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PubMed1987

[Ultrasonics of the shoulder. Diagnostic possibilities in lesions of the rotator cuff].

Twenty five healthy people and 25 patients with shoulder pain underwent US control over a 12-month period: 24 patients with shoulder pain had rotator cuff and/or biceps tendon lesions. The US findings on rotator cuff and biceps tendon lesions are compared with those of arthrography and/or surgery (96% sensitivity). US is rapid, safe, non invasive, inexpensive and often more accurate, and its use is recommended for the routine examination of the shoulder joint instead of arthrography.

Adolescent↗
PubMed2002

Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured.

The objective of this study was to determine the effectiveness of augmentation with a Gore-Tex patch in reconstruction of rotator cuff tears that cannot be repaired by direct suture. Twenty-eight shoulders of 27 patients underwent this procedure. The average age at surgery was 62 years, the average duration of symptoms before surgery was 16 months, and the average follow-up period was 44 months. The shoulders were classified into two groups according to patch size (anteroposterior dimension up to 2 cm or greater than 2 cm). The clinical outcome was evaluated by using the shoulder surgery classification system issued by the Japanese Orthopaedic Association (JOA score), and the postoperative isometric abduction strength at 90 degrees of abduction was assessed by the method of Constant. The average total JOA score improved from 57.7 to 88.7 points, a statistically significant change. There was no difference in the improvement in score between shoulders treated with small patches (12 shoulders) and those treated with large patches (16 shoulders). The average abduction strength was 6.2 kg in the small-patch group and 1.5 kg in the large-patch group, with a statistically significant difference between the two groups. Good clinical results, especially pain relief, could be achieved with this procedure in both the small- and the large-patch groups, but good abduction strength was obtained only in the small-patch group. The mechanism of the improvement by this procedure is still controversial.

Adult↗
PubMed1996

Tissue fixation security in transosseous rotator cuff repairs: a mechanical comparison of simple versus mattress sutures.

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.

Biomechanical Phenomena↗
PubMed1992

Thermography of frozen shoulder and rotator cuff tendinitis.

The role of thermography in the diagnosis of soft tissue lesions of the shoulder was evaluated by screening 28 patients with unilateral frozen shoulder and 86 patients with unilateral rotator cuff lesions. Index shoulders were then compared with the normal side. Differences in skin temperature distribution were found in 82% of subjects with frozen shoulder, nearly three-quarters of whom had reduced skin temperature. There was no consistent pattern of shoulder skin temperature found in rotator cuff tendinitis patients (49% normal, 28% reduced, 23% increased). Thermography can be helpful in the diagnosis of frozen shoulder but further studies are required to determine whether it is useful in other soft tissue shoulder lesions.

Adult↗
PubMedDate not supplied

Primary fixation strength of rotator cuff repair techniques: a comparative study.

PURPOSE: The goal of the study was to compare the primary fixation strength of transosseous suture, suture anchor, and hybrid repair techniques for rotator cuff repair. TYPE OF STUDY: Animal model experiment. METHODS: Thirty-two sheep shoulders were divided into 4 homogeneous groups, according to bone density and tendon dimensions. Infraspinatus tendons were transected from their insertions and reattached using 4 different techniques. Group 1 was repaired with a single Mason-Allen stitch and 2 transosseous tunnels for each end of the suture, knotted on the lateral cortex of proximal humerus; group 2 was repaired with double Mason-Allen stitches and 2 transosseous tunnels; group 3 was repaired with 2 Corkscrews (Arthrex, Germany); and group 4 was repaired with 2 Corkscrews combined with a single Mason-Allen transosseous suture. All specimens were tested for their fixation strengths with a material testing system. RESULTS: The mode of failure in group 1 was mainly suture breakage. In groups 3 and 4, the tendons pulled out from the sutures. In group 2, sutures broke the bony bridge between the 2 tunnels. The mean load to failure value was 160.31 +/- 34.59 N in group 1, 199.36 +/- 11.73 N in group 2, 108.32 +/- 15.98 N in group 3, and 214.24 +/- 28.52 N in group 4. Anchor fixation was significantly weaker compared with other groups (P <.001). Combination of a transosseous suture and anchor fixation (group 4) was significantly stronger than the single transosseous suture (group 1) and double anchor techniques (group 3) (P <.001). CONCLUSIONS: Hybrid technique was the strongest among the tested rotator cuff repair techniques. With the addition of one transosseous suture to two anchors, the strength of the repair could be doubled.

