A massive rotator cuff tear in association with a posterior dislocation of the long head biceps tendon: a review of the literature on posterior long head biceps tendon dislocation.

We report a complex case detailing a patient with an anterior shoulder dislocation, with an associated, severe, massive rotator cuff tear (MRCT), further complicated by an unusual occurrence of a posterior long head biceps tendon (LHBT) dislocation. A 38-year-old female presented with significant pain and limited active and passive range of motion of the left shoulder following a traumatic anterior shoulder dislocation. MRI revealed full-thickness retracted tears of the entire cuff as well as a posterolateral LHBT dislocation. The patient underwent an initial open repair of the shoulder and long head of biceps tenodesis. At 5 months follow-up, MRI confirmed a full-thickness re-tear of the supraspinatus, infraspinatus, and subscapularis tendons. Patient subsequently underwent a combined open transfer of the lower trapezius tendon to the greater tuberosity and the latissimus dorsi to the lesser tuberosity. At the final, one-year, postoperative follow-up, the patient exhibited improvements in pain and stability, though continued to experience ongoing range of motion and strength limitations. This report provides a comprehensive review of 12 previous reports describing posterior LHBT dislocation. Among the limited literature on posterior LHBT dislocation, only one case exhibited a posterior LHBT in the context of a MRCT similar to that described in this report. The combination of an unusual occurrence of a posterior LHBT dislocation in the context of a MRCT involving full thickness tears of the supraspinatus, infraspinatus, subscapularis, and teres minor tendons, is rarely documented, making this case report both clinically challenging and unique.