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PubMed2005

[Translation and psychometric testing of the Rotator Cuff Quality-of-Life Measure (RC-QOL) for use in German-speaking regions].

The evaluation of quality of life is an established criterion for evaluation of therapeutic measures. Starting from the English-speaking area a great number of different patient-based outcomes measures were developed to specifically question disorders of the musculoskeletal system and the results of treatment. Because of the lack of a German measurement tool for patients with rotator cuff disease the translation and the psychometric testing following international guidelines of the 34-item, multidimensional, English Rotator Cuff Quality-of-Life Measure (RC-QOL) was undertaken. Reliability (test-retest reliability, internal consistency), validity, practicability and acceptance of the German version of the RC-QOL were tested by 102 patients with an impingement syndrome after translation and cross-culture adaptation of the English original questionnaire. In addition, the SF-36, the Constant and UCLA scores were evaluated. Between the evaluations there was no significant difference; the Pearson correlation coefficient was 0.89 for the test-retest reliability. The internal consistency showed a high homogeneity with a Cronbach Alpha-coefficient of 0.98. A Pearson correlation coefficient between 0.67-0.76 registered a high correlation with the physical subscales of the SF-36, the Constant and the UCLA scores. The mean time required for completing the RC-QOL was 12 minutes; mean time required for evaluation was 10 minutes. The questionnaire was incompletely answered by 16 patients (15.6%). A total of 120 items (3.5%) were left unanswered. After successful translation and psychometric testing of the German version of the Rotator Cuff Quality-of-Life Measure (RC-QOL) a multidimensional measurement tool for evaluating the quality of life of German-speaking patients with pathology of the rotator cuff is available.

Female↗

PubMed2003

The significance of subacromial arthrography to verify partial bursal-side rotator cuff ruptures.

BACKGROUND: The purpose of this study was to verify a partial bursa-side rupture of the rotator cuff (RC) using different imaging techniques with special emphasis on the validity of a specific method of subacromial arthrography (SAA). METHODS: Patients (n=92, mean age 53.8 years) with a subacromial impingement syndrome underwent sonography, magnetic resonance imaging (MRI), and SAA. All diagnostic results were checked by subsequent arthroscopic surgery. RESULTS: Of 31 surgically verified ruptures, 17 showed a partial rupture located towards the bursa. These had been detected by MRI and ultrasound with a sensitivity of 64% and 41%, respectively, while SAA as a diagnostic tool yielded a sensitivity of 82%. In 14 cases of complete RC ruptures, all imaging techniques had a similar sensitivity of 86-93%. CONCLUSION: It appears that SAA is an adequate and valid diagnostic tool for the detection of partial bursa-sided RC ruptures. Ultrasound and MRI showed a comparably lower sensitivity. It is therefore concluded that SAA has clear advantages in the diagnosis of this defect with the consequence that open surgical techniques can be avoided.

Female↗

PubMed2003

Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears.

INTRODUCTION: The objective of this study was to compare the postoperative range of motion (ROM) and patient satisfaction after surgical reconstruction of traumatic and non-traumatic rotator cuff tears. MATERIALS AND METHODS: The cases of 46 consecutive patients who underwent the same standardised surgical reconstruction and postoperative rehabilitation protocol between 1993 and 1998 were reviewed. Traumatic (group I, n=20, average age 34.2 years, range 15-49 years) and non-traumatic tears (group II, n=26, average age 54.1 years, range 50-68 years) formed the two study groups. Mean follow-up lasted 47.1 months (range 13-105 months) in group I and 41.4 months (range 11-94 months) in group II. Assessment included postoperative shoulder function with Constant and Murley's score and visual analogue scale (VAS). RESULTS: Significantly ( p=0.0019) better results were observed in group I with an average of 94.1 points for Constant's score, compared with 75.3 points in group II. Postoperative shoulder function was not affected regarding full-thickness or partial tears ( p=0.239) in group I. VAS revealed an excellent or good result in all patients of group I ( n=20) and 50% of group II ( n=13/26). Quantitative comparison of postoperative ROM demonstrated significantly better results in forward flexion ( p=0.013), abduction ( p=0.0019) and external rotation ( p=0.0042) for group I. The remaining postoperative external rotation deficit for group II with a loss of 31% compared with group I (38.9 degrees vs 56.6 degrees ) was statistically and clinically relevant. CONCLUSION: The results demonstrate that surgical reconstruction of traumatic and non-traumatic rotator cuff tears is a successful procedure. Comparison of both groups revealed significantly better postoperative results in the younger, traumatic collective.

Adult↗

PubMed2004

Spontaneous healing process of a supraspinatus tendon tear in rabbits.

