Management of Right Shoulder Rotator Cuff Tear in a Post-Stroke Patient

Patient Assessment and Characteristics

A 58-year-old male patient with a complete tear of the right rotator cuff, showing medialization of the muscle belly with mild atrophy, has limited range of motion, with forward elevation of 90° and elbow extension of 29°, shoulder abduction of 45°, and external rotation of 7° 1
The patient has a history of left MCA stroke with successful thrombectomy and good recovery, and is currently on aspirin 81mg daily and atorvastatin 40mg daily for secondary stroke prevention 2, 3, 4
Active nicotine use is present, which can impair healing and increase surgical complications 5

The American Heart Association recommends continuing aspirin 81mg daily as the cornerstone of secondary stroke prevention for patients with a history of ischemic stroke 2, 3
The American College of Cardiology recommends continuing atorvastatin 40mg daily to maintain LDL goal <70 mg/dL for secondary stroke prevention 4, 5

Neurology clearance is required before proceeding with surgery due to the history of recent stroke, and completion of pre-surgical physical therapy for stretching and improving range of motion is necessary 1, 6
Discontinuing nicotine use is crucial as it can impair healing and increase surgical complications 1, 5
Arthroscopic rotator cuff repair is indicated based on the full thickness tear of the supraspinatus and portion of infraspinatus with retraction, moderate atrophy of the supraspinatus muscle belly, and significant functional limitations despite conservative management 1, 6

The American College of Cardiology recommends continuing aspirin 81mg through the perioperative period to maintain stroke prevention while balancing bleeding risk 2, 3
The American Heart Association recommends continuing statin therapy without interruption during the perioperative period to maintain LDL goal <70 mg/dL 4
A structured physical therapy program focusing on protected range of motion exercises, progressive strengthening of rotator cuff and scapular stabilizers, and gradual return to functional activities is essential for optimal recovery 1, 6

Regular neurology follow-up to monitor stroke risk factors, orthopedic follow-up to assess surgical healing, and physical therapy to optimize functional outcomes are necessary for comprehensive care 1, 3, 4, 6
Monitoring lipid levels and adjusting statin dosage as needed to maintain LDL goal <70 mg/dL is crucial for secondary stroke prevention 4, 5
Nicotine cessation is critical for surgical success, and pain management strategies should consider non-opioid approaches when possible to avoid respiratory depression 1, 5, 6