation Secondary to Both Subscapularis and Long Head of Biceps Tendon Interposition—A Case Report.Open J Orthop. 2012; 2: 51-55https://doi.org/10.4236/ojo.2012.22010Crossref Google Scholar,23Ogawa K. Ogawa Y. Yoshida A. Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.J Trauma. 1997; 43: 688-691Crossref PubMed Scopus (12) Google Scholar, 24Pantazis K. Panagopoulos A. Tatani I. Daskalopoulos B. Iliopoulos I. Tyllianakis M. Irreducible anterior shoulder dislocation with interposition of the long head of the biceps and greater tuberosity fracture: a case report and review of the literature.Open Orthop J. 2017; 11: 327-334https://doi.org/10.2174/1874325001711010327Crossref PubMed Google Scholar, 25Rickert M. Loew M. Glenohumeral interposition of a torn rotator cuff in a young motorcyclist.Arch Orthop Trauma Surg. 2006; 126: 184-187https://doi.org/10.1007/s00402-006-0104-yCrossref PubMed Scopus (8) Google Scholar,27Seo J.B. Yoon S.H. Yang J.H. Yoo J.S. Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon: a case report.J Orthop. 2020; 21: 6-9https://doi.org/10.1016/j.jor.2020.02.007Crossref PubMed Scopus (1) Google Scholar,29Soon E.L. Bin Abd Razak H.R. Tan A.H.C. A rare case of massive rotator cuff tear and biceps tendon rupture with posterior shoulder dislocation in a young adult - surgical decision-making and outcome.J Orthop Case Rep. 2017; 7: 82-86https://doi.org/10.13107/jocr.2250-0685.762Crossref PubMed Google Scholar,31Tietjen R. Occult glenohumeral interposition of a torn rotator cuff. A case report.J Bone Joint Surg Am. 1982; 64: 458-459Crossref PubMed Scopus (19) Google Scholar, 32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 33Wortley P. Omar L. Robertson W. Moore D. Sims G.C. Omar H. Nonreducible shoulder due to acute posterior dislocation of the long head of the biceps tendon: a case report and review of the literature.JBJS Case Connect. 2014; 4: e261-e264https://doi.org/10.2106/JBJS.CC.M.00032Crossref Scopus (2) Google Scholar, 34Wyatt 2nd, A.R. Porrino J. Shah S. Hsu J.E. Irreducible superolateral dislocation of the glenohumeral joint.Skeletal Radiol. 2015; 44: 1387-1391https://doi.org/10.1007/s00256-015-2183-8Crossref PubMed Scopus (3) Google Scholar All but 2 patients were male. Age ranged from 13 to 87 years. The vast majority (24 out of 28) of patients were younger than 60 years when suffering the accident. In 2 cases, the mechanism of injury remained unknown, the rest resulted from high-energy trauma (motor vehicle accidents, motorcycle or bicycle crashes, falls from height (stairs/roof), seizure, or similar). Especially in the earliest published cases, persistent subluxation was often diagnosed with significant delay.25Rickert M. Loew M. Glenohumeral interposition of a torn rotator cuff in a young motorcyclist.Arch Orthop Trauma Surg. 2006; 126: 184-187https://doi.org/10.1007/s00402-006-0104-yCrossref PubMed Scopus (8) Google Scholar,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In 66% of cases, multiple tendons were injured and interposed in the glenohumeral joint. The long biceps tendon was hindering reduction in almost half of the cases (13/28). Only in 4 cases, 4 or more tendons were affected, resulting from motorcycle or motor vehicle accidents. All 4 patients older than 60 years were involved in major falls (stairs/roof) (Table I). Advanced imaging was obtained in 22 cases (19× MRI, 3× CT), and arthrography in 3 cases. In 3 patients, persistent subluxation was diagnosed on plain radiographs leading to an immediate open surgery without further imaging. Most patients underwent an open surgery (26/28) with the deltopectoral approach used in 13 cases. An arthroscopic procedure was attempted in 6 cases, but 4 of those needed transition to open surgery. Successful arthroscopic repair was performed on an isolated displacement of the long head of biceps tendon and a young patient (15 years old) in a very recent report.14Javier J.C. Pablo C.V. Miguel Angel M.A. Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report.JSES Int. 2021; 5: 649-655https://doi.org/10.1016/j.jseint.2021.02.004Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,27Seo J.B. Yoon S.H. Yang J.H. Yoo J.S. Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon: a case report.J Orthop. 2020; 21: 6-9https://doi.org/10.1016/j.jor.2020.02.007Crossref PubMed Scopus (1) Google ScholarTable ISynopsis of studies.No.StudyYearAgeSexDirectionTendons involvedTrauma mechnismDays till diagnosisType of study1Tietjen et al,31Tietjen R. Occult glenohumeral interposition of a torn rotator cuff. A case report.J Bone Joint Surg Am. 1982; 64: 458-459Crossref PubMed Scopus (19) Google Scholar JBJS Am198219mUnknownUnknownMotorcycle12 dCase report2Bridle and Ferris,4Bridle S.H. Ferris B.D. Irreducible acute anterior dislocation of the shoulder: interposed scapularis.J Bone Joint Surg Br. 1990; 72: 1078-1079Crossref PubMed Google Scholar JBJS B199055mAnteriorSSCHeavy fallNoneCase report3Inao et al,13Inao S. Hirayama T. Takemitsu Y. Irreducible acute anterior dislocation of the shoulder: interposed bicipital tendon.J Bone Joint Surg Br. 1990; 72: 1079-1080Crossref PubMed Google Scholar JBJS Br199053mAnteriorSSC, SSP, ISP, BTMV accidentUnknownCase report4Ogawa et al,23Ogawa K. Ogawa Y. Yoshida A. Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.J Trauma. 1997; 43: 688-691Crossref PubMed Scopus (12) Google Scholar J Trauma199721mPosteriorISPMV accidentUnknownCase report5Walch et al,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar J Shoulder Elbow Surg200149mAnteriorSSC, SSPMV accidentUnknownCase report6Walch et al,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar J Shoulder Elbow Surg200158mAnteriorSSC, BTSkiing8 moCase report7Walch et al,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar J Shoulder Elbow Surg200146mPosteriorISPUnknown4 moCase report8Walch et al,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar J Shoulder Elbow Surg200129fPosteriorSSP, ISPMV accident18 moCase report9Walch et al,32Walch G. Boulahia A. Robinson A.H. Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff.J Shoulder Elbow Surg. 2001; 10: 85-91Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar J Shoulder Elbow Surg200113mPosteriorSSC, SSP, ISPContact sports6 moCase report10Rickert and Loew,25Rickert M. Loew M. Glenohumeral interposition of a torn rotator cuff in a young motorcyclist.Arch Orthop Trauma Surg. 2006; 126: 184-187https://doi.org/10.1007/s00402-006-0104-yCrossref PubMed Scopus (8) Google Scholar Arch Orthop Trauma Surg200620mUnknownRC, BTMotorcycle72 dCR and review11Connolly et al,6Connolly S. Ritchie D. Sinopidis C. Brownson P. Aniq H. Irreducible anterior dislocation of the shoulder due to soft tissue interposition of subscapularis tendon.Skeletal Radiol. 2008; 37: 63-65https://doi.org/10.1007/s00256-007-0370-yCrossref PubMed Scopus (18) Google Scholar Skelet Radiol200887mAnteriorSSCFall17 dCase report12Dodson et al,7Dodson C.C. Bedi A. Sahai A. Potter H.G. Cordasco F.A. Complete rotator cuff tendon avulsion and glenohumeral joint incarceration in a young patient: a case report.J Shoulder Elbow Surg. 2010; 19: e9-e12https://doi.org/10.1016/j.jse.2009.07.014Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar J Shoulder Elbow Surg201032mUnknownSSC, SSP, ISP, BTMotorcycle5 weeksCase report13Ilaslan et al,12Ilaslan H. Bilenler A. Schils J. Ricchetti E.T. Sundaram M. Pseudoparalysis of shoulder caused by glenohumeral interposition of rotator cuff tendon stumps: a rare complication of posterior shoulder dislocation.Skeletal Radiol. 