[Subacromial hematoma due to rotator cuff rupture]

This is an unusual case report of an elderly patient with spontaneous acute rupture of rotator cuff complicated by large subacromial hematoma. The hematoma fluid was aspirated with significant reduction of pain. The shoulder movements were restored after one month with conservative therapy. The compensatory role of preserved deltoid muscle is considered in the rehabilitation of normal shoulder movement, which may replace aggressive immobilization or surgical procedures in the elderly population. Investigation of hematoma fluid compared with blood 24 hours after the event revealed severe lactic acidosis with low glucose level, preserved red blood cell count and significant decrease of white blood cells. There were normal values of CBC, pH, lactate and glucose in blood. These results showed high susceptibility of leukocytes to anaerobic and acid environment and its dependence on oxygen supplement.