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At least 667 records · Page 37Linked to original sources

PubMed2004

Magnetic resonance imaging of the rotator cuff in destroyed rheumatoid shoulder: comparison with findings during shoulder replacement.

PURPOSE: To evaluate the predictive value of preoperative magnetic resonance imaging (MRI) with respect to rotator cuff ruptures. MATERIAL AND METHODS: Thirty-one patients with rheumatic disease underwent preoperative MRI before shoulder arthroplasty. The scans were reviewed independently by two experienced radiologists. Three surgeons performed all the replacements (hemiarthroplasties), and the condition of the rotator cuff was assessed. Complete and massive tears of the rotator cuff were recorded and compared at surgery and on MRI. RESULTS: With MRI, 21 shoulders (68%) were classified as having complete or massive tears of the rotator cuff and at surgery 14 shoulders (45%). Cohen's kappa coefficient was 0.44 (95% CI: 0.16 to 0.72) and accuracy 0.71 (95% CI: 0.52 to 0.86). CONCLUSION: In severely destroyed rheumatoid shoulder, the findings of soft tissues were incoherent both with MRI and at surgery. The integrity of tendons could not readily be elucidated with MRI because of an inflammatory process and scarred tissues; in surgery, too, changes were frequently difficult to categorize. Preoperative MRI of severely destroyed rheumatoid shoulder before arthroplasty turned out to be of only minor importance.

Adult↗

PubMedDate not supplied

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction.

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates.

Arthroscopy↗

PubMed1994

Ultrasonography and arthrography in the diagnosis of tears of the rotator cuff.

The accuracy of ultrasonography and arthrography in the prediction of lesions of the rotator cuff was evaluated and compared with the operative findings in a retrospective study of forty-nine patients (forty-nine shoulders). In the detection of full-thickness (stage-III) tears of the rotator cuff, ultrasonography had an over-all sensitivity of 74 per cent, a specificity of 95 per cent, an accuracy of 84 per cent, a predictive value of a positive test of 95 per cent, and a predictive value of a negative test of 75 per cent. In contrast, arthrography demonstrated a sensitivity of 93 per cent, a specificity of 95 per cent, an accuracy of 94 per cent, a predictive value of a positive test of 96 per cent, and a predictive value of a negative test of 91 per cent. Ultrasonography could not reliably differentiate between partial (stage-II) and full-thickness (stage-III) tears. Lesions of the long head of the biceps brachii tendon were recorded by ultrasonography for twenty-two patients (45 per cent) and by arthrography for eleven patients (22 per cent). The ultrasonographic finding of fluid in the sheath of this tendon is not a reliable sign of a lesion in the tendon.

Adult↗

PubMedDate not supplied

The biomechanical role of the subscapularis in latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.

Inferior functional results of latissimus tendon transfer for the treatment of irreparable rotator cuff tears have been reported in the presence of a subscapularis tendon tear. A biomechanical or experimental explanation for the necessity of an intact subscapularis is unavailable. It was, therefore, the purpose of this investigation to study the biomechanical role of the subscapularis in the treatment of a posterosuperior rotator cuff tear with latissimus dorsi transfer. A biomechanical cadaveric model was developed to reproduce glenohumeral motion patterns created by loading of the transferred latissimus dorsi tendon with and without simultaneous action of the subscapularis muscle. Significant differences could be demonstrated not only for translation but also for rotation of the humeral head depending on subscapularis action. In the neutral and in the abducted/externally rotated position of the arm, anterior translation and dislocation of the joint were encountered without subscapularis action. Our results provide evidence that motion patterns of the humeral head are significantly altered in the absence of the stabilizing effect of the subscapularis muscle. The inferior functional results of latissimus dorsi transfer in the presence of subscapularis dysfunction are explained by the loss of centering of the humeral head upon abduction and elevation if subscapularis function is deficient.

Aged↗

PubMed1995

Effect of field of view on MR diagnosis of rotator cuff tears.

