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Results for “Rotator Cuff”

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PubMed1993

Acromioclavicular joint cyst associated with rotator cuff tear. A report of three cases.

Acromioclavicular joint cyst (AJC) is a rare condition, usually occurring in the presence of a wide communication between glenohumeral and acromioclavicular joints in patients with a massive rotator cuff tear. In the presence of AJC, accurate evaluation of the status of the rotator cuff should always be made. Removal of the cyst only must be avoided because the condition tends to recur if the cuff tear is not repaired. When the tear is so large that it cannot be repaired, excision of the cyst should be associated with a resection of the lateral end of the clavicle.

Acromioclavicular Joint↗

PubMed2005

Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors.

OBJECTIVE: The purpose of this study was to analyze the causes of errors in the detection and measurement of rotator cuff tears in our patient population. SUBJECTS AND METHODS: Seventy-one consecutive patients with shoulder pain who were prospectively studied with sonography had subsequent arthroscopy that showed a full-thickness or partial-thickness tear or intact cuff. For sonography and arthroscopy, the length or degree of retraction and width of a tear, when present, was recorded. When there were discrepant findings, representative images were jointly evaluated by the radiologist and orthopedic surgeon to determine the cause of the error. RESULTS: Fifteen detection errors were found, including five misses (three < 5-mm subscapularis and two small partial-thickness tears), four errors inherent with the test (distinguishing large bursal side or extensive partial-thickness from full-thickness tears and tendinopathy from partial-thickness tears), three errors of an unknown cause, two due to misinterpretation, and one error inherent with the patient. Seventeen measurement errors occurred with full-thickness tears, 15 of those in patients with large or massive tears. Bursal thickening (n = 4), non-visualization of the torn tendon end (n = 2), nonretracted tear (n = 2), and complex tear (n = 1) contributed to the errors. Eight measurement errors occurred with partial-thickness tears. Difficulty distinguishing tendinopathy from partial-thickness tears (n = 3) and complex tears (n = 3) accounted for six errors. CONCLUSION: Although infrequent, detection errors were due to limitations inherent with the test or misses. Limitations inherent with the patient and misinterpretation of the findings were rare. Most measurement errors occurred in patients with large or massive cuff tears.

Arthroscopy↗

PubMed1992

Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging.

The purpose of this study was to describe MR findings in full-thickness tears of the rotator cuff. Of 102 shoulders examined by MR imaging, 31 were found to have a full-thickness tendon tear at arthroscopy/bursoscopy (five shoulders) or open surgery (26 shoulders). All shoulders were imaged in oblique coronal and axial planes. MR images of the 102 shoulders were evaluated for (1) the presence of fluid in the subacromial and subdeltoid bursae; (2) abnormal signal of the supraspinatus, subscapularis, infraspinatus, and teres minor tendons; (3) interruption of tendon continuity and thinning of the tendon; and (4) proximal retraction of the junction of the muscle and tendon. The presence or absence of each finding was determined by consensus of two radiologists, who interpreted the images without knowledge of the surgical findings. Results in those 31 shoulders with proved full-thickness tears were: fluid in the subacromial bursae (29 shoulders), interruption of tendinous continuity (22 shoulders), focally increased signal of the tendon equivalent to that of water (27 shoulders), and musculotendinous retraction (24 shoulders). The finding of subacromial fluid was a sensitive indicator (93%) of a full-thickness tear, and interruption of tendinous continuity was a specific finding (96%) in diagnosing a full-thickness tear. Our experience shows interruption of tendon continuity is the most specific MR finding of full-thickness rotator cuff tears, while subacromial fluid is the most common finding.

Arthroscopy↗

PubMed1982

Pyarthrosis simulating ruptured rotator cuff syndrome.

A 50-year-old black man was admitted with a diagnosis of a ruptured rotator cuff syndrome two weeks after an injury to the right shoulder and treatment by intra-articular steroid injection. At operation pus and necrotic debris were found in the shoulder joint, but the rotator cuff was anatomically intact. Surgical debridement, irrigation, and intravenous antibiotics resulted in good recovery with satisfactory function. The pyarthrosis apparently resulted from the preoperative intra-articular injection.

