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PubMed1993

[MRI in the pre-operative evaluation of lesions of the rotator cuff].

The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was complete with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning.

Adult↗

PubMed1994

[Satisfactory results of surgical reconstruction of rotator cuff ruptures, 1984-1990].

OBJECTIVE: Evaluation of the middle-long term results of open surgical treatment of rotator cuff tears and identification of pre- and peroperative parameters with predictive value for the final result. DESIGN: Retrospective study (1984-1990). SETTING: Department of orthopaedics of the Sint Antonius Hospital, Nieuwegein, the Netherlands. METHOD: All patients were asked to cooperate on an extensive standard anamnesis and physical examination. Re-evaluation of the X-rays, arthrograms and operation reports took place. There were three stragglers. RESULTS: The follow-up concerned 41 shoulders in 40 patients (21 women, 19 men). The average age was 61 years (37-77). The average postoperative period was 5 years (2.5-9.2). The subjective final result was satisfactory in 80% as judged by persistent complaints and function of the operated shoulder. Young and active patients were less satisfied with the final result than older, female patients. More persistent complaints were seen in larger and longer existing cuff tears. CONCLUSIONS: Open surgical treatment of rotator cuff tears gave a satisfying result, as described in literature. Sex, age, level of activity and size of the tear appeared to be predictive parameters for the subjective final result.

Adult↗

PubMed2005

[Arthroscopic-assisted mini-open repair of rotator cuff tears].

OBJECTIVES: We retrospectively evaluated the results of patients who underwent arthroscopic-assisted mini-open repair of rotator cuff tears. METHODS: Twenty-three patients (7 males, 16 females; mean age 56 years; range 41 to 75 years) underwent arthroscopic-assisted mini-open repair for nonretracted rotator cuff tears. The right shoulder was involved in 15 patients and the left in eight patients; 83% being on the dominant side. The range of motion was measured with a goniometer, and muscle strength by manual examination. The patients were assessed by physical examination, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the UCLA scale, and magnetic resonance imaging (MRI). The mean follow-up was 32 months (range 12 to 61 months). RESULTS: All the patients had medium-sized ruptures. Biceps tenotomy was performed in three patients for tears affecting more than 50% of the biceps tendon. The mean preoperative active forward flexion increased from 99 degrees to 161 degrees , and active external rotation from 28 degrees to 50 degrees postoperatively (p<0.05); the strength of the supraspinatus and infraspinatus muscles increased significantly (p<0.05). The mean UCLA score was found as 31.6, showing an excellent result in nine patients (39.1%), good in 12 patients (52.2%), moderate in one (4.4%), and poor in one patient. The mean preoperative ASES score increased from 23.7 to 92.4 (p<0.05). The mean healing time was 1.7 months (range 1.5 to 12 months). Twenty-one patients (91.3%) were satisfied with the outcome. Of 16 patients with postoperative MRI scans, three (18.8%) exhibited recurrent ruptures. CONCLUSION: In selective cases, the clinical and functional results are successful following arthroscopic-assisted mini-open repair for rotator cuff tears.

Adult↗

PubMed2002

[Arthroscopic treatment of rotator cuff calcifying tendinitis].

OBJECTIVES: We evaluated the effectiveness of arthroscopic treatment in patients with rotator cuff calcifying tendinitis unresponsive to conservative treatment. METHODS: Arthroscopic treatment was performed in 10 patients (6 females, 4 males; mean age 46 years; range 34 to 53 years) in whom pain and functional disability persisted for more than a year despite conservative therapy for rotator cuff calcifying tendinitis. Arthroscopic bursectomy was also carried out. One patient underwent repair for rotator cuff tear. The patients were evaluated before and after surgery with the use of Constant scores and direct radiographs. The mean follow-up period was 12 months (range 6 to 19 months). RESULTS: The mean Constant scores were 66 (range 45 to 70) and 93 (range 89 to 96) before surgery and on final examinations, respectively. Postoperative radiographs demonstrated incomplete removal of calcifications in four patients; however, complaints of pain disappeared in these patients and radiologic controls showed that residual deposits underwent spontaneous resorption. CONCLUSION: Arthroscopic removal of calcium deposits together with bursectomy seems to be effective and reliable in patients with chronic calcifying tendinitis unresponsive to conservative treatment.

Adult↗

PubMed1992

Operative treatment of failed repairs of the rotator cuff.

