CASE REPORT


Ultrasound-guided Arthroscopic Tuberoplasty for Greater Tuberosity Malunion: A Case Report



Akira Ando1, Kazuaki Suzuki2, Masashi Koide1, Yoshihiro Hagiwara2, *
1 Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumiku, Sendai, 981-3217, Japan
2 Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan


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Creative Commons License
© 2020 Ando et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan; Tel: +81-22-7177245; Fax: +81-22-7177248; E-mail: hagi@med.tohoku.ac.jp


Abstract

Background:

Greater Tuberosity (GT) malunion can lead to impingement against the acromion, resulting in pain, stiffness, and weakness of the rotator cuff. For patients with lesser degrees of displacement, partial removal of the GT with rotator cuff repair (tuberoplasty) under fluoroscopic guidance is considered.

Case report:

A sixty-five year old female fell from a standing height and suffered a minimally displaced isolated GT fracture. She was conservatively managed for four months and referred to our institution due to persisting pain and stiffness. The shoulder motion was severely restricted (anterior elevation: 90°, lateral elevation: 45°, external rotation with the arm at side: 25°, hand behind back: 4th lumber vertebrae) and pain aggravated especially when laterally elevated. Plain radiography and computed tomography showed small superiorly malunited GT and magnetic resonance imaging showed no rotator cuff pathology. Ultrasound images showed impingement of the GT against the acromion when laterally elevated. Arthroscopic excision of the malunited GT and rotator cuff repair along with capsular release and acromioplasty was performed under ultrasound guidance. The ultrasound images were simultaneously delineated to the arthroscopic monitor. Dynamic evaluation of the reshaped GT passing under the acromion was possible.

Conclusion:

Intraoperative use of ultrasound during arthroscopic tuberoplasty offers advantages over fluoroscopic guidance concerning control of the amount of bone resection and dynamic evaluation between the GT and the acromion in addition to the problems of radiation and space-occupying devices.

Keywords: Ultrasound, Arthroscopic tuberoplasty, Greater tuberosity malunion, Acromion, Rotator cuff, Rotator cuff pathology.