Acute Disease↗

PubMed1993

Magnetic resonance imaging of impingement and rotator cuff disorders. A surgical perspective.

In conclusion, the clinical picture of impingement syndrome is one of a continuum occurring as a result of compression of the bursa and rotator cuff within the subacromial space. In its early stages nonoperative management will often suffice, but in resistant cases and in cuff tears operative intervention is often indicated. The usefulness of MR imaging has greatly expanded for the orthopaedist diagnosing and treating the patient with impingement. After careful clinical evaluation and plain radiographs, MR imaging can significantly add to our knowledge as to the extent of the disease process. This added information can aid in tailoring an individualized treatment regimen and can be invaluable in the preoperative planning for patients with rotator cuff pathology.

Humans↗

PubMedDate not supplied

Isokinetic torque imbalances in the rotator cuff of the elite water polo player.

The specific repetitive activity of water polo, like baseball pitching, emphasizes adduction and internal rotation. This study used the Cybex II to evaluate the isokinetic strength of the rotator cuff in elite water polo players and in a group of control subjects. The water polo players were significantly stronger than the controls. Of greater importance was the confirmation of imbalances in the rotator cuff force couples of adduction/abduction and external/internal rotation. These changes are similar to those reported for pitchers. The adductors in the water polo group had gained in relative strength resulting in an increase in the adduction/abduction ratio to about 2:1. The internal rotators had gained in relative strength resulting in a decrease in the external/internal ratio to about 0.6:1. For both force couples the differences are more apparent at a slow speed. Side-to-side differences were not significant.

Biomechanical Phenomena↗

PubMed2002

Magnetic resonance imaging analysis of coracoid morphology and its relation to rotator cuff tears.

The purpose of this study was to define the magnetic resonance imaging (MRI) anatomy of the subcoracoid space and to determine its relation to rotator cuff tears. Routine clinical MRI sequences of 100 shoulders were reviewed, and standardized measurements of the subcoracoid space were taken and compared with previously published computed tomographic (CT) data. MRI and CT values were very similar. There were no significant differences between the coracoid morphology of patients with normal findings and patients with varying degrees of rotator cuff disease involving the supraspinatus tendon. The excellent agreement between MRI and CT measurements indicates that different investigators may use either imaging modality to obtain reproducible results. The role of coracoid anatomy in the development of lesions of the subscapularis tendon and the long head of the biceps remains to be defined.

Adult↗

PubMed2004

Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality?

BACKGROUND: Different metal and biodegradable suture anchors are available for rotator cuff repair. Poor bone quality may result in anchor loosening and tendon rerupture. HYPOTHESES: Higher bone mineral density is associated with higher pull-out strength of suture anchors. Depending on anchor placement, pull-out strengths of anchors are different within the greater tuberosity. STUDY DESIGN: Cadaveric biomechanical study. METHODS: Trabecular and cortical bone mineral densities were determined for different regions within the greater tuberosity. Metal screw-type and biodegradable hook-type anchors were cyclically loaded. RESULTS: Mean failure load of metal and biodegradable anchors was 273 N and 162 N, respectively, for the proximal part (P < .01) and 184 N and 112 N, respectively, for the distal part (P < .01). Both types of anchors showed higher failure loads in the proximal-anterior and -middle parts of the greater tuberosity than in the distal part (P < .01). A significant positive correlation was found between cortical bone mineral density and failure load of metal anchors (P < .01). CONCLUSION: Bone quality, anchor type, and anchor placement have a significant impact on anchor failure loads. CLINICAL RELEVANCE: Suture anchors should be placed in the proximal-anterior and -middle parts of the greater tuberosity. In the distal parts, biodegradable hook-like anchors should be used with caution.

Aged↗

PubMed1990

[Comparative arthrographic and echographic study of degenerative lesions of the rotator cuff of the shoulder].

