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At least 1,063 records · Page 59Linked to original sources

PubMed2005

Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff.

BACKGROUND: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff. HYPOTHESIS: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: A prospective, randomized, single-blind study was carried out on 50 patients. The population was divided into 2 groups of equal numbers (navigation group and feedback group). In all patients, treatment-resistant pain was evident for longer than 6 months. A total of 3 therapy sessions of constant low-energy focused shock wave therapy was administered in weekly intervals in both groups. Local anesthesia was not applied. Radiographs and clinical assessment, including the Constant and Murley shoulder scoring system and the visual analog scale for pain, were performed both before therapy and after 12 weeks. In the navigation group, the calcium deposit was localized using a radiographically guided, 3-dimensional, computer-assisted device. The feedback group was treated after locating the point of maximum tenderness through palpation by the therapist with feedback from the patient. RESULTS: Both groups had significant improvements in the Constant and Murley score and the visual analog scale after 12 weeks. The results from the navigation group were statistically significantly superior to those of the feedback group. In the navigation group, 6 calcium deposits disappeared and 9 altered, compared to 1 disappearance and 12 alterations in the feedback group. No severe complications occurred. CONCLUSION: Three-dimensional, computer-assisted navigation reveals significantly better results and is therefore recommended when extracorporeal shock wave therapy is used in the treatment of calcific tendinitis of the rotator cuff.

Adult↗

PubMed1986

Rotator cuff tears: preliminary application of high-resolution MR imaging with counter rotating current loop-gap resonators.

A new class of radio frequency (RF) coils for magnetic resonance (MR) imaging and spectroscopy is introduced. The coils consist of two loop-gap resonators of equal diameters positioned along a common axis. They are tuned to the mode in which the current in the two loops flows in opposite directions. These coils are "decoupled" from a uniform excitation field of arbitrary orientation (including circularly polarized fields) by intrinsic decoupling and by means of back-to-back fast recovery diodes. Measurements made with the coils and a phantom saline tank indicate that the signal-to-noise ratio obtainable with these coils is almost identical to that obtained with single loops. Imaging of several anatomic areas, including knee, wrist, and shoulder, has been performed with a 1.5-T MR system that uses circularly polarized RF. A small series of patients with torn rotator cuffs underwent imaging. Difficulties in establishing the diagnosis with MR imaging because of anatomic complexity are illustrated. The value of pulse sequences with long repetition times to increase the signal intensity of fluid in the joint is shown.

Humans↗

PubMedDate not supplied

Comparison of ultrasonic suture welding and traditional knot tying in a rabbit rotator cuff repair model.

The purpose of this study is to evaluate ultrasonic suture welding of monofilament suture in an animal model of rotator cuff repair with biomechanical and histologic analyses. We randomly assigned 46 shoulders in 23 rabbits to 1 of 3 treatment groups: sham-operated (n = 15), knotted (n = 15), and welded (n = 16). Supraspinatus defects were surgically created and acutely repaired with suture anchors loaded with either No. 2-0 Ethibond for knotted group or No. 2-0 nylon for welded shoulders. Eighteen weeks postoperatively, all animals were killed, and the shoulders underwent either biomechanical testing or histologic analysis. The maximum stress of the sham-operated group (20.6 N/mm2) was significantly greater than that of both the knotted (10.2 N/mm2) and welded (8.3 N/mm2) groups (P < .05), but no differences were observed between the knotted and welded groups. Although some histologic changes were noted, none was considered to be significant to distinguish either group.

Animals↗

PubMed1983

Operative treatment of chronic ruptures of the rotator cuff of the shoulder.