INTRODUCTION: The rotator cuff has a characteristic structure, in that one surface faces articular cartilage and another faces bursa. This structure may produce differences in the healing process between the rotator cuff and other tendons. We investigated the spontaneous healing process of a surgically created supraspinatus tendon tear in rabbits. MATERIALS AND METHODS: A transverse, full-thickness tear of the supraspinatus tendon was created and its healing examined. RESULTS: A tear of 12 mm was not repaired within 3 weeks. With a tear of 5 mm, reparative tissue gradually encroached into the defect from the bursal side, and the tear united from the bursal side to the articular side by 12 weeks. The healing rates (width of reparative tissue/width of the tendon x 100%) were 32.2%, 52.4%, 58.0%, 88.9%, and 93.8% at 1, 2, 3, 6, and 12 weeks, respectively. The reparative tissue had continuity to the epitenon of the bursal side. Immunohistochemical study showed that at week 1, type III collagen was detected in the reparative tissue and the cutting ends, and the expression gradually decreased. On the other hand, the expression of type I collagen in the reparative tissue was weak at week 1 and increased until week 3. PCNA-positive cells were observed in the reparative tissue. CONCLUSION: These results show that the origin of the reparative tissue is the epitenon, and from the bursal side rather than the articular side. This model is very useful for the investigation of the remodeling process of an acute rotator cuff tear.

Animals↗

PubMed2004

Comparison of debridement versus suture in large rotator cuff tears: long-term study of 64 shoulders.

INTRODUCTION: The goal of this study is to determine whether suturing is superior to non-closure in terms of the subjective long-term outcome in large rotator cuff tears. MATERIALS AND METHODS: A total of 64 shoulders with rotator cuff tears of at least 3 cm diameter and followed up for a mean period of 5 years and 8 months were retrospectively examined. The patients' medical history, clinical findings, radiographs and Constant scores were studied. Patients whose tears had been closed with an open suture (n=33) were compared with those whose tears had not been closed (n=31). RESULTS: Neither the comparison between open suturing and debridement nor that between open and arthroscopic debridement reveal a significant difference with regard to the overall Constant score or the individual parameters. CONCLUSION: These results suggest that in the long-term, suturing of large rotator cuff tears is not superior to debridement.

Arthroscopy↗

PubMed2004

Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors.

INTRODUCTION: The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. MATERIALS AND METHODS: Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent arthroscopy by a single surgeon. The preoperative diagnosis was based on the clinical examination and MRI. Their mean age was 69 years (range 62-79 years), and the average follow-up was 31 months (range 24-46 months). If indicated, the performed arthroscopic debridement included acromioplasty, debridement of the cuff, resection of the distal part of the clavicle or tenotomy of the long head of the biceps. In 28 cases (85%) acromioplasties and in 6 cases (18%) biceps tenotomies were performed, 2 of which were a single tenotomy without any associated acromioplasty. One patient had been managed with concomitant resection of the distal part of the clavicle. RESULTS: The Constant and Murley Score improved by a mean of 30 points, from a mean of 37 points (range 21-52) preoperatively to a mean of 67 points (range 31-82) at the time of follow-up. Some 82% of the patients were satisfied with the procedure. The result was considered unsatisfactory because of inadequate pain relief in 4 shoulders, because of limited active abduction in 1 and because of limited external rotation in 1. A poor outcome was associated with a complete tear of the subscapularis tendon in 6 patients. The radiological study showed no significant narrowing of the subacromial space. CONCLUSION: Our early results suggest that arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands. However, its long-term consequences remain to be evaluated by studies with lengthy follow-up. Prognostic factors that may lead to a negative outcome are preoperative superior migration of the humeral head, presence of subscapularis tear, presence of glenohumeral arthritis and decreased range of motion.

Acromion↗

PubMed2006

Glenohumeral interposition of a torn rotator cuff in a young motorcyclist.

This report describes the rare case of a traumatic rotator cuff tear in a young patient which led to a pseudo-paralyzed shoulder by interposition of the tendon stump into the glenohumeral joint. The patient underwent an open rotator cuff repair and regained an almost normal shoulder function after 12 weeks. A review of the literature is presented.

Accidents, Traffic↗

PubMed2006

Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction.