PURPOSE: To determine the effect of decreasing the field of view (FOV) on the accuracy of MR for diagnosing rotator cuff tears. MATERIAL AND METHODS: One hundred shoulder MR scans with surgical correlation were evaluated for the presence or absence of a cuff tear. The sensitivity and specificity of MR relative to the surgical results were determined for the 59 patients scanned with a 24-cm FOV, and the 41 patients scanned with an 18-cm FOV. All other imaging parameters including acquisition time were identical. The sensitivity and specificity of the two groups were compared using a t-test. RESULTS: The specificity of MR for diagnosing a rotator cuff tear improved from 0.65 for the 24-cm FOV group to 0.89 for the 18-cm FOV group (P = 0.04). The sensitivity changed from 0.91 to 0.96 (P = 0.25). CONCLUSION: Reducing the FOV from 24 cm to 18 cm results in a statistically significant improvement in specificity of MR for diagnosing rotator cuff tears.

Adult↗

PubMedDate not supplied

Excursion of the rotator cuff under the acromion. Patterns of subacromial contact.

Nine fresh-frozen, human cadaveric shoulders were elevated in the scapular plane in two different humeral rotations by applying forces along action lines of rotator cuff and deltoid muscles. Stereophotogrammetry determined possible regions of subacromial contact using a proximity criterion; radiographs measured acromiohumeral interval and position of greater tuberosity. Contact starts at the anterolateral edge of the acromion at 0 degrees of elevation; it shifts medially with arm elevation. On the humeral surface, contact shifts from proximal to distal on the supraspinatus tendon with arm elevation. When external rotation is decreased, distal and posterior shift in contact is noted. Acromial undersurface and rotator cuff tendons are in closest proximity between 60 degrees and 120 degrees of elevation; contact was consistently more pronounced for Type III acromions. Mean acromiohumeral interval was 11.1 mm at 0 degrees of elevation and decreased to 5.7 mm at 90 degrees, when greater tuberosity was closest to the acromion. Radiographs show bone-to-bone relationship; stereophotogrammetry assesses contact on soft tissues of the subacromial space. Contact centers on the supraspinatus insertion, suggesting altered excursion of the greater tuberosity may initially damage this rotator cuff region. Conditions limiting external rotation or elevation may also increase rotator cuff compression. Marked increase in contact with Type III acromions supports the role of anterior acromioplasty when clinically indicated, usually in older patients with primary impingement.

Acromion↗

PubMed1989

[Computed tomography of the rotator cuff--a comparison with other imaging technics].

We consider CT to be suitable for investigating the following lesions of the rotator cuff: 1) tendopathia calcarea. 2) Rotator cuff atrophy suitable for surgery. 3) Bone defects. 4) Inflammatory changes with effusions. For demonstrating rotator cuff defects that might require surgery, we recommend CT arthrography, if possible with sagittal sections. This is particularly the case for younger patients with a history of trauma and evidence of a complex shoulder injury and in cases with persistent symptoms after surgical intervention of ineffective conservative treatment. CT, however, is only indicated if sonography supplies limited information or if sonography is negative with positive clinical findings.

Adolescent↗

PubMed1991

Effect of arm rotation on MR imaging of the rotator cuff.

The effect of humeral rotation on the appearance of the rotator cuff tendon in oblique coronal magnetic resonance images was evaluated in 70 such images. Internal rotation produced overlap of the supraspinatus and infraspinatus tendons with soft-tissue interposition or apparent discontinuity of the tendon in 22 cases, including 14 of 15 shoulders positioned in the first 30 degrees between extreme internal and external rotation. Imaging in internal rotation makes assessment of the tendon difficult and should be avoided.

Humans↗

PubMed1995

[The anterolateral deltoid muscle flap-plasty: the procedure of choice in large rotator cuff defects].

We analysed the results of shoulder reconstruction using an anterolateral deltoid muscle flap plasty in 101 patients with large rotator cuff lesions. This method was first described in Apoil and Augereau in 1985. We modified and extended their technique. Regular follow-up examinations were possible in 100 patients (27 females, 73 males, age 61.3 +/- 8.7 years). One patient died of sepsis of unknown aetiology during the hospital stay. All patients suffered from severe pain and sleepless nights prior to the operation. They also had long histories of unsuccessful and frustrating treatment. The rotator cuff lesions found intraoperatively were at least 5 x 5 cm in size. We used an anterolateral deltoid muscle flap to reconstruct these large defects. Physical therapy was started on the 1 postoperative day and was continued for about 6 months (6.8 +/- 2.6 months). The average hospital stay was 10.9 +/- 5.3 days. After the treatment 90% of all patients were subjectively satisfied or very satisfied with the result, while 12% had moderate and 5% unsatisfactory results. No pain was felt at all by 75% of the patients, and 21% showed decidedly less pain. Severe pain attacks were found in only 4% of the patients, but their pain was less intense than preoperatively. The shoulder function improved significantly, and 72% recovered their strength completely. Most of the patients were able to work after 6 months. The overall result was good to very good in 83%. This high percentage of good shoulder function and patient satisfaction makes this the operation technique of choice for large rotator cuff lesions.

