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Results for “Rotator Cuff”

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At least 1,099 records · Page 61Linked to original sources

PubMed2000

[Arthrography, ultrasound and MRI in rotator cuff lesions: a comparison of methods in partial lesions and small complete ruptures].

PURPOSE: To evaluate the accuracy of arthrography, ultrasound and MR imaging in rotator cuff disease. METHODS: 40 patients suffering from subacromial impingement syndrome for at least three months and who were selected for surgery, underwent ultrasound, double-contrast arthrography and MR imaging. Patient preselection focused on partial and small complete tears. RESULTS: 13/26 surgically confirmed tears were partial tears (articular surface: 10, bursal surface: 2, intra-substance tearing: 1). Arthrography, ultrasound and MR imaging yield a sensitivity for complete tears of 91%, 69% and 92% with a specificity of 100%, 93% and 93%. For partial tears sensitivity was 50%, 69% and 69% with a specificity of 100%, 79% and 86%. Concerning evaluation of localisation, extent and correct classification ultrasound was correct in 17/26 cases, MR in 21/26 cases. CONCLUSION: Arthrography is not helpful in detecting partial tears. Ultrasound and MR imaging yield comparable accuracy. MR imaging has advantages concerning better evaluation of extent, location and classification as well as for the detection of associated pathologies.

Arthrography↗

PubMedDate not supplied

Effects of methylprednisolone and betamethasone injections on the rotator cuff: an experimental study in rats.

Thirty-one female Sprague-Dawley rats were used to determine the effects of subacromial corticosteroid injections on the rotator cuff. The injection technique was tested in 6 animals, which were excluded from the study. The remaining 25 rats were randomly divided into three groups of 8 animals each; a single rat received no injections. Every other week for 8 weeks, one shoulder in each rat was injected with methylprednisolone, betamethasone, or saline in a dosage equivalent to that used in humans. The supraspinatus and infraspinatus tendons were removed 10 days after the last injection and evaluated. There were no pathologic changes in the tendons injected with saline. In 43% of the methylprednisolone-treated rats and 29% of the betamethasone-treated rats, the tendons were abnormally soft and light-colored. In 43% of the methylprednisolone group and 71% of the betamethasone group, fragmentation of collagen bundles and inflammatory cell infiltration were evident. Subacromial injections of methylprednisolone or betamethasone repeated frequently can cause deleterious changes in the normal structure of the rat rotator cuff. In light of these findings, therapy for subacromial impingement syndrome of the shoulder with frequent, repeated steroid injections is potentially harmful.

Analysis of Variance↗

PubMed1989

[Degenerative lesions of the rotator cuff of the shoulder. Current status of the surgical treatment].

With age there is a progressive deterioration in the capsulo-tendinous cuff of the shoulder: When rotator cuff lesions are limited (in general to the supra-spinatus), the cuff remains continent and functional, thereby ensuring good centering of the humeral head. At this stage antero-superior arthrolysis may be indicated for cases of failure of conservative treatment. When there is a large degree of capsulo-tendinous perforation (affecting posteriorly the supra-spinatus), the cuff no longer ensures centering of the humeral head and friction with the lip of the acromion progresses until an eccentric arthrosis of the shoulder develops. The surgical treatment of choice is then a deltoid flap procedure which fills in the loss of substance in the cuff and centers the humeral head. The course of eccentric arthrosis of the shoulder itself involves three stages: --stage I: limited to acromio-humeral friction where a deltoid flap is indicated as treatment; --stage II: extension or arthrosis to the gleno-humeral level, but without formation of a neoglenoid, where an unrestricted gleno-humeral prosthesis, centered by a combined flap procedure, is in our opinion the best surgical solution; --stage III: where the formation of an eccentric supero-medial neoglenoid produces very unpredictable functional results after arthroplastic procedures.

Adult↗

PubMed2006

A surgical tip for shoulder hemiarthroplasty in a patient with a deficient rotator cuff.

The deltopectoral approach has long been the workhorse for exposure of the shoulder. However, this exposure involves dividing the subscapularis tendon. Despite meticulous repair, suboptimal return of subscapularis may further reduce a patient's functional capacity with an already deficient rotator cuff. This report describes an alternative approach for shoulder hemiarthroplasty, preserving subscapularis, in a patient with a deficient rotator cuff.

Arthritis↗

PubMedDate not supplied

Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters.