INTRODUCTION: Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( > or = 5 cm(2)) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements. PATIENTS AND METHODS: Of 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have co-morbidities that negatively impacted their ability to perform intense exercise underwent a comprehensive clinical examination of involved and uninvolved side shoulder and elbow active range of motion and strength (both isometric instrumented manual muscle testing and concentric isokinetic measurements). RESULTS: At 2 years following surgery, pre-operative UCLA Shoulder Scores improved from 10.6 +/- 3 to 27.4 +/- 5 and pre-operative ASES Function Scores improved from 20.1 +/- 10 to 43.2 +/- 5. However, isometric involved side shoulder abductor torque was decreased by 28.2% with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6% at 60 degrees/s and by 53.8% at 120 degrees/s with isokinetic testing. Isometric involved side elbow extensor torque was decreased by 39% with instrumented manual muscle testing, and concentric elbow extensor torque was decreased by 17.7% and 19.2% at 60 and 120 degrees/s, respectively, with isokinetic testing. Including three additional patients who were contacted via telephone, the majority of patients (21 of 22, 95.4%) were satisfied with their improved shoulder function and reduced pain. CONCLUSIONS: Despite reduced pain and improved shoulder function, residual involved side shoulder abductor; shoulder external rotator and elbow extensor strength deficits were evident at 2 years following surgery. This suggests the need for more focused rehabilitation, particularly for involved side elbow extensor strengthening to further improve patient function and minimize disability.

Aged↗

PubMed2006

Humeral osteochondroma causing a subscapularis tear: a rare source of shoulder dysfunction.

The proximal humerus is a well-known site of predilection for the solitary osteochondroma-the most common benign bone tumor. Subscapularis tears were underreported in the pre-arthroscopic era. Literature about rotator cuff impairment caused by osteochondromas is almost non-existent. We will present the case of a young man, who had a complete non-traumatic subscapularis tear, where the tendon had been peeled off the lesser tuberosity by an osteochondroma. Diagnostic features such as MRI and arthroscopy are emphasized. The patient was successfully treated by open resection of the tumor and reattachment of the tendon with suture anchors.

Adult↗

PubMed2000

Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales.

Evaluation of upper extremity function after reconstructive surgery is increasingly important both to predict outcome and for the control of cost-effectiveness. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients with rotator cuff deficiency and correlated to the Constant-Murley Shoulder Score and a visual analogue scale for satisfaction. Seven women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 +/- 10.5 years, r/l: 14/9, follow-up 57.8 +/- 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons (ASES) Shoulder Index, the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). Additionally, a visual analogue scale for satisfaction was employed. All four scores and the visual analogue scale revealed improvement at a statistically significant level (P < 0.01) after surgery. All questionnaires showed a significant correlation with the Constant-Murley Shoulder Score (ASES: r = 0.871, P < 0.01; DASH: r = -0.758, P < 0.01, SST: r = 0.494, P < 0.05, Pearson's correlation coefficient). Taken together, all questionnaires were easy to apply, and reliable evaluation of shoulder function was possible with significant correlation to the Constant-Murley Shoulder Score postoperatively. The SST was easy to apply, and compound outcome analysis was possible with the ASES Shoulder Index and DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination, which is advantageous but restricts the application to the office. For postoperative assessment without the patient having to return to the clinic, the ASES Shoulder Index is preferred because of its good correlation to the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762).

Adult↗

PubMed2001

Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis--a matched-pair analysis of 100 patients.

Conservative or operative treatment for rotator cuff calcifying tendinitis was investigated in 100 patients in a matched-pair analysis. They were examined clinically and ultrasonographically 35-60 months after the initial visit. The mean Patte score was 91.8 for the patients who underwent surgical treatment and 81 for the ones who received conservative therapy (p < 0.004), while the age-related Constant-score was 103.4 and 95, respectively. Ultrasonography showed 28% calcifications in the surgical group, 18% newly formed and 10% that did not resolve after surgery. In the conservatively treated group, 33% calcifications were seen, of which 67% resolved. The number of rotator cuff ruptures was significantly higher in the conservative group. In the surgical group, 2% of partial tears and in the conservative group 5% of partial and 4% of complete cuff ruptures were found. Conservative treatment for calcifying tendinitis leads to less favourable pain results in the long term than surgical treatment. Surgery shortens the painful period and may reduce the number of future rotator cuff ruptures. Finally, the subjective functional outcome is significantly better after surgery.

Activities of Daily Living↗

PubMed2001

In-vitro reconstruction of massive rotator cuff ruptures with triceps tendon or coracoacromial ligament.

The possibility of reconstructing a massive rotator cuff rupture with a free graft of the triceps tendon or the coracoacromial ligament was tested experimentally in an anatomical and biophysical cadaver investigation. After dissection of the rotator cuff, a section of the supraspinatus tendon was removed to simulate a defect in the cuff. In dissection of the grafts, a bony squama was incorporated by osteotomy. The rotator cuff was reconstructed by suturing the free grafts into the defect. In addition, the bony squama was refixed in a prepared bone groove in the greater tuberosity of the humerus. The tensile strength and the elasticity of the grafts were compared with that of the supraspinatus tendon in rupture tests. The mean value of the maximum load determined (FRm) was greatest for the triceps tendon (706.451 N), while very much lower values were found for the coracoacromial ligament (395.836 N) and the supraspinatus tendon (496.792 N). The mean value of the maximum elasticity (LAm) was lowest for the coracoacromial ligament (4.701%); the supraspinatus tendon (7.047%) and the triceps tendon (8.250%) showed very much greater elasticity.

