PMC9975288_01
The preoperative images.. A) Shoulder X-ray at the initial visit to our hospital. B) X-ray fluoroscopy after the attempted closed reduction. C-E) CT scans showing a large Hill-Sachs lesion and defect of the anterior glenoid surface. F) T2-weighted fat suppression image on coronal MRI showing a broad bone bruise in the humeral head. G, H) T2-weighted MRI showing severe muscle atrophy and fatty infiltration of the subscapularis, supraspinatus, and infraspinatus, indicating chronic significant rotator cuff tear.
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FIG1
Despite the aid of X-ray fluoroscopy and a scalene block, a closed reduction could not be accomplished (Figure 1A, 1B). A computed tomography (CT) scan showed a large Hill-Sachs lesion with approximately a 40% loss of the glenoid surface anteriorly (Figure 1C-1E). Magnetic resonance imaging (MRI) revealed atrophy of the subscapularis, supraspinatus, and infraspinatus, indicating that these rotator cuffs had torn (Figure 1F-1H).
The perioperative images.. A) The intraoperative photograph immediately following reduction of the humeral head and transfer of the coracoid to the glenoid. White arrowheads indicate full-thickness tear of the subscapularis and supraspinatus. The white outlined arrowhead indicates the transferred coracoid. SSP: supraspinatus, SSC: subscapularis, HH: humeral head. B, C) Postoperative X-ray and CT scan.
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FIG2
Intraoperatively, progressive osteoarthritis of the glenohumeral joint was noted, and the subscapularis, supraspinatus, and infraspinatus tendons were noted to be completely torn (Figure 2A). Finally, the glenohumeral joint was fixed with Kirschner wires to maintain the reduction (Figure 2B, 2C).
Fifty months after surgery.. A) Radiograph showing progression of the osteoarthritis. B, C) CT scans showing reconstruction of the glenoid surface by the transferred coracoid. D) White arrowheads indicate integrity of the repaired supraspinatus tendon on T2-weighted MRI. E) Flexion. F) External rotation. G) The patient can touch the back of her head with the elbow back. H) Internal rotation. I) The patient can stand up by herself.
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FIG3
While X-ray imaging noted progression of osteoarthrosis of the glenohumeral joint (Figure 3A), a CT scan noted the transferred coracoid reconstructed the defect within the anterior rim of the glenoid (Figure 3B, 3C). MRI demonstrated integrity of the repaired rotator cuff tear (Figure 3D). Her shoulder's active range of motion is currently 120  in flexion, 30  in external rotation, hand behind the head with elbow back, and the fifth lumber spine in internal rotation (Figure 3E-3H).