Preoperative knowledge of full-thickness rotator cuff tear size is important in counseling patients because tear size affects the choice of surgical techniques and the functional outcome of surgery. Twenty-six shoulders of twenty-five consecutive patients were included in a prospective study that compared the preoperative accuracy of magnetic resonance arthrography and ultrasonography for tear size in millimeters with intraoperative findings. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonance arthrographic data for the width of tears. Adoption of a "curved line measurement" for ultrasonographic evaluation of large tears eliminated the tendency of ultrasonography to underestimate tears greater than or equal to 35 mm in width. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonancearthrographic data for retraction of tears. However, a limitation of ultrasonography to evaluate retractions of more than 30 mm was found. Therefore, ultrasound is of equal value for tears less than 30 mm, but magnetic resonance arthrography is more accurate for tears greater than 30 mm.

Adult↗

PubMed1997

MR imaging of shoulder impingement and rotator cuff disease.

A number of imaging modalities, such as conventional radiography, arthrography, ultrasonography, and MR imaging, can be used in the evaluation of shoulder pain related to impingement, tendinosis, and rotator cuff tear. Of these techniques, only MR imaging provides anatomic information coupled with superior soft-tissue contrast. MR imaging of the shoulder effectively demonstrates a variety of morphologic abnormalities that may be associated with tendon degeneration. Rotator cuff tears are also well depicted and may be further characterized with regard to tendon involvement, degree of retraction, and secondary muscular atrophy.

Humans↗

PubMed2003

Practical assessment of rotator cuff muscle volumes using shoulder MRI.

Reliable quantitative assessment of rotator cuff (RC) muscle volumes can be done by reconstructing multiple MRI images of the entire shoulder. However, an equally reliable, but less time-consuming, method is needed for clinical practice. We compared the only method reported for estimation of volume with a new simple MRI technique. Both methods were validated by multiple MRI image reconstruction. We performed MRI scans of 10 cadaver shoulders and determined the cross-sectional areas of RC muscles with two methods, using image analyzing software. In Method 1, the cross-sections were determined on a single image, previously described as a Y-shaped image. In Method 2, the cross-sections were calculated from two images: the Y-shaped and an image located medially, twice the distance from the glenoid articular surface compared to the Y-shaped image. We compared the results of these two methods with the volume of multiple MRI image reconstruction, which took into account all images consisting of RC cross-sections. Pearson correlations for Method 1 were 0.96, 0.94 and 0.75, and for Method 2, 0.96, 0.97 and 0.93 for the supraspinatus, infraspinatus/teres minor and subscapularis muscle volumes when compared with the volumes determined by the multiple image reconstruction method. The Bland-Altman method showed better agreement with multiple MRI image reconstruction, using Method 2, to determine supraspinatus, infraspinatus, and subscapularis muscle volumes (p < 0.001 for each). The mean intra- and inter-observer variabilities of Method 1 was 3.9% and 2.9% and that of Method 2, 3.0% and 1.7%, respectively. Both methods can be used for quantitative assessment of RC muscle volumes. However, Method 2, using two easily reproducible MRI images is more accurate for the evaluation of the supraspinatus and infraspinatus/teres minor muscles and particularly for the subscapularis muscle.

Aged↗

PubMed2004

Work above shoulder level and degenerative alterations of the rotator cuff tendons: a magnetic resonance imaging study.

OBJECTIVE: To determine whether work performed with the arms in a highly elevated position is associated with alterations in the rotator cuff tendons as assessed by magnetic resonance imaging (MRI). METHODS: A cross-sectional study was performed in a historical cohort of male machinists, car mechanics, and house painters. The participants were right-handed, ages 40-50 years, and had been employed in their trades for not less than 10 years. Seventy-one percent of invited subjects participated (136 of 192). Lifetime upper arm elevation was assessed by direct measurements combined with individual work histories obtained by questionnaire and from registry data. Supraspinatus tendinopathy was evidenced by MRI signal intensity changes and morphologic alterations. Infraspinatus and subscapularis tendinopathy were also assessed. Additional outcomes were acromioclavicular joint degeneration and humeral head cysts. The MRI findings were evaluated by radiologists who were blinded to exposure status and symptoms. RESULTS: An exposure-response relationship was found between lifetime upper arm elevation and supraspinatus tendinopathy, with an age-adjusted odds ratio of 1.27 (95% confidence interval 1.02-1.60) for a 5-month increase in the total number of full-time working months spent with the arm elevated >90 degrees . CONCLUSION: Work with the arms in a highly elevated position is associated with MRI-diagnosed alterations in the supraspinatus tendon. By demonstrating the first part of a possible biologic pathway, the study corroborates the work-relatedness of rotator cuff disorders.

Adult↗

PubMedDate not supplied

Increasing the insertion depth of suture anchors for rotator cuff repair does not improve biomechanical stability.