The results of 63 operative repairs of chronic tears of the rotator cuff in 61 patients are reviewed retrospectively; the mean follow-up was 32.7 months. Fifty-four patients presented with symptoms of persistent pain and seven patients with gross loss of movement. All the patients had failed to respond to conservative treatment. Results were assessed in terms of relief of pain, restoration of movement, the patients' ability to return to work and whether they were satisfied with the results. Overall, a good result in terms of relief of pain was achieved in 40 shoulders. In 31 shoulders (30 with pain and one without pain) the operation included particular measures to decompress the subacromial space; 26 of the patients achieved relief of pain which was significantly better than in those patients whose operation did not include a decompression. The complications and failures are discussed. It is suggested that operative repair of the chronically torn rotator cuff of the shoulder is a worthwhile operation and that the operation should include an adequate decompression of the subacromial space.

Adult↗

PubMedDate not supplied

Intraarticular morphine and bupivacaine reduces postoperative pain after rotator cuff repair.

BACKGROUND AND OBJECTIVES: To determine whether intraarticular injection of morphine, fentanyl, or sufentanil added to bupivacaine provided pain control after open rotator cuff repair. METHODS: These data were collected as a prospective, randomized, blinded observer study. All patients received a standard interscalene anesthetic with 1.4% mepivacaine with 1:200,000 epinephrine. At the conclusion of surgery, they received an intraarticular injection after the shoulder capsule was closed. Patients were randomized into 4 groups. All received 20 mL of 0.25% bupivacaine: group 1, plain; group 2, with 1 mg of morphine added; group 3, with 50 microg of fentanyl added; and group 4, with 10 microg of sufentanil added. Pain scores in the postanesthesia care unit were evaluated at 0, 30, 60, 90, 120, and 240 minutes and at 4-hour intervals postoperatively using a visual analogue scale. Breakthrough pain was managed with morphine, via patient controlled analgesia pump. RESULTS: Thirty-nine patients were entered into the study. Pain scores at 2 hours and beyond were lowest in group 2. Total morphine utilization was significantly lower for the first 24 hours in group 2. CONCLUSIONS: Intraarticular injection of the shoulder with 0.25% bupivacaine and 1 mg morphine at the conclusion of surgery provided pain control and diminished morphine used in the first 24 hours after open rotator cuff repair. Fentanyl and sufentanil did not improve the analgesia over that achieved with bupivacaine alone.

Analgesics, Opioid↗

PubMedDate not supplied

Tissue-engineered rotator cuff tendon using porcine small intestine submucosa. Histologic and mechanical evaluation in dogs.

To determine its efficacy in stimulating the regeneration of a rotator cuff tendon, an implant of 10-ply porcine small intestinal submucosa was used to replace a completely resected infraspinatus tendon in 21 adult mongrel dogs. The contralateral infraspinatus tendon was elevated and then reattached to the greater tubercle with sutures to mimic conventional repair (sham operation). Mechanical evaluations were performed at 0, 3, and 6 months (five specimens at each time period). Histologic comparisons were made at 3 and 6 months (three specimens). At both times, the gross appearance, histologic continuity, and failure mode of the constructs mimicked those of sham-operated and native infraspinatus tendons, thus suggesting host tissue ingrowth and implant remodeling with solid integration of the regenerated tissue to muscular and bony interfaces. Tissue ingrowth occurred without histologic evidence of foreign body or immune-mediated reactions or adhesions to peripheral tissues. Sham operations simulated tendon mobilization and reimplantation procedures routinely performed to treat chronic rotator cuff tendon injuries. Although the ultimate strength of small intestinal submucosa-regenerated tendons was significantly less than that of native infraspinatus tendons (P < 0.001), it was similar to that of reimplanted tendons at 3 (P > 0.05) and 6 months (P > 0.05).

Animals↗

PubMed2003

Arthroscopic evaluation and management of rotator cuff tears.

