Surgical Fixation:
Following standard preoperative consent and induction of general
anesthesia he was placed in the lateral decubitus position, and the left
upper extremity was prepped and draped in the usual sterile fashion.
A 7 cm longitudinal lateral shoulder incision was then made over the
deltoid insertion on the humerus. The distal posterior deltoid tendon
end was identified and a nonabsorbable high-strength suture loop
(FiberWire No. 2; Arthrex) was utilized to place a four-throw whipstitch
through the distal tendon (figure 2).
Careful dissection was performed down to the deltoid tuberosity along
the tract left from the avulsed posterior tendon. A pilot hole was
drilled across near cortex of the humeral shaft. This was performed at
the anatomic insertion point of the tuberosity. The suture ends were
next passed through the cortical button (TightRope, Arthrex, FL, USA).
The cortical button was inserted and flipped on the near cortex of the
humerus. The sutures were pulled, bringing the tendon securely down to
the tuberosity of the humerus. A free needle was used to suture to the
proximal aspect of the tendon with a krackow suture technique. After
three locking throws each, the two suture ends were then tied
approximately 1.5 cm from the tuberosity. The wound was then copiously
irrigated and closed in the standard fashion. The patient’s operative
shoulder was placed into a sling immobilizer.
The patient started a progressive supervised rehabilitation program
beginning with passive shoulder elevation and pendulum exercises
starting one week after surgery. Three weeks following surgery
supervised active shoulder range of motion was allowed. This was
followed by shoulder girdle strengthening 8 weeks postoperatively.
Focused strengthening of the shoulder started with forward flexion,
internal and external rotation. Shoulder abduction strengthening was
then pursued following adequate range of motion and forward flexion
strength. Our patient was able to return to work full-time and pain free
4 months postoperatively. At the 6 month postoperative visit the
patient’s left shoulder returned to preinjury level. Range of motion of
the operative shoulder was 30 degree of extension to 170 degrees of
flexion and abduction. Strength of the deltoid was measured to be 5/5 on
physical exam. At two years following the surgical procedure, the
patient had returned to all weightlifting with no limitations, pain or
complaints (Video 1).