The purpose of this study was to evaluate whether deeper-than-recommended insertion of a suture anchor within the rotator cuff footprint of human cadaveric humeri affects fixation characteristics. Metallic 5-mm screw-in anchors loaded with a single No. 2 suture were placed in the infraspinatus footprint of 8 human cadaveric humeri at standard and deep depths. Specimens were cyclically loaded from 10 to 45 N for 500 cycles and then loaded to failure. Cylic displacement, failure load, and failure mode were compared. All deep anchors became flush within a few cycles, and both anchor depths displaced and rotated at the bone surface. Displacement of the deep anchors was significantly greater than that of standard anchors. There was no difference in failure load. Cyclic testing showed significant displacement, regardless of anchor position, possibly leading to gap formation of the repair. Deep placement of suture anchors for increased purchase caused greater displacement and is not recommended.

Aged↗

PubMedDate not supplied

Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site.

There is a high rate of recurrent and residual tears after rotator cuff repair surgery. Recent cadaveric studies have provided surgeons with new knowledge about the anatomy of the supraspinatus tendon insertion. Traditional repair techniques fail to reproduce the area of the supraspinatus insertion, or footprint, on the greater tuberosity anatomically. Double-row suture anchor (DRSA) fixation is a new technique that has been developed to restore the supraspinatus footprint better. In this study, 3-dimensional mapping was used to determine the area of the footprint recreated with 3 different repair methods: a transosseous simple suture technique, fixation with a single row of suture anchors, and DRSA fixation. The DRSA fixation technique consistently reproduced 100% of the original supraspinatus footprint, whereas the single-row suture anchor fixation and transosseous simple suture techniques reproduced only 46% and 71% of the insertion site, respectively. Therefore, the footprint area of the DRSA fixation technique was significantly larger (P < .05) than that of the other 2 techniques. Furthermore, double-row fixation may provide a tendon-bone interface better suited for biologic healing and restoring normal anatomy.

Aged↗

PubMedDate not supplied

Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report.

Forty-three athletes under age 40, more than half of which were collegiate or professional, with partial rotator cuff tears were treated arthroscopically and observed for a minimum of 24 months. By history and mechanism of injury, two main groups were identified. Group A had 14 patients with acute, traumatic injuries. All 14 had inflamed subacromial bursas, but increased glenohumeral translation and labral lesions were uncommon. Twelve patients (86%) had satisfactory postoperative results and nine (64%) returned to preinjury sports after arthroscopic subacromial decompression and tear debridement. Group B had 29 overhead athletes with insidious, atraumatic shoulder pain. They were not as successful with debridement (19 [66%] satisfactory and 13 [45%] return to preinjury sports). Within Group B, three subgroups were identified based on the examination under anesthesia and subacromial inflammation. Group B1 (8 patients) had normal-appearing subacromial spaces and often increased anterior glenohumeral translation with posterior labral tears. These patients did poorly after arthroscopic tear debridement (3 [38%] satisfactory and 2 [25%] return to sports). Group B2 (12 patients) had inflamed subacromial bursas and increased glenohumeral translation. This group had marginal results with debridement (7 [58%] satisfactory and 6 [50%] return to sports). Group B3 (9 patients) with subacromial inflammation, yet without increased glenohumeral translation, had excellent pain relief (100%) but less than half (4) returned to preinjury sports.

Adult↗

PubMedDate not supplied

The effects of overuse combined with intrinsic or extrinsic alterations in an animal model of rotator cuff tendinosis.

An in vivo animal model was used to evaluate overuse and overuse plus intrinsic tendon injury or extrinsic tendon compression in the development of rotator cuff injury. Forty-four male Sprague-Dawley rats were divided into groups of 22. Each left shoulder received an intrinsic or extrinsic injury plus overuse (treadmill running), and each right shoulder received only overuse. Eleven rats from each group were sacrificed at 4 and 8 weeks. Supraspinatus tendons were evaluated histologically or geometrically and biomechanically. Ten rats constituted a cage-activity control group. Both supraspinatus tendons of the experimental groups had increases in cellularity and collagen disorganization and changes in cell shape compared with control tendons. Tendons with injury plus overuse exhibited a worse histologic grade than those with overuse alone. The cross-sectional area of both supraspinatus tendons of the experimental rats was significantly more than in control tendons. The area of the injury plus overuse tendons was increased on average compared with overuse-alone tendons. Biomechanically, the tissue moduli of overuse/intrinsic injury tendons at 4 weeks and those of the overuse/extrinsic injury tendons at 8 weeks were significantly lower than in control tendons. Tissue moduli of the overuse/injury tendons were significantly lower than in the overuse-alone tendons at 8 weeks. This study demonstrated that damage to the supraspinatus tendon can be caused by overuse and intrinsic injury, overuse and extrinsic compression, and overuse alone.

Animals↗

PubMed1988

Rotator cuff tears: correlation of sonographic and surgical findings.