Sonography is a simple technique which is currently employed in the study of rotator cuff lesions in the shoulder. A comparative US and arthrographic study was carried out on 52 patients with a "painful shoulder", to evaluate US yield in this pathologic condition. Arthrography was positive for a rotator cuff lesion in 31/52 cases (25 full-thickness and 6 incomplete lesions) and demonstrated associated conditions (capsulitis, chondral lesions, lesions of the long head of biceps, capsulo-ligamentous hypotonia, effusions) in 11 case. Arthrographic findings were negative in 10 cases. US demonstrated a lesion in 25/31 of positive arthrographic cases, and it was negative in 3/6 incomplete lesions. In 7/11 patients US yielded additional information as to associated conditions. US false-positives were 3/10, while in the extant 7/10 cases US was negative too. Thanks to its high sensitivity and specificity (80% and 70%, respectively, in our series), US appears as a valuable diagnostic complement to arthrography; the former may even replace the latter in those cases where conservative treatment is expected.

Adolescent↗

PubMedDate not supplied

Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings.

Our purpose was to compare the accuracy of ultrasonography (US) and magnetic resonance (MR) in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings. Using US and MR, we studied all painful shoulders seen during 1998 in our orthopaedic unit. Diagnosis was confirmed in 61 cases. The diagnosis of full thickness rotator cuff tear was highly specific on both imaging techniques (100% for US and 97.1% for MR) but was not as sensitive on US (57.7%) as on MR (80.8%). The diagnosis of partial tear was acceptably specific (67.9% for US and 75.5% for MR) but was not sensitive (overall, 12.5% for US vs 50% for MR). The specificity of a US diagnosis of a tear allows us to recommend surgery, thus making it a good imaging technique for the initial study of painful shoulders. The low sensitivity makes it necessary to undertake an additional MR study. If the MR also discovers no pathology, the sensitivity based on the US and MR images (92.7%) can be sufficient to avoid a false-negative diagnosis.

Arthroscopy↗

PubMed2004

Return to play for rotator cuff injuries and superior labrum anterior posterior (SLAP) lesions.

The shoulder is a frequently injured joint in athletes, and the most common injuries in active patients include instability, rotator cuff injuries, and superior labrum lesions. These three types of injuries often involve different mechanisms of injury, variable methods of surgical repair, and different considerations in rehabilitation and return to play. This article focuses upon rotator cuff injuries and superior labrum lesions, treated nonoperatively and operatively. Return to play with these injuries depends upon many factors including upon the age of the patient, the severity of the pathology,the type of treatment rendered, and the expectations of the patient.

Athletic Injuries↗

PubMedDate not supplied

Mini-incision rotator cuff repair: a longitudinal assessment with no deterioration of result up to nine years.

The reported short- and intermediate-term results of mini-incision rotator cuff repair have been satisfactory. This study was carried out to assess whether these results are sustained in the long term. Seventy-nine consecutive mini-incision cuff repairs were initially reviewed and the results analyzed at a mean of 2 years after surgery by use of a subjective self-scoring system in which patients scored pain, function, active forward flexion, and strength, as well as patient satisfaction. Subsequently, 74 of the initial 79 patients were available for the second review at a mean of 7 years (range, 5-9 years). At 2 years, there were 74% good to excellent results, which improved to 84% at 7 years. Six patients had a poor result at 2 years, compared with 5 patients at 7 years. Within this group of 5 with a poor result, there were 4 who had subsequent trauma and markedly deteriorated to score as poor. Sixty-five percent of the compensation group had good to excellent results at a mean of 7 years compared with ninety percent of the non-compensation group. The manual workers within the workers' compensation subgroup did worse than the sedentary workers at 2 years; however, at the 7-year review, this difference was statistically no longer apparent. This study found that, in the absence of reinjury, there is no deterioration in the results of mini-incision cuff repair in up to 9 years' follow-up.

Adult↗

PubMedDate not supplied

Tears of the rotator cuff associated with neurologic disorders: a description of two cases.

Based on their clinical experience with the two cases described, the authors analyze the association between surgically treatable tear of the rotator cuff and neurologic pathology. A semeiologic sign is emphasized, which may be of help in differential diagnosis involving isolated lesion of the rotator cuff. Furthermore, after a review of the literature, the authors express doubts as to the type of surgical treatment to be carried out.

Aged↗

PubMed2005

Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases.

