Repeated Hemarthrosis with Massive Rotator Cuff Tear

An 80-year-old woman with repeated hemarthrosis of the right shoulder was examined and treated arthroscopically. Plain radiographs indicated narrowing of the acromiohumeral interval (3 mm) with large acromial spur. Under fluoroscopic visualization, the impingement between the humeral head and the medial edge of the acromion was seen at 50° abduction. The area of impingement of the humeral head seemed to be just medial to the greater tuberosity. Arthroscopically, a crater formation was seen at this site. Active bleeding was seen at the center of the crater, which was interpreted as the principal cause of intra-articular hemorrhaging. The undersurface of the acromion was irregular because of the presence of osteophyte. At 50° abduction, the crater impinged with the medial edge of the acromion. We assume that both the presence of osteophyte and the instability caused by the massive rotator cuff tear might contribute to the attrition of the humeral head. In this patient, intra-articular hemorrhaging was successfully treated arthroscopically by coagulation of the bleeding point with minimal abrasion of the undersurface of the acromion. We believe that the arthroscopy facilitated the clinical management of the repeated hemarthrosis with massive rotator cuff tear.