Aged↗

PubMedDate not supplied

Infection after rotator cuff repair.

Sixteen patients (15 men and 1 woman) were treated for infection complicating rotator cuff repair during the period 1975 through 1994. Eight of the 16 patients had their initial procedure performed elsewhere. The remaining 8 procedures were performed at our institution with the known incidence of this complication being 0.27%. In addition to intravenous antibiotic therapy, an average of 3.5 (range 2 to 8) operative procedures were required to eradicate the infections. Micro-organisms cultured were Propionibacter in 6, coagulase negative Staphylococcus in 4, Staphylococcus aureus in 4, Peptostreptococcus magnus in 1, and both Propionibacter and coagulase-negative Staphylococcus in 1. The deltoid was restored in all patients; the rotator cuff was reparable in 11. In the 12 shoulders with greater than 1 year of follow-up (average 51 months, range 14 to 165 months), active elevation averaged 110 degrees and external rotation 50 degrees. Four patients had no pain, 4 had minimal pain, and the remaining 4 had moderate pain. Satisfactory final results, which were determined by the patients' opinion or with the use of either the University of California, Los Angeles score or the modified Neer system, were obtained in 5 (42%) of the shoulders.

Adult↗

PubMed2005

Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation.

PURPOSE: The purpose of this study was to compare the functional as well as the structural outcomes of single-row and dual-row fixation after arthroscopic full-thickness rotator cuff repair. TYPE OF STUDY: Retrospective cohort study. METHODS: A consecutive series of 80 shoulders in 78 patients with full-thickness rotator cuff tears was evaluated using the rating scale of the University of California Los Angeles (UCLA) and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) at an average of 35 months (range, 24 to 60 months) after arthroscopic rotator cuff repair. Thirty-nine shoulders were repaired using the single-row technique and 41 shoulders using the dual-row technique. Postoperative cuff integrity was determined through magnetic resonance imaging and was classified into 5 categories: type I, sufficient thickness with homogenously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, presence of a minor discontinuity; type V, presence of a major discontinuity. RESULTS: The average UCLA score improved significantly to 32.4 in the single-row and to 33.1 in the dual-row group. The ASES shoulder index improved significantly to 93.0 in the single-row group and to 94.6 in the dual-row group. However, there was no statistical difference between the groups in the postoperative scores. Postoperative MRI revealed 11 type I, 6 type II, 12 type III, 4 type IV, and 6 type V in the single-row group, and 22 type I, 8 type II, 7 type III, 4 type IV, and no type V in the dual-row group. A statistical difference was observed between the groups (P < .01). CONCLUSIONS: Arthroscopic rotator cuff repair yielded successful functional outcomes without significant difference between single and dual-row fixation techniques. However, dual-row repairs excelled in structural outcome over the single-row technique. LEVEL OF EVIDENCE: Level III.

Adult↗

PubMedDate not supplied

Comparison of fast spin-echo and conventional spin-echo sequences in the MR diagnosis of rotator cuff tears.

The fast spin-echo (FSE) technique has been a successful alternative to conventional spin-echo (CSE) imaging in the brain, spine, and pelvis, but not in the knee. This study evaluated the performance of the FSE technique in comparison with the established CSE technique as a reference standard. Oblique coronal images of 30 shoulders were obtained by both FSE and CSE techniques. The FSE images were compared with CSE images in terms of blurring and motion artifact, fat signal intensity, structural conspicuity, and visualization of joint effusion and rotator cuff tears. We imaged 30 consecutive patients with suspected rotator cuff tears who were referred for MR examination. FSE images often were worse in blurring and motion artifact than CSE images. FSE images showed higher fat signal intensity, but visualized structural conspicuity, joint effusion, and rotator cuff tear as well as CSE images. Our results suggest that the FSE technique is not equal to the CSE technique but can be used for the diagnosis of rotator cuff tears.

Adolescent↗

PubMed2001

Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency.