High-resolution, real-time sonography of the rotator cuff was performed in 51 shoulders, and the results were correlated with findings obtained during subsequent surgery. Prospective sensitivity of sonography in detection of a tear was 100%; specificity, 75%; and accuracy, 92%. Retrospective estimation of tear size on sonograms correlated well with the intraoperative measurements for small and moderate lesions. Large lesions were often underestimated sonographically. Retrospectively, partial tears were correctly diagnosed in seven patients, and bursal thickening was recognized in 17 patients. Sonography of the shoulder proved to be an accurate, noninvasive method for the diagnosis of complete rotator cuff tears. It is useful for estimating tear size and location and may be useful in recognizing partial tears.

Adult↗

PubMed2006

Normal MR imaging anatomy of the rotator cuff tendons, glenoid fossa, labrum, and ligaments of the shoulder.

The shoulder is commonly imaged using MR imaging, with or without intraarticular contrast medium. Some anatomic structures, such as the rotator cuff tendons and bony components, can be assessed without arthrographic technique, whereas the glenohumeral ligaments and labrum require arthrographic technique for more accurate assessment. In either case, an understanding of the normal anatomy of the shoulder with regard to bony and soft tissue structures is essential for MR imaging interpretation. In this article we discuss normal anatomy and variations of the glenohumeral joint(bone and soft tissues), rotator cuff tendons, and coracoacromial arch.

Humans↗

PubMedDate not supplied

Arthroscopic "interval slide" in the repair of large rotator cuff tears.

An arthroscopic technique for coracohumeral ligament release from a retracted supraspinatus tendon is presented. The procedure is technically simple and can greatly improve the mobility of retracted rotator cuff tears, thus expanding the application of arthroscopic repair to larger tears.

Aged↗

PubMed1993

Anterior dislocation of the shoulder and rotator cuff rupture.

Thirty-seven patients older than 40 years of age were seen after sustaining primary anterior dislocations of the shoulder. An associated rupture of the rotator cuff in each patient had been missed, often being mistaken for an axillary neuropathy. Eleven of these patients developed recurrent anterior instability that was due to rupture of the subscapularis and anterior capsule from the lesser tuberosity. In no patient was there a Bankart lesion. Repair of the capsule and subscapularis restored stability in all of the patients with recurrence.

Adult↗

PubMed2005

Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis.

OBJECTIVES: To investigate the test-retest reliability of the following clinical diagnostic characteristics of myofascial trigger points: taut band, spot tenderness, jump sign, pain recognition, referred pain and local twitch responses (LTRs). DESIGN: Test-retest reliability study. SETTING: This study was undertaken in an outpatient physiotherapy department. SUBJECTS: Fifty-eight patients (31 males and 27 females) with rotator cuff tendonitis were recruited into this study. INTERVENTION: Rotator cuff muscles were assessed by an expert for the presence or absence of the main clinical diagnostic characteristics of trigger point assessment. The process was then repeated three days later by the same expert. MAIN MEASURES: Outcomes included the presence or absence of: a taut band, spot tenderness, jump sign, pain recognition, referred pain and LTRs. RESULTS: Kappa values between testing situations for the taut band, spot tenderness, jump sign and pain recognition were 1. Kappa scores for referred pain ranged between 0.79 and 0.88 and for the local twitch response between 0.75 and 1 depending on the muscles under investigation. CONCLUSIONS: The presence or absence of the taut band, spot tenderness, jump sign and pain recognition was highly reliable between sessions. Referred pain and local twitch response reliability varied depending on the muscle being studied.

Adult↗

PubMed1986

Surgical treatment of tears of the rotator cuff in athletes.

Forty-five athletes with either a partial or a complete tear of the rotator cuff were treated with anterior acromioplasty and repair of the tear. The minimum duration of follow-up was twenty-four months (average, forty-two months). Thirty patients had an incomplete tear and fifteen had a complete tear. Postoperatively, thirty-nine (87 per cent) of the patients stated that they were improved compared with their preoperative status, although only thirty-four patients (76 per cent) felt that they had a significant reduction of pain postoperatively. Objectively, twenty-five (56 per cent) of the patients were rated as having a good result, which allowed them to return to their former competitive level without significant pain. Twelve (41 per cent) of the twenty-nine athletes who had been involved in pitching and throwing returned to their former competitive status. Seven (32 per cent) of the twenty-two pitchers and throwers who had been active at a professional or collegiate level returned to the same competitive level. In our experience, a repair of the rotator cuff combined with an acromioplasty in a young athletic population provides satisfactory relief of pain but does not guarantee that the patient will be able to return to his or her former competitive status in all sports.

Acromion↗