The development of arthroscopic techniques has provided the shoulder surgeon with new opportunities to improve the chances of salvaging these difficult rotator cuff tears while generally avoiding the potential disastrous consequences attendant to the open procedures. The arthroscope can be used to review and document the status of the joint and cuff, assess the tear pattern, debride damaged tissues, and smooth the acromion. In addition, a trained shoulder arthroscopist can mobilize the available tissues and repair any viable tendon to bone, without damage to the overlying muscles, through small cosmetic incisions in an outpatient surgery setting. If there proves to be an irreparable injury, debridement and bone smoothing can be readily performed, avoiding iatrogenic injury to the remaining healthy tissues, especially the deltoid muscle. The patient and the surgeon must accept that the arthroscope is merely a helpful surgical tool, a convenient method to visualize the anatomy without damaging other tissues. When one attempts to repair a massive cuff tear, even with the aid of the arthroscope, there are no miracles or magic involved and often the results are less than perfect. Fortunately, once one can see the relevant anatomy, the opportunities to safely repair the tissues are then unprecedented.

Arthroscopy↗

PubMed1990

Complications of rotator cuff surgery.

It is essential to understand shoulder anatomy and the pathology and extent of a rotator cuff tear before an effective repair can be achieved. Most surgical-repair failures can be avoided by: (1) achieving adequate healing of the deltoid that has been detached from the acromion, (2) not excising too much of the acromion, (3) correctly repairing the rotator cuff, including intimal tears, and (4) carefully preserving the nerve supply to important shoulder girdle muscles. Nevertheless, if a complication arises, it must be correctly managed in order to salvage shoulder function.

Humans↗

PubMedDate not supplied

Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears.

Ultrasound (US) and magnetic resonance imaging (MRI) of 422 cases were evaluated to compare the feasibility in diagnosing full-thickness rotator cuff tears (FTRCTs). On the basis of different US performers, they were divided into two groups: Group 1 performed by a 5-year experience technician and Group 2 performed by a 10-year experience radiologist. Sensitivity, negative predictive value (NPV), accuracy of US, and correlation between the two modalities were better in Group 2. When an expert is available, US can be used for diagnosing FTRCTs; otherwise, MRI should be performed.

Adolescent↗

PubMed1996

MR arthrography in the diagnosis of rotator cuff tears. Standard spin-echo alone or with fat suppression?

PURPOSE: To examine the value of fat-suppressed images in MR arthrography of the shoulder in patients with rotator cuff tears. MATERIAL AND METHODS: MR arthrography was performed in 25 patients (9 women, 16 men) ranging from 19 to 64 years. Standard T1-weighted spin-echo images (sSE) and fat-suppressed images (FS) were obtained after intraarticular injection of contrast material. The MR studies were analyzed according to contrast, image quality and conspicuity of pathology. A diagnosis was established without knowledge of the conventional arthrographic findings on the basis of sSE versus FS techniques. RESULTS: The contrast between the intraarticular fluid and the adjacent structures in FS images was increased compared to sSE images in all patients. The conspicuity of anatomical structures was improved in 8 patients. Without fat suppression, 2 false-negative and one false-positive full-thickness tears were diagnosed. With the FS technique, 14 full-thickness tears and 4 partial-thickness tears of the cuff were correctly classified. CONCLUSION: The results suggest that, if MR arthrography is chosen for a diagnosis of rotator cuff disorders, a fat suppression sequence should be included.

Adult↗

PubMed2006

Massive rotator cuff tears repaired on top of humeral head by McLaughlin's procedure.

The clinical and radiographic outcomes of McLaughlin's procedure for massive rotator cuff tears were investigated in 25 shoulders, in which the cuff tears were so severe that the tendons were sutured on the top of the humeral head. The mean age at surgery was 62.2 years (range, 39-74 years). The mean follow-up period was 50 months (range, 24-80 months). The University of California, Los Angeles score significantly improved from 10.9 to 31.8 points postoperatively; the postoperative result was classified as excellent in 11 shoulders, good in 11, and poor in 3. Osteoarthritis progressed postoperatively in 7 shoulders (28%), and upper migration of the humeral head progressed in 6 (24%), although both progression rates were no higher than those for other common procedures. When torn tendons reach over the top of the humeral head with the arm at the side in patients with massive tears that are not reparable to the greater tuberosity, satisfactory clinical outcomes can be expected.