2013; 42: 135-139https://doi.org/10.1007/s00256-012-1478-2Crossref PubMed Scopus (5) Google Scholar Skeletal Radiol201348mPosteriorSSC, BTSeizureUnkownCase report14Ilaslan et al,12Ilaslan H. Bilenler A. Schils J. Ricchetti E.T. Sundaram M. Pseudoparalysis of shoulder caused by glenohumeral interposition of rotator cuff tendon stumps: a rare complication of posterior shoulder dislocation.Skeletal Radiol. 2013; 42: 135-139https://doi.org/10.1007/s00256-012-1478-2Crossref PubMed Scopus (5) Google Scholar Skeletal Radiol201312mPosteriorSSP, ISPMotorcycle8 moCase report15Gudena et al,9Gudena R. Iyengar K.P. Nadkarni J.B. Loh W. Irreducible shoulder dislocation - a word of caution.Orthop Traumatol Surg Res. 2011; 97: 451-453https://doi.org/10.1016/j.otsr.2011.02.004Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Ortho Trauma Surg Res201162mAnteriorSSP, ISP, TMFall down stairsNoneCase report16Luenam and Kosiyatrakul,18Luenam S. Kosiyatrakul A. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.Musculoskelet Surg. 2013; 97: 273-278https://doi.org/10.1007/s12306-012-0211-6Crossref PubMed Scopus (10) Google Scholar Musculoskelet Surg201336mPosteriorSSP, ISPMV accident3 dCR and review17Luenam and Kosiyatrakul,18Luenam S. Kosiyatrakul A. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.Musculoskelet Surg. 2013; 97: 273-278https://doi.org/10.1007/s12306-012-0211-6Crossref PubMed Scopus (10) Google Scholar Musculoskelet Surg201255mPosteriorSSC, SSP, ISP, TMMotorcycleUnknownCR and review18Miles et al,21Miles Z.E. Gordon R.J. Wilkinson M.P.R. Irreducible Traumatic Anterior Shoulder Dislocation Secondary to Both Subscapularis and Long Head of Biceps Tendon Interposition—A Case Report.Open J Orthop. 2012; 2: 51-55https://doi.org/10.4236/ojo.2012.22010Crossref Google Scholar Open J Ortho201264mAnteriorSSC, BTHeavy fall6 weeksCase report19Lin et al,17Lin C.L. Su W.R. Jou I.M. Chih W.H. Occult interpositional rotator cuff - an extremely rare case of traumatic rotator cuff tear.Korean J Radiol. 2012; 13: 98-101https://doi.org/10.3348/kjr.2012.13.1.98Crossref PubMed Scopus (3) Google Scholar Korean J Radiol201217mSuperolateralSSC, SSPBicycle fallNoneCase report20McArthur et al,19McArthur C. Welsh F. Campbell C. Posterior dislocation of long head of biceps tendon following traumatic anterior shoulder dislocation: imaging and intra-operative findings.J Radiol Case Rep. 2013; 7: 19-26https://doi.org/10.3941/jrcr.v7i9.1516Crossref PubMed Scopus (3) Google Scholar Musculoskelet Radiol201369mAnteriorBTUnknown fallNoneCase report21Wortley et al,33Wortley P. Omar L. Robertson W. Moore D. Sims G.C. Omar H. Nonreducible shoulder due to acute posterior dislocation of the long head of the biceps tendon: a case report and review of the literature.JBJS Case Connect. 2014; 4: e261-e264https://doi.org/10.2106/JBJS.CC.M.00032Crossref Scopus (2) Google Scholar Bone Joint J201444mAnteriorBTMotorcycleNoneCR and review22Bruce-Brand et al,5Bruce-Brand R.A. O'Connor B.R. Quinn M. Fleming P. Subscapularis tendon interposition after anterior shoulder dislocation and reduction.BMJ Case Rep. 2014; 2014https://doi.org/10.1136/bcr-2014-206320Crossref PubMed Scopus (1) Google Scholar BMJ Case Rep201451mAnteriorSSCFall from height3 weeksCase report23Wyatt et al,34Wyatt 2nd, A.R. Porrino J. Shah S. Hsu J.E. Irreducible superolateral dislocation of the glenohumeral joint.Skeletal Radiol. 