BACKGROUND: Hemiarthroplasty for the treatment of shoulders with glenohumeral arthritis and severe rotator cuff deficiency has been reported to provide reasonable clinical results. The purposes of this study were to determine the clinical and radiographic results of hemiarthroplasty for this condition and to identify pathological and technical factors that may influence its outcome. METHODS: Thirty patients (thirty-three shoulders) managed with hemiarthroplasty because of glenohumeral arthritis and a massive, irreparable tear of the rotator cuff were followed for an average of five years (range, two to eleven years). Eight shoulders had undergone a prior acromioplasty and resection of the coracoacromial ligament. A small prosthetic head was used in three shoulders; a medium head, in twenty-six; and a large head, in four. Clinical results were graded according to the limited-goals criteria of Neer et al. RESULTS: The mean pain score decreased from 4.2 points preoperatively to 2.2 points at the time of the most recent follow-up (p = 0.0001). However, at the time of the most recent follow-up, nine shoulders (27%) had moderate pain at rest (four shoulders) or pain with activity (five shoulders). Mean active elevation improved from 72 degrees (range, 30 degrees to 150 degrees) to 91 degrees (range, 40 degrees to 165 degrees) (p = 0.008). Anterosuperior instability occurred in seven shoulders and was associated with a history of subacromial decompression (p = 0.04). The result was graded as successful for twenty-two shoulders (67%). CONCLUSIONS: Shoulder hemiarthroplasty provides marked pain relief in three-quarters of patients with glenohumeral arthritis and severe rotator cuff deficiency. It is a reconstructive option that provides durable results, but it may be complicated by instability and progressive bone loss.

Aged↗

PubMed2003

Microcirculation associated with degenerative rotator cuff lesions. In vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder.

BACKGROUND: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas. METHODS: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31. RESULTS: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 +/- 13 cm/cm(2) and the mean capillary diameter was 10 +/- 0.7 microm. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 +/- 14 cm/cm(2), whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone. CONCLUSIONS: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.

Arthroscopy↗

PubMed2000

The depressor function of biceps on the head of the humerus in shoulders with tears of the rotator cuff.

We investigated the function of biceps in 18 patients (19 shoulders) with lesions of the rotator cuff. Their mean age was 59 years. Another series of 18 patients (19 shoulders) with normal rotator cuffs as seen on MRI acted as a control group. Their mean age was 55 years. A brace was used to maintain contraction of biceps during elevation. Anteroposterior radiographs were obtained with the arm elevated at 0 degrees , 45 degrees and 90 degrees with and without contraction of biceps. The distance between the centre of the head of the humerus and the glenoid was compared in the two groups. We found that in the group with tears there was significantly greater proximal migration of the head of the humerus at 0 degrees and 45 degrees of elevation without contraction of biceps but depression of the head of the humerus at 0 degrees, 45 degrees and 90 degrees when biceps was functioning. We conclude that biceps is an active depressor of the head of the humerus in shoulders with lesions of the rotator cuff.

Adult↗

PubMedDate not supplied

[Echography, magnetic resonance and double-contrast arthrography of the rotator cuff. A prospective study in 30 patients].

Shoulder pain is a common clinical problem with different etiologies. Without a specific diagnosis, treatment could be ineffective, causing functional limitation, chronic pain and atrophy. US and MRI allow in many cases to correctly define the different etiologies causing shoulder pain, often due to rotator cuff conditions. From June to September 1992, thirty patients with clinically suspected acute or chronic rotator cuff lesion were studied with US, MRI and double contrast arthrography. US and MRI findings were evaluated and compared using arthrography and surgery as the gold standard. The overall accuracy of MRI was 93%: the method yielded accurate information about size and number of rotator cuff tears, and about bursal, bone and muscle involvement. US accuracy was 83% in the diagnosis of large tears, 63% in the diagnosis of small and partial tears and only 11% in the diagnosis of tendinitis. Both MRI and arthrography exhibited high accuracy (respectively 91 and 100%) in the detection of rotator cuff tears when their results were compared with surgical findings. A flow chart to be used in the patients with acute or chronic shoulder pain was drawn from the critical analysis of the above results.

Arthrography↗

PubMed1994

[Endoscopic acromioplasty in total rupture of the rotator cuff].

