Acute massive rotator cuff tear and biceps tendon dislocation following posterior shoulder dislocation: A case report

Table 1 Reported cases of posterior shoulder dislocation with massive rotator cuff tears compared with the present case

Ref.	Age (years) and sex	Trauma episode and injury type	Clinical features and examination findings	Imaging findings	Treatment	Outcomes
Moeller[12], 1975	32, Male	Car accident (fell asleep at the wheel)	Open posterior dislocation with humeral head extrusion and through the skin. Supraspinatus, infraspinatus, and subscapularis muscle insertion avulsed; biceps tendon dislocation from bicipital groove	X-ray: Posterior shoulder dislocation; no fracture. Direct visualization: RCT involving supraspinatus, infraspinatus, subscapularis, and biceps tendon	Debridement, humeral head open reduction, rotator cuff and capsule open repair, biceps tenodesis, and skin defect management	ROM partial recovery, 70° abduction. Voluntary activity of the infraspinatus and deltoid muscles was overall reduced at 2 years
Steinitz et al[2], 2003	27, Male	Football injury	Severe pain; complete loss of passive external rotation; gross weakness in abduction and external rotation at 1 week; biceps tendon subluxation; transverse ligament tear	X-ray: Posterior dislocation, CT: No fracture, MRI: Massive global tear (supraspinatus, infraspinatus, subscapularis), biceps tendon displaced but intact	Open repair with suture anchors and biceps tendon reposition and sheath repair	Full ROM; resumed contact sports in 3 months; returned to games next season
Schoenfeld and Lippitt[5], 2007	22, Male	Motorcycle accident	Shoulder pain; limited passive external rotation; weakness in supraspinatus and external rotation; developing atrophy; no neurovascular deficits	X-ray: Posterior shoulder dislocation; small reverse Hill-Sachs lesion. CT: Confirmed posterior dislocation; reverse Hill-Sachs lesion involving < 5% humeral head. MRI: Full-thickness tear of supraspinatus and infraspinatus tendons; intact long head of biceps, subscapularis, and teres minor	Diagnostic arthroscopy followed by open rotator cuff repair using transosseous sutures	Full ROM and strength at 6 months; no residual pain or instability; returned to regular work at 4 months; satisfied at 1 year
Bhatia et al[11], 2007	22, Male	Contact sports injury (rugby)	Posterior shoulder dislocation with weakness and paresthesia; complete tears of supraspinatus, infraspinatus, and subscapularis tendons; disruption of anterior and posterior joint capsules; injury to inferior glenohumeral ligament; dislocation of long head of biceps tendon; associated axillary nerve and lower brachial plexus injuries	X-ray: Posterior subluxation of humeral head; “empty glenoid” sign. MRI: Full-thickness tears of supraspinatus, infraspinatus, subscapularis; biceps tendon dislocation; anterior capsule tear; inferior glenohumeral ligament injury; osteochondral lesion on humeral head; persistent posterior subluxation (approximately 75% humeral head posterior to glenoid rim)	Open surgical repair of rotator cuff tendons, joint capsule, glenohumeral ligaments, and tenodesis of the long head of the biceps tendon	Full return to professional rugby at 14 months post-surgery; near-normal strength and ROM achieved at 2 years
Luenam and Kosiyatrakul[3], 2013	36, Male	Motor vehicle collision (steering wheel)	Shoulder posterior dislocation; limited active and passive abduction and external rotation due to pain; no neurovascular deficits; shoulder unstable with posterior subluxation on exam under anesthesia	X-ray and CT: Posterior dislocation of glenohumeral joint; no osseous glenoid rim lesion, no reverse Hill-Sachs lesion, no proximal humeral fracture. MRI: Posterior subluxation of humeral head; massive RCT involving supraspinatus and infraspinatus tendons; glenohumeral capsule avulsed	Open repair via posterior approach: Rotator cuff reattached by double-row technique with bone anchors; glenohumeral capsule re-approximated and sutured	At 1 year, full function with no pain or instability; status maintained at 2 years post-surgery
	55, Male	Motorcycle accident	Shoulder posterior dislocation; significant pain and loss of active shoulder motion; weakness in abduction, external and internal rotation; no neuro deficits; superior migration of humeral head	X-ray: Posterior dislocation confirmed; superior humeral head migration, narrowed acromio-humeral interval. MRI: Massive global RCT involving subscapularis, supraspinatus, infraspinatus, teres minor; small reverse Hill-Sachs lesion	Open repair of the rotator cuff and ligaments; biceps tenodesis; combined posterior and deltopectoral approaches	Satisfactory recovery with slight shoulder stiffness; returned to full work duties; no pain or instability at 24-month follow-up
Soon et al[6], 2017	34, Male	Bicycle fall	Failed closed reduction due to interposed long head of biceps tendon; avulsion of glenohumeral capsule	X-ray: Posterior dislocation. MRI: Massive full-thickness tear of supraspinatus and subscapularis; LHBT interposed in joint; capsular avulsion	Open reduction and cuff repair with suture anchors	Full ROM and strength at 6 months after surgery as well as full return to work
Quiceno et al[10], 2021	20, Male	Car accident	Pseudoparesis and weakness; posterior capsule detachment and LHBT dislocation	X-ray: Posterior shoulder dislocation. MRI: RCT (supraspinatus, infraspinatus, teres minor, subscapularis); posterior capsule detachment; medial biceps tendon dislocation	Arthroscopic repair of the rotator cuff and capsule; biceps tenodesis	Full recovery by 3 months and return to regular work at 6 months after surgery
Present case	60, Male	Motorcycle accident	Severe pain and pseudoparalysis; preserved passive ROM; no neurovascular deficit	X-ray/CT: Posterior shoulder dislocation with minimal glenoid bone loss (< 10%), reduced joint space (acromiohumeral interval 3.8 mm). MRI: Complete tears of supraspinatus, infraspinatus, and subscapularis; Patte stage 3 retraction; LaFosse stage 3 subscapularis tear; medial LHBT dislocation and rupture; mild fatty infiltration (Goutallier 2/1/1/0)	Arthroscopic double-row bridge repair with LHBT tenotomy	Full ROM recovery by 12 months after surgery, excellent ASES/UCLA scores at 1- and 2-year follow-ups

RCT: Rotator cuff tear; ROM: Range of motion; CT: Computed tomography; MRI: Magnetic resonance imaging; LHBT: Long head of the biceps tendon; ASES: American Shoulder and Elbow Surgeons shoulder score; UCLA: University of California, Los Angeles, shoulder scale.