Adult↗

PubMed1985

Rotator cuff tears: evaluation using double-contrast shoulder arthrography.

To determine the accuracy of double-contrast arthrography in complete rotator cuff tears, we studied 805 patients thought to have a complete rotator cuff tear who had undergone double-contrast shoulder arthrography (DCSA) between 1978 and 1983. The results of this study indicate that DCSA is exquisitely sensitive and as accurate as the single-contrast examination. The site of disruption was directly visualized in 93% of cases, and the size of the defect and status of the torn tendon edges were reliably predicted. Such information may influence the surgeon in patient selection for operative repair as well as surgical approach.

Arthrography↗

PubMed2005

Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study.

BACKGROUND: The precise results of arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff remain to be reported. HYPOTHESIS: Arthroscopic transtendon repair is useful in patients with Ellman grade 3 (>6 mm) partial-thickness articular-side tears of the supraspinatus tendon. STUDY DESIGN: Descriptive laboratory study and case series; Level of evidence, 4. METHODS: In 43 cadaveric shoulders (mean age, 80 years; range, 50-97 years), the authors measured the width of the supraspinatus insertion (medial-to-lateral direction) and the distance between the articular cartilage edge and the tendon insertion at a site 10 mm lateral to the anterior margin of the greater tuberosity. A clinical study group of 17 patients (mean age, 42 years; range, 17-51 years) was observed for a mean follow-up of 39 months (range, 25-57 months). University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores and postoperative overhead athletic activities were evaluated. RESULTS: The mean width of the supraspinatus insertion was 9.6 mm (SD, 1.6 mm; range, 7-13 mm; 95% confidence interval, 9.1-10.1 mm; 95% prediction interval, 6.4-12.8 mm). The mean distance between the articular cartilage edge and the tendon insertion was 0.3 mm (range, 0-2 mm). After the procedure, the mean University of California at Los Angeles and Japanese Orthopaedic Association scores significantly improved from 17.3 and 68.4 points to 32.9 and 94.8 points, respectively (P < .01). Rated on the Japanese Orthopaedic Association scale, results were excellent in 14, good in 2, and fair in 1 patient; there were no poor results. Of 6 overhead-throwing athletes, 2 returned to their previous sports at the same level, 3 returned at a lower level, and 1 was unable to return. CONCLUSION: Arthroscopic transtendon repair is a safe, reliable procedure in patients with grade 3 partial-thickness articular-side tears. In the majority of patients, partial tears of more than 6 mm of the supraspinatus tendon thickness involved more than 50% of the entire tendon thickness.

Adolescent↗

PubMed2006

Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study.

The reported functional results of rotator cuff repair performed arthroscopically have been good. Only little is known about the cuff integrity after arthroscopic repair and how it influences the outcome. The aim of the study is to set a baseline of what rate of healing response respectively re-tears to expect and how cuff integrity alters the outcome. Fifty-three consecutive patients with an isolated supraspinatus tendon tear were arthroscopically operated and their tendons repaired. All pre- and postoperative data were prospectively collected. At a minimum follow-up after 24 months (average 26.4 months), the integrity of the cuff was evaluated by an open magnetic resonance imaging and the patients' function and satisfaction were documented and graded to the sex- and age-related Constant-score also using a dynamometer for strength testing. The re-tear rate was 24.5% with 13 non-healed tendons. The Constant-score of all patients improved significantly. The scores of the patients with a re-tear were significantly lower than those of the patient with an intact cuff. That was due to a less good performance in strength testing. The other categories of the Constant-score did not show any differences. The age of the patients with a re-tear was significantly higher. With the exception of age, we did not find any negative prognostic factor for a re-tear, and with the exception of re-tear no other factor influenced the Constant-score. Arthroscopic supraspinatus tendon repair yields a re-tear rate of 25% which is comparable with the results of open or mini/open repair. Cuff integrity influences postoperative strength and Constant-score. Patients older than 65 years show a higher re-tear rate. Therapeutic Level IV is the level of evidence.