Animals↗
PubMed1997

Rotator cuff impingement. Pathogenesis, MR imaging characteristics, and early dynamic MR results.

Shoulder impingement can be diagnosed based on clinical findings, but clinical staging of its severity, which may range from reversible edema and hemorrhage to a complete rotator cuff tear, is often not possible. MR imaging allows direct examination of the thickness, signal characteristics, and continuity of the rotator cuff. Furthermore, MR imaging can be used not only to determine the status of the cuff, but also to detect pathology involving surrounding structures and to identify anatomic variations that may contribute to the impingement. Rapid MR imaging during active unguided shoulder motion will likely further increase our understanding of the biomechanics of the shoulder at different stages of impingement, and may shed further light on the pathogenesis of this disorder.

Adult↗
PubMedDate not supplied

Transplant of the teres major in the treatment of irreparable injuries of the rotator cuff (long-term analysis of results).

Purpose of this study is to evaluate the effectiveness of muscle transfer of the teres major in the treatment of irreparable posterosuperior injuries of the rotator cuff. Long-term monitoring of the results obtained in 20 patients treated at our clinic using this method are reported, comparing the data obtained in evaluations of results with preoperative values. Clinical evaluations were obtained using the Constant Score System, while X-ray examination showed the presence of osteoarticular modifications, and MRI and electromyography the preserved morphology and function of transplant. The mean Constant Score increased from 31.6 points preoperatively to 66.1 points postoperatively at the time of follow-up. At follow-up, MRI allowed us to evaluate any fatty degeneration of the muscle fibers of transfer and the integrity of tendinous insertion on the humeral greater tuberosity. The obtained results allowed us to reveal the advantages and the disadvantages of teres major transplant in irreparable posterosuperior ruptures of the cuff.

Adult↗
PubMedDate not supplied

[Outcome of endoscopic subacromial decompression operation in tendinitis and partial rupture of the rotator cuff].

AIM OF THE STUDY: The series of this article compares 148 patients with chronic tendinitis (group I) and 28 patients with significant partial-thickness tears (group II) of the rotator cuff managed with arthroscopic debridement and acromioplasty. METHODS: All patients were evaluated by an independent observer with a mean follow-up of 26.5 (12-51) respectively 23.4 (12-50) months using the Constant-score, the ASES-score and a visual analog scale. The mean age in group I was 48.5 (25.4-71) and in group II 56.1 (33.2-80.6) years. RESULTS: In group I 127 patients (86%) and in group II 17 patients (62%) were satisfied at latest follow-up (p < 0.05). Concerning the exclusively subjective ASES-score with a maximum of 100 points group I had an average of 78.8 and group II of 61.6 points (p = 0.0019). According to the criteria of Constant group I scored with a mean of 81 points for the operated shoulder and 91.6 points for the non-operated side and group II with either 65.2 points and 89.9 points (p = 0.0036). CLINICAL RELEVANCE: Recognizing these results a thorough activity-related preoperative discussion with the patient about the treatment options for significant partial-thickness cuff ruptures should be performed.

Acromioclavicular Joint↗
PubMedDate not supplied

Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears.