Thirty-one patients had a repeat repair after a failure of a previously performed repair of the rotator cuff, and the causes of the original failure and the results of the repeat repair were analyzed. The clinical situation was complex, with multiple factors contributing to the failures. A large or massive tear of the cuff in thirty patients (97 per cent) and persistent subacromial impingement in twenty-eight patients (90 per cent) were the most common factors associated with failure. The over-all result of the repeat repair was satisfactory in sixteen patients (52 per cent) and unsatisfactory in fifteen (48 per cent). Twenty-five patients (81 per cent) had satisfactory relief of pain. However, fourteen patients (45 per cent) had persistent weakness that led to an unsatisfactory result. The factors that were associated with a better result were an intact acromion, an intact origin of the deltoid muscle, and the finding that the remaining tissue of the rotator cuff was of good quality. The factors that were associated with an inferior result were a previous lateral acromionectomy, a previously detached origin of the deltoid muscle, and the finding that the tissue of the rotator cuff that was available at the time of the repeat operation was of poor quality. Persistent pain is the primary indication for a repeat repair. The functional results are not as predictable, especially when the tissue of the cuff is poor and the deltoid origin has been detached previously.

Adult↗

PubMed1993

Impingement of the rotator cuff in athletes caused by instability of the shoulder joint.

An impingement of the rotator cuff can be caused by chronic anterior instability of the shoulder joint. This particular disease is often found in athletes engaged in overhead motion in abduction/external rotation of the arm, such as in ball sports like volleyball or European handball, racket sports like tennis or badminton, or swimming. For those patients that cannot be cured by conservative treatment such as muscular stabilization, surgical treatment is indicated: anterior reconstruction of the capsule and/or the glenoid labrum, and in addition--if necessary--subacromial decompression and revision of the rotator cuff. Between October 1988 and April 1992, we operated on 66 shoulders in 64 top athletes suffering from chronic anterior or multidirectional instability of the shoulder joint that had caused an impingement syndrome of the rotator cuff. In all cases, the athlete was unaware of the instability. Conservative treatment had been unsuccessful. Surgical treatment was successful in close to 90% of the athletes.

Arthroscopy↗

PubMedDate not supplied

Reversed arthroscopic subacromial decompression for massive rotator cuff tears.

This prospective study evaluates the results of a procedure for massive rotator cuff tears that we term reversed arthroscopic subacromial decompression (ASD). The procedure includes an arthroscopic debridement of the subacromial space and glenohumeral joint, an arthroscopic tuberoplasty, and depending on the pathologic condition of the long head of the biceps, a biceps tendon tenotomy. Reversed ASD avoids a classic acromioplasty in order to preserve the integrity of the coracoacromial arch. Twenty-three patients with a mean age of 69 years underwent this procedure. After a mean follow-up of 40 months, the age-adjusted Constant score increased significantly, from 65.9% to 90.6% (P <.001), with 14 excellent, 5 good, 2 satisfactory, and 1 poor result. Preexisting osteoarthritic changes increased significantly but had no impact on the final clinical results. The acromiohumeral distance decreased from 5.1 to 4.5 mm (P =.004). There were no complications directly related to the surgical procedure. When compared with classic ASD studies for massive rotator cuff tears, we obtained similar midterm results with regard to pain relief, functional recovery, and patient satisfaction. We, therefore, conclude that reversed ASD with tenotomy of the long head of the biceps tendon offers a less invasive treatment strategy for massive rotator cuff tears while preserving the integrity of the coracoacromial arch.

Aged↗

PubMed1984

Rotator cuff tears associated with os acromiale.

We studied the cases of eight patients, one with bilateral involvement, who had a rotator cuff tear and an associated lesion delineated roentgenographically - a separate fragment of the acromion that we believe to be an ununited ossification center of the acromion (os acromiale). In reviewing the literature, we found no mention of an association between a rotator cuff tear and os acromiale. It is highly unlikely that such an association is coincidental because it appears that in our patients abnormal motion existed through the site of fibrous union of the acromion and may have contributed to the impingement of the acromion on the rotator cuff. Repair of the rotator cuff with removal of the loose fragment of acromion was done in the six patients who had operative treatment.

Acromion↗

PubMed2002

Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors.

The rat shoulder animal model has been used previously to study the role of intrinsic injury (modeled as an acute insult to the tendon), extrinsic injury (modeled as external subacromial impingement), and overuse factors on rotator cuff tendinosis. These studies demonstrated that it is possible to produce rotator cuff tendinosis with any one of these factors in isolation. The current study uses the rat shoulder model to study the roles of extrinsic compression, overuse, and overuse in combination with extrinsic compression, on the development of rotator cuff tendinosis. The results of this study demonstrate that the injury created by overuse plus extrinsic compression is greater than the injuries created by overuse or extrinsic compression alone, particularly when important biomechanical variables are considered. While ineffective in causing a change in supraspinatus tendon properties in animals with normal cage activity, extrinsic compression had a significant and dramatic effect when it was combined with overuse activity. Without an additional factor, such as overhead activity, the extrinsic compression alone may be insufficient to cause tendinosis. The results of the present study support the role of multiple factors in the etiology of some rotator cuff injuries.