PURPOSE: This study was performed to review and compare the outcome of a consecutive series of 96 rotator cuff repairs performed with an open versus arthroscopic technique. The arthroscopic repairs include the beginning of the learning curve. TYPE OF STUDY: Case series. METHODS: In a 24-month period from 1999 to 2001, 95 patients underwent a cuff repair with bony reattachment by 1 surgeon; 4 patients had surgery on both shoulders. We present subjective outcome data from 96 of 99 operated shoulders by the use of a visual analog scale (VAS), the Simple Shoulder Test (SST), and the question of overall patient satisfaction. Thirty shoulders undergoing surgery before February 2000 had open cuff repair (12 classic open, 18 mini-open) and 66 shoulders undergoing surgery after February 2000 had an arthroscopic cuff repair with suture anchors. All but 3 shoulders had the supraspinatus/infraspinatus tendon refixed, 32% had a subscapularis reattachment, and 21% an additional SLAP repair. RESULTS: Groups A (30 shoulders, open repair) and B (66 shoulders, arthroscopic repair) were comparable concerning tear size, cause of the tear, professional shoulder strain, and preoperative pain intensity. At follow-up evaluation (15-40 months after surgery), group B had significantly better pain relief on the VAS (P < .05), more yes answers in the SST (9.7 vs. 8.7, not significant), and a higher patient satisfaction rate of 92.4% versus 80% (not significant). From the 12 questions of the SST, all but 1 showed a higher percentage of yes answers in group B; for 3 questions concerning mobility the difference was significant (P < .07). There was no correlation between tear size and outcome in the SST. CONCLUSIONS: Arthroscopic cuff repair yielded equal or better results than open repair, even at the beginning of the learning curve. Patients with an arthroscopic repair had a significantly better decrease in pain and a better functional result concerning mobility. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might even benefit more than small ones. LEVEL OF EVIDENCE: Level IV.

Adolescent↗

PubMedDate not supplied

Latissimus dorsi tendon transfer for massive rotator cuff tears: a cadaveric study.

Certain massive defects of the rotator cuff tendinous insertion cannot be repaired primarily to the greater tuberosity. If restoration of strength is an important treatment goal to the patient, then a tendon transfer may be considered. Ten cadaver shoulders were dissected to define the anatomy of the latissimus dorsi tendon (LDT) and its distance relationship to the axillary and radial nerves with the arm in various positions. The axillary nerve lies superior to the LDT insertion, and the radial nerve passes medial and inferior to the LDT insertion. With the arm internally rotated and the shoulder flexed, the distances from the axillary and radial nerves to the LDT insertion were 2.3 cm and 2.8 cm, respectively. With the arm internally rotated and the shoulder abducted, the distances from the axillary and radial nerves to the LDT insertion were 1.8 cm and 2.0 cm, respectively. Understanding specific anatomic relationships is one of the factors contributing to the safety of the LDT transfer procedure with respect to nerve injury.

Adult↗

PubMed1997

The rotator cuff. Commentary.

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Adult↗

PubMedDate not supplied

Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries.

In the examination and rehabilitation of patients with shoulder injuries it is necessary to isolate the individual rotator cuff muscles as much as possible. We subscribe to the belief that, independent of the deltoid, the rotator cuff muscles can become fatigued, injured, or atrophied individually, Accordingly, we feel that these muscles must be considered separately during examination and rehabilitation. This paper describes methods and positions to isolate the cuff and, thus, enable the examiner to be more precise in diagnosis and treatment. In addition, individual exercises for each component are described.

Athletic Injuries↗

PubMedDate not supplied

Experimental study on rotator cuff repair.

It was the purpose of the experimental study to use laboratory experience to verify the effectiveness of different methods used to repair the rotator cuff. The sheep was used as an animal model because its infraspinous tendon is the most similar to that in the human. Three static trials were conducted using Instron machines, comparing the repair systems used most by the same authors in their clinical work, the hold of the suturing wires with two different threading procedures in the bone tunnels and two types of knotting, and the breakage loading of the suturing wires in the two different miniplate systems. The authors conclude that tendinous anchoring must be entrusted to reinforced suturing systems (modified SCOI and Mason Allen), the threading of wires in pairs in a single bone tunnel makes surgery easier and shortens the amount of time required, with threading of wires similar to or better than threading with a single wire. There are no differences in breakage loading of the wire at the level of the holes in the two miniplates considered in this study.

Animals↗