Aged↗

PubMed1999

Neural response of mechanoreceptors to acute inflammation in the rotator cuff of the shoulder joint in rabbits.

We examined with electrophysiological techniques the effects of experimentally induced inflammation on the mechanosensitive afferent units in the rotator cuff of the shoulder joint of 21 rabbits. We identified 21 mechanosensitive units belonging to group III. 12 units had mechanical thresholds of > 7.0 g and 9 units had thresholds of < 7.0 g. After injection of inflammatory agents, kaolin and carrageenan, into the joint space, ongoing afferent discharge rates increased in all units. The average discharge rate increased significantly from 7 imp/s to 15 imp/s after injection. 5 units had a decreased mechanical threshold after the injection. Acute inflammation seems to have an excitatory and sensitizing effect on the high- and low-threshold units in the rotator cuff.

Acute Disease↗

PubMed1996

Partial-thickness tears of the rotator cuff. A clinicopathological review based on 66 surgically verified cases.

This review is based on 66 patients with partial-thickness tears of the rotator cuff, verified at operation. Their average age was 54 years, and all had symptoms of subacromial impingement. The duration of shoulder pain was for between 2 and 108 months (mean 11.4 months). Ultrasonography, arthrography and bursography were helpful in establishing the diagnosis. On exploration, tears were found in the supraspinatus tendon, with 9 extending into the infraspinatus. After anterior acromioplasty, excision of the diseased portion and tenorrhaphy were undertaken. Satisfactory results were obtained in 62 patients (94%) with an average follow-up of 32 months. Spontaneous repair at the torn site was never seen. In addition to Neer's staging of impingement, we propose a new classification based on the integrity of the cuff tendon. We conclude that a partial-thickness cuff tear is an important cause of shoulder disability, which deserves much more clinical attention; misdiagnosis is common and leads to mismanagement. When conservative treatment fails, accurate diagnosis and proper surgical repair are essential.

Adult↗

PubMed2004

Genetic influences in the aetiology of tears of the rotator cuff. Sibling risk of a full-thickness tear.

From a retrospective, cohort study of 205 patients diagnosed with full-thickness tears of the rotator cuff, we determined, using ultrasound, the prevalence of such tears in their 129 siblings. Using 150 spouses as controls, the relative risk of full-thickness tears in siblings versus controls was 2.42 (95% CI 1.77 to 3.31). The relative risk of symptomatic full-thickness tears in siblings versus controls was 4.65 (95% CI 2.42 to 8.63). The significantly increased risk for tears in siblings implies that genetic factors play a major role in the development of full-thickness tears of the rotator cuff.

Adult↗

PubMed1990

Diagnosis and treatment of incomplete rotator cuff tears.

The histopathologic changes leading to rotator cuff rupture are gradual and progressive. Incomplete tears can be observed in the articular or bursal surface. These partial lesions are infrequently demonstrated with arthrography or bursography. Although structural variations in cuff integrity can be demonstrated with ultrasound or magnetic resonance imaging, precise definition of partial tears is difficult. The exact location and extent of incomplete tears can be documented with shoulder arthroscopy. Anterior acromioplasty, either open or arthroscopic, is indicated for the treatment of chronic mechanical impingement refractory to conservative management. When a sizable partial defect is identified at open surgery, the degenerated tissue is excised and the tendon is reattached to bone or repaired with side-to-side suture. Arthroscopic treatment consists of debridement of the torn cuff margins, followed by arthroscopic subacromial decompression (ASD). When the incomplete tear in an active individual involves more than one-half the cuff thickness, arthroscopic and open techniques can be combined. Twenty partial-thickness tears were encountered among 130 patients who had ASD for chronic impingement. Fifteen had a satisfactory result, but five required additional surgery. A system of grading partial-thickness tears based on location, depth, and area is presented in an effort to standardize the observations of various investigators and to permit comparison of the results of arthroscopic treatment.

Humans↗