Animals↗

PubMed1993

Arthroscopic debridement versus open repair for rotator cuff tears. A prospective cohort study.

We compared two treatments for tears of the rotator cuff of 1 to 4 cm in size. One group of 22 patients had an arthroscopic subacromial decompression and rotator-cuff debridement; the other comparable group of 23 patients had open repair and acromioplasty. Review was at 2 to 5 years postoperatively. Both groups had similar pain relief and range of active forward flexion, with significant improvement from the preoperative condition. The open repair group scored better for function, strength and overall score, but patient satisfaction was similar in the two groups. We recommend the use of arthroscopic subacromial decompression and debridement for low-demand patients who require mainly pain relief and range of movement. Open repair is necessary if strength and functional recovery are the prime objectives.

Adult↗

PubMedDate not supplied

Algorithm for the treatment of calcific tendinitis in the rotator cuff: indications for arthroscopy and results in our experience.

Calcific tendinitis of the rotator cuff is a relatively frequent pathology and at times, in some phases, it is a disabling one: for this reason, numerous therapeutic options have been proposed. The authors propose an algorithm for the classification and treatment of calcific tendinitis and report their experience with arthroscopic treatment over a three-year period from 2001 to 2004. Based on the algorithm proposed, out of a total of 126 shoulders affected with calcific tendinitis of the rotator cuff for which debridement was indicated, 106 us-guided percutaneous surgeries (EPT), and only 20 arthroscopies were performed. Arthroscopy is indicated, on the basis of the algorithm that we followed, in patients affected by chronic and persistent calcific tendinitis who did not benefit from the execution of previous types of non-surgical treatment for a period of at least 6 to 12 months. Shoulder instability was found to be present in 8 patients out of 20 treated arthroscopically. After arthroscopy, short- and medium-term results were always positive with the exception of one case that evolved into adhesive capsulitis. Based on an analysis of this series, we were able to confirm the usefulness and clinical applicability of an algorithm to classify and treat calcific tendinitis of the rotator cuff; we also confirmed the role of arthroscopic treatment that in cases which did not respond to conservative procedures proved to be effective in resolving symptoms.

Adult↗

PubMed2004

Atrophy of the deltoid muscle following rotator cuff surgery.

BACKGROUND: Less invasive procedures have recently been introduced to facilitate an earlier return to sports or work activities after rotator cuff repair. Few reports, however, have verified whether such procedures are really less invasive than conventional open repair. The purpose of this study was to compare the postoperative thickness of the deltoid muscle in patients treated with either conventional or mini-open rotator cuff repair. METHODS: Conventional open repair was performed from 1994 through 1997 in forty-three patients with rotator cuff tears. The mini-open deltoid-splitting approach was introduced in 1997, and the cases of thirty-five patients who underwent that procedure were reviewed. The two groups were compared with respect to the thickness of the anterior fibers of the deltoid muscle measured on the transverse magnetic resonance images, the degree of active forward flexion, and the times required for return to work and sports activities. RESULTS: The thickness of the anterior deltoid fibers did not change significantly after surgery in the mini-open repair group, whereas it was significantly decreased in the open repair group at six months as well as at twelve months postoperatively (p < 0.05). At three months postoperatively, the mean University of California at Los Angeles score for active forward flexion in the patients treated with the mini-open repair (4.9 points) was significantly greater than that in the patients in the conventional open repair group (4.6 points) (p < 0.05). In addition, the mean time-period required for return to work in the mini-open repair group (2.4 months) was significantly shorter than that required in the control group (3.4 months) (p < 0.05). CONCLUSIONS: The mini-open repair appeared to cause less postoperative atrophy of the deltoid muscle than did the conventional open rotator cuff repair, and patients treated with the mini-open repair recovered more quickly.

Adult↗

PubMed2003

Stress distribution patterns at the coracoacromial arch in rotator cuff tear measured by computed tomography osteoabsorptiometry.

When a rotator cuff tear occurs, forces compressing the humeral head toward the glenoid are disturbed, and the kinematics of the glenohumeral joint change. Therefore, stress distributions at the coracoacromial arch in cuff tear shoulders should differ from those in normal shoulders. To investigate this hypothesis, we studied stress distribution patterns at the coracoacromial arch in normal and cuff tear shoulders using a computed tomography (CT) osteoabsorptiometry method, in which bone density correlates directly with long-term physiologic loading. Eight normal subjects and 11 patients with cuff tear were examined. The stress distributions at the undersurface of the acromion and the posterolateral surface of the coracoid process differed markedly between normal and cuff tear shoulders. In cuff tear shoulders, a high-density area was located at the anterior or the anterolateral part of the undersurface of the acromion, while it was located at the posterior part in all but one normal shoulder. Additionally, a high-density area was located at the superior or the lateral part of the coracoid process in most of the cuff tear shoulders; on the other hand, it was located at the base in all but one normal shoulder. We believe that the differences in stress distribution patterns are due to impingement at the coracoacromial arch in cuff tear shoulders. CT osteoabsorptiometry can provide useful information in performing coracoacromial arch decompression for cuff tear shoulders.

