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).