We attempted to assess the accuracy of magnetic resonance imaging (MRI) in determining the size of recurrent cuff tears in correlation with size measured at surgery. Thirty-seven shoulders in 33 patients who had reoperation for a presumed failed rotator cuff repair were retrospectively evaluated. All patients had preoperative MRI, the results of which were read by a musculoskeletal radiologist to determine the presence of a tear and to estimate its size. All tears were measured intraoperatively in sagittal and coronal planes. Thirty-three shoulders had recurrent tears of the rotator cuff, and MRI correctly identified the presence of 30 of them. MRI correctly identified only 1 of the 4 patients without a recurrent tear of the cuff. The correlation coefficient for MRI accurately defining the size of cuff tears was 0.46. The sensitivity of MRI for the diagnosis of retear was 91%, and the specificity was 25%. MRI is accurate in diagnosing a recurrent full-thickness cuff tear in postsurgical shoulders. However, it is relatively inaccurate in correctly defining the size of the tear. MRI also has a tendency to overdiagnose cuff tears in postsurgical patients with continued pain and symptoms.

Humans↗
PubMed1986

Factors influencing the operative results of rotator cuff rupture.

This paper reports the conclusions from a clinical, radiological and mathematical analysis of 126 patients with rotator cuff ruptures who were treated by operation. There were 83 men and 43 women. The mean age was 53.4 years and the average follow-up period was 3.5 years. According to a new method of scoring, an acceptable result was achieved in 78% of cases (excellent in 29%, good in 23%, and fair in 26%). The chi-square and the two tailed t-tests indicated that the following preoperative or operative variables influenced the results significantly: time away from work before operation (p less than 0.001); operative delay (p less than 0.001); the number of operations on the rotator cuff (p less than 0.001); atrophy of the spinati muscles (p less than 0.001); degenerative changes of the greater tuberosity (p less than 0.001); the heaviness of the patient's work (p less than 0.005); the extent of the resection of the acromion (p less than 0.005) and indication for operation (pain, lack of motion or both) (p less than 0.025). According to regression and covariance analyses, these factors independently influenced the final outcome. The following variables did not significantly predict or influence the operative result: age of the patient; sex; conjoined lesions; the size of the rupture; the site of the rupture or detachment of the deltoid.

Disability Evaluation↗
PubMed1991

Surgical management of complex irreparable rotator cuff deficiency.

The authors surgically treated 23 shoulders in 23 patients with disabling pain associated with irreparable tears of the musculotendinous cuff. In a total of 12 shoulders with preserved passive motion, normal deltoid function, loss of glenohumeral joint surfaces, and sculpturing of the coracoacromial arch, a standard or oversized Neer II humeral prosthesis without glenoid replacement was selected. A total of 11 shoulders that failed to meet these prerequisites or demanded heavy use after operation underwent arthrodesis. Twenty-two patients (12 from the hemiarthroplasty group and 10 from the arthrodesis group) were available for evaluation at an average follow-up period of 37.5 months. Comfort level and overall function were improved in both groups. Active forward elevation improved an average of 44 degrees in the hemiarthroplasty group and an average of 15 degrees in the arthrodesis group. The success of hemiarthroplasty and the problems of glenoid loosening in the presence of cuff deficiency with upward head displacement have led to the conclusion that humeral hemiarthroplasty is the preferred method for managing complex irreparable tears of the rotator cuff in which the articular surface is destroyed, yet the deltoid muscle is functional. Shoulder arthrodesis is reserved for those patients who have both irreparable tears of the rotator cuff and irreparable deficiencies of the deltoid muscle, or the younger patient with demands for substantial strength at low angles of flexion.

Aged↗
PubMed2001

Outcome of nonoperative management of full-thickness rotator cuff tears.

