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PubMed1988

[Significance of a transthoracic imaging technic in shoulder arthrography].

Even in this era of sonography, arthrography of the shoulder is an important diagnostic investigation, making it possible to exclude unrecognized connective tissue lesions in patients with chronic shoulder pain resistant to therapy. Sometimes standard X-ray techniques do not yield all the information the surgeon needs about ventral or dorsal localization of a rotator-cuff rupture. An additional approach to the joint is needed: a transthoracic lateral-view X-ray provides the surgeon with adequate information to help in selection of the most appropriate operative approach to the shoulder.

Arthrography↗
PubMed1988

Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera.

In 200 shoulders from cadavera, we studied the pathological changes on the undersurface of the acromion as associated with tears of the rotator cuff. After radiographic and histological analysis, we found that in the specimens that had a partial tear of the cuff the undersurface of the acromion was almost intact. Although a lesion in the anterior one-third of the undersurface of the acromion was always associated with a tear of the cuff, the reverse was not true. We concluded that the pathogenesis of most of the tears probably is a degenerative process.

Acromion↗
PubMed1986

Ultrasonographic evaluation of the rotator cuff and biceps tendon.

Ultrasonography of the rotator cuff and biceps tendon was investigated in 106 patients who had been referred for arthrography of the shoulder. Both the sensitivity and the specificity of ultrasound in detecting a tear of the rotator cuff were 91 per cent. The predictive value of a negative sonogram was 95 per cent and the predictive value of a positive sonogram was 84 per cent. Ultrasonography proved to be superior to arthrography in the examination of the normal and abnormal biceps tendon. Sonographically detectable effusions from the tendon sheath of the biceps were present in 19 per cent of this population of patients. This finding was statistically highly associated (90 per cent) with rotator cuff tears and other soft-tissue abnormalities of the shoulder. Based on these results, it appears that ultrasonography can be used as the initial imaging test for many patients with suspected abnormalities of the rotator cuff or biceps tendon.

Adolescent↗
PubMed1987

Incomplete thickness rotator cuff tears diagnosed by subacromial bursography.

Incomplete thickness rotator cuff tears (ITRCT) adjacent to the bursal sac were diagnosed preoperatively by subacromial bursography and confirmed by surgical exposure. There were five men and one woman with an average age of 41.8 years. The preoperative duration of shoulder pain ranged from four to 36 months (average, 15.8 months). Clinical manifestations included crepitus and a painful arc in five of the six cases. Glenohumeral arthrography was normal in all cases. Subacromial bursography, subsequently performed, revealed pooling of the contrast medium in a torn area of the bursal side of the rotator cuff in all cases. Surgical treatment was recommended after the failure of conservative treatment for three to ten months. The surgical treatment consisted of both anterior acromioplasty and tendon suture. Wedge resection and shoelace suture repair of the tendon produced satisfactory results in all cases followed for ten to 72 months (average, 44.3 months). ITRCT adherent to the bursal sac were noted in 2.4% of a cadaver survey. Subacromial bursography can be a useful diagnostic procedure for this specific entity in subacromial impingement syndrome.

Adult↗
PubMed1986

Rupture of the rotator cuff of the shoulder associated with rupture of the tendon of the long head of the biceps.

Twenty cases of associated rupture of the rotator cuff and the tendon of the long head of the biceps were studied. This was out of a series of 54 patients referred to our unit with symptoms referable to the rotator cuff or to recent tendon rupture. In the majority of these patients there was marked loss of shoulder function due to rupture of the cuff. In 13 of 15 patients treated surgically the cuff lesion was either substantial or severe. The tendon lesion was partial in 3 cases and total in 12. In addition to repairing the cuff, the tendon was fixed in the bicipital groove in 7 of the 15 patients operated on. In 2 of 3 patients with partial rupture the tendon was not fixed but after several months the partial rupture became complete. The results in the 15 cases of associated ruptures treated surgically were satisfactory in 11 cases (73%) as determined by recovery of shoulder function. Fixation of the tendon was carried out in all the partial ruptures (13 cases), and in complete ruptures if they were recent or not more than 6 months duration in subjects of middle age or slightly more. Of the 12 complete ruptures fixation generally improved the power of elbow flexion and supination and reduced or diminished the cosmetic defect due to the bulge on the front of the arm which the biceps was contracted.

Adult↗
PubMed1985

[Lesions of the rotator cuff of the shoulder. Surgical treatment. Apropos of 100 surgically treated cases].

After reviewing 98 cases with an average follow-up period of one to nine years, the authors describe the surgical indications for simple reinsertion of the supraspinatus muscle, reinsertion with muscle belly transfer, acromioplasty, and simple removal of intratendinous calcifications. The painful shoulder without tendinous tears confirmed by arthrography and with anterior involvement is easily improved by resecting the acromiocoracoid ligament, the anterior border and the inferior portion of the acromion. This anterior release can be associated with a curettage of calcifications if present. Tears of the supraspinatus can be reinserted on the greater trochanter without muscles transfer in 90% of cases. Satisfactory pain relief and function return while only very extensive tears with significant muscle retraction may require transfer of the muscle belly. Surgical repair of the rheumatologic should however, is performed rarely, and should be reserved for the infrequent cases that do not respond to medical therapy.

Humans↗
PubMed1985

Surgery for full-thickness rotator-cuff tears.

We reviewed the cases of 100 patients who were operated on for a tear of the rotator cuff and found significant improvements in pain in all of them and in function in the majority of patients. The size of the cuff tear did not significantly affect the results, although patients with a smaller tear tended to fare slightly better.

Acromion↗
PubMed1983

Rotator cuff tear. Diagnosis and treatment.

Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended as a means of minimizing a progression of symptoms and findings. It was more important to achieve adequate tension in the cuff tissues than to obtain a water-tight closure. Even patients with old complete tears may obtain good results from reconstruction of the rotator cuff. However, merely closing a rotator cuff tear will not permit a good functional result if the ability of the muscles to contract adequately is lost forever. This group of patients rarely achieves full restoration of muscle strength in their operated shoulders, primarily due to muscle atrophy. In shoulders previously operated on, functional results were not as good as in those cases operated on for the first time. Avoidance of interposed soft tissue grafts and restoration of a direct continuity of viable rotator cuff tissue to its bony insertion are recommended whenever possible, to achieve the optimum functional result. In those patients with arthritis of the glenohumeral joint or permanent long-standing nonfunctional rotator cuff muscle, the results of reconstruction were poor. A carefully supervised postoperative rehabilitation program is essential for optimum results.

Acromion↗
PubMed1981

Tears of rotator cuff.

Tears of the rotator cuff can be very challenging for the surgeon. He should be aware of the variations in the pathologic lesions that can be encountered and should understand the functions of the cuff-capsule mechanisms so that deficiencies can be appropriately defined and treated. A definite diagnosis, based on the history, physical examination, roentgenography, and arthrography, should be made. In some patients with acute tears of the rotator cuff, early operative treatment is warranted. Chronic cuff disease is often treated conservatively. When operative invervention is justified, the anterior or anterosuperior surgical approach is most useful, and the classic plastic surgery flap techniques provide a model for planning and executing the repair. Postoperative external support and the physical therapy program should be tailored to the complexity and the security of the cuff repair.

Humans↗