Does the presence of an ultrasound dot-like lesion of the rotator cuff affect outcomes after humeral intramedullary anterograde nailing?

BACKGROUND: Functional outcomes of anterograde intramedullary nailing of the humerus have been described as potentially impaired by the surgical approach through the rotator cuff. Aim of this study was to evaluate the clinical function and ultrasound conditions of the rotator cuff in patients that underwent anterograde nailing of the humerus. METHODS: Twenty-two patients, mean age 56 (range: 19-82), underwent surgery between January 2016 and 2018 for fractures of the humeral neck and diaphysis. The anterolateral transdeltoid approach was performed in all cases. At follow-up, shoulder examination, constant score, simple shoulder test and VASScale were administered. In addition, patients underwent an ultrasound evaluation of the rotator cuff. All results were compared to the unaffected side. RESULTS: The average follow-up was 35 months (range: 23-46). There was a statistically significant reduction in ROM compared with the contralateral side. The mean constant score weighted by sex and age was 78.4 and the average Simple Shoulder Test was 8.4. The ultrasound showed a lesion of the supraspinatus tendon in 27.3% of patients with no symptoms. Adot-like lesion, interpreted as a postoperative scar, was found in otherwise healthy tendons of 45.5% of asymptomatic patients. CONCLUSIONS: Short-term results after anterograde intramedullary nailing of the humerus through an anterolateral access were satisfactory in terms of shoulder function and pain. Ultrasound analysis could detect focal cuff lesions in the supraspinatus tendon and this finding was correlated to worse results. Contrarily, the presence of a dot-like lesion without tendon discontinuity did not compromise the final outcome.