Adult↗

PubMed1999

Shoulder after rotator cuff repair: MR imaging findings in asymptomatic individuals--initial experience.

PURPOSE: To assess the magnetic resonance (MR) imaging appearance of the successfully repaired rotator cuff in an asymptomatic population. MATERIALS AND METHODS: Fifteen subjects who had undergone clinically successful rotator cuff repair were included in the study. All underwent functional testing of the affected shoulder and had good to excellent scores on the Constant scale. Standard MR imaging sequences were performed at 1.5 T, including oblique coronal fast spin-echo T2-weighted MR imaging with fat saturation. RESULTS: Three (10%) of 30 supraspinatus and infraspinatus tendons had normal signal intensity, and 16 (53%) had mildly increased signal intensity on fast spin-echo T2-weighted fat-saturated images, compatible with tendonitis or tendinosis. Three partial and four complete tears of the supraspinatus tendon and two partial and two complete tears of the infraspinatus tendon were seen. Other findings included subacromial-subdeltoid effusion (10 subjects), joint effusions (five subjects), and bone marrow edema (six subjects). CONCLUSION: Postoperative signal intensity changes consistent with tendonitis or tendinosis were common, and clinically "silent" partial and complete rotator cuff tears were seen. Such postoperative MR imaging findings should be interpreted with caution, and meticulous correlation with symptoms and clinical results is recommended.

Aged↗

PubMed1991

[Contribution of MRI to the preoperative evaluation of rotator cuff tears].

The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was completed with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning.

Female↗

PubMed2004

Therapeutic results of acromioclavicular joint dislocation complicated by rotator cuff tear.

PURPOSE: To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear. METHODS: Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association. RESULTS: There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36-79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromio-clavicular joint. CONCLUSION: For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.

Acromioclavicular Joint↗

PubMed1993

Posterior rotator cuff strengthening using theraband(r) in a functional diagonal pattern in collegiate baseball pitchers.

The deceleration phase of the pitching mechanism requires forceful eccentric contraction of the posterior rotator cuff. Because traditional isotonic strengthening may not be specific to this eccentric pattern, a more effective and functional means of strengthening the posterior rotator cuff is needed. Twelve collegiate baseball pitchers performed a moderate intensity isotonic dumbbell strengthening routine for 6 weeks. Six of the 12 subjects were randomly assigned to an experimental group and placed on a Theraband(R) Elastic Band strengthening routine in a functional-diagonal pattern to emphasize the eccentric contraction of the posterior rotator cuff, in addition to the isotonic routine. The control group (n = 6) performed only the isotonic exercises. Both groups were evaluated on a KIN-COM(R) isokinetic dynamometer in a functional diagonal pattern. Pretest and posttest average eccentric force production of the posterior rotator cuff was compared at two speeds, 60 and 180 degrees /s. Data were analyzed with an analysis of covariance at the .05 level with significance at 60 degrees /s. Values at 180 degrees /s, however, were not significant. Eccentric force production at 60 degrees /s increased more during training in the experimental group (+19.8%) than in the control group (-1.6%). There was no difference in the two groups at 180 degrees /s; both decreased (8 to 15%). Theraband was effective at 60 degrees /s in functional eccentric strengthening of the posterior rotator cuff in the pitching shoulder.

Journal Article↗

PubMed2001

[Value of CT bursography in the evaluation of rotator cuff tears].

PURPOSE: To describe the technique and assess the value of subacromial CT bursography in patients with partial surface tear of the rotator cuff tendon. MATERIALS AND METHODS: 15 patients with shoulder pain suggestive of tendinopathy or tear of the rotator cuff were evaluated with subacromial CT bursography. RESULTS: Subacromial CT bursography was normal in 4 patients. Partial surface tear was detected in 7 patients [irregularities (n=2), defect (n=2), superficial tear (n=3)]. Full thickness tear was detected in 4 patients. CONCLUSION: The authors described the technique for subacromial CT bursography to visualize partial surface tears of the rotator cuff tendon. This simple and reliable technique could be an alternative to MR imaging, especially when MR evaluation is not possible.

Adult↗