2015; 44: 1387-1391https://doi.org/10.1007/s00256-015-2183-8Crossref PubMed Scopus (3) Google Scholar Skelet Radiol201553mSuperolateralSSC, SSP, ISP, BTFall out of driving carNoneCase report24Agnollitto et al,1Agnollitto P.M. Chu M.W. Lorenzato M.M. Zatiti S.C. Nogueira-Barbosa M.H. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear.Radiol Bras. 2016; 49: 53-55https://doi.org/10.1590/0100-3984.2013.0011Crossref PubMed Scopus (5) Google Scholar J Radiol Brasl201627fUnknownSSC, SSP, ISPMotorcycle15 dCase report25Soon et al,29Soon E.L. Bin Abd Razak H.R. Tan A.H.C. A rare case of massive rotator cuff tear and biceps tendon rupture with posterior shoulder dislocation in a young adult - surgical decision-making and outcome.J Orthop Case Rep. 2017; 7: 82-86https://doi.org/10.13107/jocr.2250-0685.762Crossref PubMed Google Scholar Journal Ortho Case Reports201734mPosteriorSSC, SSP, BTFall from bicycle3 dCase report26Pantazis et al,24Pantazis K. Panagopoulos A. Tatani I. Daskalopoulos B. Iliopoulos I. Tyllianakis M. Irreducible anterior shoulder dislocation with interposition of the long head of the biceps and greater tuberosity fracture: a case report and review of the literature.Open Orthop J. 2017; 11: 327-334https://doi.org/10.2174/1874325001711010327Crossref PubMed Google Scholar Open Ortho Journal201757mAnteriorBTMotorcycleNoneCase report27Seo et al,27Seo J.B. Yoon S.H. Yang J.H. Yoo J.S. Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon: a case report.J Orthop. 2020; 21: 6-9https://doi.org/10.1016/j.jor.2020.02.007Crossref PubMed Scopus (1) Google Scholar Jour Orthopaedics202057mPosteriorBTMotorcycleNoneCase report28Javier et al,14Javier J.C. Pablo C.V. Miguel Angel M.A. Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report.JSES Int. 2021; 5: 649-655https://doi.org/10.1016/j.jseint.2021.02.004Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar J Shoulder Elbow Surg Int202115mPosteriorSSP, ISP, BTMotorcycle4 dCase reportm, male; SSC, subscapularis; SSP, supraspinatus; ISP, infraspinatus; BT, biceps tendon; MV, motor vehicle; f, female; RC, rotator cuff; CR, case report. Open table in a new tab m, male; SSC, subscapularis; SSP, supraspinatus; ISP, infraspinatus; BT, biceps tendon; MV, motor vehicle; f, female; RC, rotator cuff; CR, case report. The patient reported in this case report thus differs from the majority of cases regarding trauma mechanism and extent of injury. Special attention should be paid to postreduction x-rays to detect or rule out persistent dislocation/subluxation, which should prompt further diagnostic imaging if necessary. Tissue interposition after closed reduction of a dislocated shoulder must be suspected if persistent subluxation is present. Delay in diagnosis is avoidable by taking postreduction x-rays in at least 2 or, better, 3 planes, including 1 axial view. Irrespective of age and injury pattern, we strongly recommend rotator cuff repair whenever feasible in terms of muscle and joint condition. Surgery should be performed as soon as possible to achieve the best possible results, for example, avoiding joint replacement surgery.30Spross C. Behrens G. Dietrich T.J. Olaf Kim C.H. Puskas G.J. Zdravkovic V. et al.Early arthroscopic repair of acute traumatic massive rotator cuff tears leads to reliable reversal of pseudoparesis: clinical and radiographic outcome.Arthroscopy. 2019; 35: 343-350https://doi.org/10.1016/j.arthro.2018.08.048Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar In regard to the surgical approach, the deltopectoral incision seems favorable over the delta-split in terms of joint reduction and visualization.