Rotator cuff tears in the patient with paraplegia.

Shoulder problems are common in patients with paraplegia because of long-term weight bearing that occurs when crutches or wheelchairs are used and when transfers are done. Two moderate and two large rotator cuff tears in three patients with paraplegia were operated on and evaluated with the use of our shoulder assessment system. A special roentgenographic projection designated as a "push-up view" was used after the operation for evaluation. It is an anteroposterior projection of both shoulders on a large casette and is done while the patient lifts himself or herself up with extended elbows off the seat of an armchair. The operative methods employed were anterior acromioplasty in all shoulders, tenorrhaphy in two, lateral transfer of the tendon of the long head of the biceps brachii (Bush procedure) in two with large tears, and superior capsular reconstruction with the use of an autogenous fascia lata graft for a recurrent large tear. The results were satisfactory in three shoulders and unsatisfactory in the shoulder with the recurrent tear. To relieve pain and preserve function in the patient with paraplegia, especially during transfers, early recognition of the cuff tear, a meticulous repair, and rehabilitation are essential. The "push-up" view is useful for assessment of the integrity of the rotator cuff.