Humans↗

PubMed1999

Postoperative ossifications of the shoulder. Incidence and clinical impact.

Periarticular ossifications of the shoulder after surgery have been described since the beginning of the century. Risk factors and the clinical impact of heterotopic bone formation have been discussed controversially. After open surgery on the shoulder, 131 patients (rotator cuff repair n = 106, acromioplasty n = 25) were included in a retrospective study if pre- and postoperative X-rays were available. The age of the 90 men and 41 women averaged 51 years (range 29-67 years). The minimum follow-up was 2 years. Also, 108 patients were interviewed by questionnaire to estimate the subjective outcome of the procedure (5 patients were reported dead). A clinical examination was carried out on 86 patients using the Constant score for evaluation of the objective outcome. Heterotopic ossifications were found in 35 cases (26.7%), 28 of them after rotator cuff reconstruction and 7 after acromioplasty. A good to excellent result was reported by 89% (n = 65) of the patients without and by 80% (n = 28) of the patients with ossifications. The Constant score averaged 69 points and 74 points (n = 60), respectively. A significant difference between the two collectives could not be calculated. As significant risk factors for the formation of heterotopic bone, the existence of osteoarthritis and the duration and complexity of the procedure could be cited. The appearance of periarticular ossifications after surgery of the shoulder seems to be of minor clinical impact. Severe cases with major functional deficits should and can be prevented by a fast and atraumatic operation technique.

Acromion↗

PubMed1998

Morphologic changes in long head of biceps brachii in rotator cuff dysfunction.

Morphologic changes in the long head of the biceps brachii (LHB) and bicipital groove associated with cuff tears were studied in 170 cadavers. In specimens with minimum or moderate cuff tears, the primary finding was relative stenosis at the bicipital groove induced by enlargement of the LHB. However, this stenosis was not apparent in specimens with massive cuff tears and in these specimens, the medial wall of the groove exhibited wear and tear, a potential cause of LHB instability. We suggest that the long head of the biceps brachii muscle can potentially compensate for inadequate rotator cuff function. This increasing activity could lead to enlargement of the tendon and cause deterioration of the bicipital gliding mechanism.

Adult↗

PubMedDate not supplied

Magnetic resonance imaging of the shoulder.

The authors have reviewed the field of magnetic resonance imaging of the shoulder. This review includes abnormalities of the rotator cuff mechanism and glenoid labrum, and other disorders.

Arthritis↗

PubMedDate not supplied

Shoulder MRI: the subacromial/subdeltoid bursa fat stripe in healthy and pathologic conditions.

The MRI appearance of the subacromial/subdeltoid (SA-SD) bursa is described here in both healthy and pathological conditions. Based on one case of rotator cuff tear and intrabursal fluid outlined by two adjacent fat stripes we reviewed 20 shoulder MR examinations to define the normal and abnormal appearance of the peribursal fat. We found four pathological patterns: lateral displacement, tear-drop configuration, obliteration and double fat stripe.

Adipose Tissue↗

PubMed1995

Role of shoulder ultrasonography in the evaluation of the painful shoulder.

The purpose of this study was to determine the accuracy of ultrasonography in the detection of rotator cuff tears. In a prospective study of 41 patients, the ultrasound results could be compared with the combined results of (CT) arthrography, arthroscopy and operation. The sensitivity of sonography in detecting partial and total rotator cuff tears was 86%, the specificity 91%, the positive predictive value 96% and the negative predictive value 73%. In spite of the relatively small size of this series, our results are comparable with those of most other studies. Based on these results, sonography can provide a non-invasive, rapid and inexpensive diagnostic method for screening patients with shoulder complaints. A disadvantage of the method is its long learning curve.

Adult↗

PubMed1991

Precision acromioplasty in arthroscopic subacromial decompression of the shoulder.

Arthroscopic techniques for subacromial decompression have been criticized for lack of precision in resecting the anterior acromial undersurface and evaluating the amount of bone resected. The goal of subacromial decompression is production of a flat undersurface for the acromion and acromioclavicular joint, thus enlarging the supraspinatus outlet and deterring impingement. Achieving this goal using the arthroscope requires preoperative evaluation of the acromial morphology, planning of the dimensions of bony resection, a reproducible acromioplasty method with intraoperative evaluation of the adequacy of resection, and postoperative confirmation of the resulting acromial shape. A precise technique for arthroscopic acromioplasty has been developed in the course of performing over 200 shoulder arthroscopies. This method adheres to conventional open surgical goals for bony resection and allows for reliable intraoperative evaluation of the result. Using this technique, over 90% good and excellent results may be achieved in treatment of stage II subacromial impingement syndrome.

Acromioclavicular Joint↗