PURPOSE OF THE STUDY: The authors have conducted a study to evaluate the possible efficacy of endoscopic decompression without repair in the treatment of rotator cuff tears. MATERIAL AND METHOD: We report 42 cases of endoscopic acromioplasty realized for full-thickness rotator cuff tears. Mean follow-up was 28.8 months. The principal presenting symptom was pain, with a mean duration of 29 months. Antero-external acromioplasty was realized by endoscopy using motorized drill bits, with sectioning or resecting the acromio-coracoid ligament. Revision consisted of a standard clinical examination, following the protocol of Constant, and a radiologic examination by sub-acromial frontal and scapular profile x-rays as advised by Liotard. RESULTS: The functional results were very good, with 94 per cent of patients satisfied. The mean Constant score was 67.4 (14-100) corresponding on the average to 84 per cent of the score of a healthy shoulder for the same age and sex. The improvement concerned essentially the score of the pain, which increased on the average 7.4 points out of 15 (10.2/15 at revision) and of the activity level (14.8/20 as opposed to 8/20 initially). Less important was the improvement of the active mobility score (from 25.2 to 34/40 at revision). The force was measured according to the Constant scale, with a mean of 8.3 points out of 25. The mean duration of absence from work for the active patients was 2.4 months. Neither infectious nor neurological complications were noted. The radiographic analysis showed a decrease of the acromial edge, significative as compared to the opposite side. On the profile x-ray, we observed 48 per cent flat acromions in contrast to 80 per cent curved types on the opposite side. The only element influencing the pain score was the size of the rupture, but the statistical result was weak. The final Constant score was strongly influenced by by the size of the rupture, the active mobility, the pre-operative active and passive mobility, as well as by the presence of head excentration on pre-operative x-rays. DISCUSSION: Comparison with other series of endoscopic acromioplasty for full-thickness rotator cuff tears has permitted us to confirm the validity of our series. We have especially evaluated this series in comparison to those with surgical repair. The subjective results, as well as those for pain, are equivalent; results on active mobility and force were not as good. We propose, therefore, this technique of low morbidity, in the presence of total ruptures in older and sedentary patients. The antalgic effect of endoscopic acromioplasty allows, in these patients, a functionally satisfying rehabilitation.

Acromion↗

PubMed2005

Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis.

BACKGROUND: The Delta III reverse-ball-and-socket total shoulder implant is designed to restore overhead shoulder function in the presence of irreparable rotator cuff deficiency by using the intact deltoid muscle and the stability provided by the prosthetic design. Our purpose was to evaluate the clinical and radiographic results of this arthroplasty in a consecutive series of shoulders with painful pseudoparesis due to irreversible loss of rotator cuff function. METHODS: Fifty-eight consecutive patients with moderate-to-severe shoulder pain and active anterior elevation of <90 degrees due to an irreparable rotator cuff tear were treated with a Delta III total shoulder replacement at an average age of sixty-eight years. Seventeen of the procedures were the primary treatment for the shoulder, and forty-one were revisions. The patients were examined clinically and radiographically after an average duration of follow-up of thirty-eight months. RESULTS: On the average, the subjective shoulder value increased from 18% preoperatively to 56% postoperatively (p < 0.0001); the relative Constant score, from 29% to 64% (p < 0.0001); the Constant score for pain, from 5.2 to 10.5 points (p < 0.0001); active anterior elevation, from 42 degrees to 100 degrees (p < 0.0001); and active abduction, from 43 degrees to 90 degrees (p < 0.0001). The patients for whom the implantation of the Delta III prosthesis was the primary procedure and those who had had previous surgery showed similar amounts of improvement. The total complication rate, including all minor complications, was 50%, and the reoperation rate was 33%. Of the seventeen primary operations, 47% (eight) were associated with a complication and 18% (three) were followed by a reoperation. Of the forty-one revisions, 51% (twenty-one) were associated with a complication and 39% (sixteen) were followed by a reoperation. Subjective results and satisfaction rates were not influenced by complications or reoperations when the prosthesis had been retained. CONCLUSIONS: Total shoulder arthroplasty with the Delta III prosthesis is a salvage procedure for severe shoulder dysfunction caused by an irreparable rotator cuff tear associated with other glenohumeral lesions. Complications were frequent following both primary and revision procedures, but they rarely affected the final outcome. The procedure has a substantial potential to improve the condition of patients with severe shoulder dysfunction, at least in the short term.

Adult↗