The study documented the functional outcome in a consecutive series of 46 patients from an individual practice meeting the inclusion criteria of (1) a full-thickness rotator cuff tear seen by ultrasonography, arthrogram, or magnetic resonance imaging, (2) absence of a Workers' Compensation claim or previous surgery, (3) followup of at least 1 year, and (4) election of nonoperative management by the patient. Twenty-six of the tears involved only the supraspinatus, two involved the supraspinatus and infraspinatus, and two involved the supraspinatus, infraspinatus, and subscapularis (16 reports did not specify the size of the tear). Treatment consisted only of patient education and a home program of gentle stretching and strengthening. Patients completed the Simple Shoulder Test at the initial visit and sequentially at 6-month intervals thereafter. At an average followup of 2.5+/-1.6 years, 27 (59%) patients experienced improvement with nonoperative treatment, 14 (30%) patients experienced worsening, and five (11%) patients remained unchanged. The average number of Simple Shoulder Test functions the patients could perform initially was 5.6+/-3.2. At the latest followup, the average number of Simple Shoulder Test functions the patients could perform improved to 7.0 +/-3.8. The ability to sleep on the affected side and the ability to place the hand behind the head were significantly improved.

Aged↗
PubMed1995

Rotator cuff tear and acromioclavicular joint cyst.

A 58 year old man is described who developed a subcutaneous synovial cyst over the acromioclavicular joint. The cyst developed in association with a massive tear of the rotator cuff and the long head of the biceps, which was demonstrated by arthrography. A loose fragment of the acromion was found intraoperatively. The patient was treated surgically by a combination of excision of the cyst, acromioplasty, removal of the loose acromial fragment, and a duramater allograft to close the rotator cuff defect. The functional result was unsatisfactory.

Acromioclavicular Joint↗
PubMed2004

The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes.

We conducted this study to determine whether a test, the posterior impingement maneuver, could be used to prospectively identify articular side tears of the rotator cuff and/or posterior labrum. Sixty-nine athletes presented with posterior shoulder pain that developed during overhand athletics. Injured shoulders were placed into 90 degrees to 110 degrees of abduction, slight extension, and maximum external rotation, and an effort was made to elicit pain deep within the posterior aspect. Overall sensitivity of the test was 75.5%, and specificity was 85%. When only athletes with noncontact injuries (gradual onset of pain) were considered, sensitivity was 95% and specificity was 100%. A positive posterior impingement sign correlated highly with undersurface tearing of the rotator cuff and/or tearing of the posterior labrum in athletes with gradual onset of posterior shoulder pain during overhand athletics.

Adult↗
PubMed2004

Massive tears of the rotator cuff treated with a deltoid flap.

We retrospectively reviewed the charts of 29 patients younger than 65 years at surgery treated with deltoid flap reconstruction for massive postero-superior rotator cuff tears. All tears involved supraspinatus and infraspinatus tendons and were associated with tendon stump retraction to the glenoid rim, a preservable long biceps tendon, and an intact subscapularis tendon. Mean follow-up was 10.5 years. Patient satisfaction rate was 89%. Mean global Constant score improved from 43 to 71.5 points, mean pain score from 6.3 to 13.2, mean anterior flexion from 100 to 157 degrees, and force in elevation from 2.3 to 3 kg. Two thirds of patients had no humeral head migration. Of the 18 patients whose flap was examined by magnetic resonance imaging, 15 had no tear and 12 had a flap signal of muscle intensity; mean flap thickness was 5 mm. Pre-operative factors associated with poorer outcomes were upwards humeral head migration with a subacromial space smaller than 6 mm, presence of glenohumeral osteoarthritis, and supraspinatus amyotrophy greater than 40%. Deltoid flap reconstruction is a valid option in this patient population.

Aged↗
PubMed2006

Technique for arthroscopic rotator cuff repair.

Modern arthroscopic tools and techniques have allowed surgeons to operate on a wide variety of injuries using procedures less invasive than traditional open methods. For shoulder surgery in general, and rotator cuff repairs specifically, methods now yield a similar footprint as open procedures with several advantages, including reduced tissue trauma, postoperative pain, swelling, and concern about the deltoid attachment, which should lead to good outcomes.

Arthroscopy↗