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PubMed2001

Reduction of operating and recovery room times and overnight hospital stays with interscalene blocks as sole anesthetic technique for rotator cuff surgery.

BACKGROUND: The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. METHODS: Fifty-three patients who underwent shoulder rotator cuff repair in the sitting position were divided into four groups according to the anesthesia technique used: Group 1 (general anesthesia), Group 2 (interscalene block), Group 3 (interscalene combined with general anesthesia) and Group 4 (general anesthesia combined with local injection of local anesthetics). Interscalene blocks were performed preoperatively, using a nerve stimulator. After appropriately locating the brachial plexus, a mixture of 40 ml of 2% lidocaine and 0.5% bupivacaine (v/v) was injected. RESULTS: As compared to general anesthesia, the use of an interscalene block alone reduced the following operating room times: 1) from the patient's arrival in the operating room to the beginning of surgery and 2) from the end of surgery to the patient's departure from the operating room. Use of the interscalene block also resulted in a reduction of recovery time when compared to Groups 1, 3 and 4 by 40, 56 and 66%, respectively. Compared to Group 1, this anesthesia technique was furthermore associated with a 64% decrease in the number of patients hospitalized overnight. CONCLUSIONS: This study confirms that the interscalene block as sole anesthesia technique is safe and effective and can contribute to shorten the hospital length of stay of patients undergoing shoulder rotator cuff surgery.

Adult↗
PubMed1998

Gradient-echo versus fat-suppressed fast spin-echo MR imaging of rotator cuff tears.

OBJECTIVE: The purpose of this study is to compare fat-suppressed T2-weighted fast spin-echo sequences with T2-weighted multiplanar gradient-echo sequences in revealing rotator cuff disorders. MATERIALS AND METHODS: Oblique coronal fat-suppressed fast spin-echo images and gradient-echo images of 39 patients who underwent surgery of the shoulder were retrospectively reviewed. Images from the two techniques were reviewed separately. Each set of images was interpreted twice by four musculoskeletal radiologists independently and without knowledge of the surgical findings. Sensitivity and specificity for both sequences were determined. The kappa statistic was used to calculate intraobserver and interobserver agreement of interpretations. RESULTS: For detecting any tear, the sensitivity of the four readers was 71-96% using fast spin-echo and 58-100% using gradient-echo imaging. Confidence intervals showed no difference between the two sequences. Sensitivity of detecting full-thickness tears was 83-100% for both sequences. Interobserver agreement was good. CONCLUSION: T2-weighted gradient-echo and fat-suppressed T2-weighted fast spin-echo sequences depict rotator cuff tears equally well and take less time to acquire than conventional dual-echo spin-echo sequences.

Female↗
PubMed1995

[Anatomy and pathology of the rotator cuff].

In this contribution we stress the fact that not all rotator cuff tendinopathies are degenerative in nature. Moreover, we insist on a clear distinction between intrinsic and extrinsic tendinopathies. In a final note we point out that the impingement syndrome is not always due to a developmental or acquired spur of the anterior part of the acromion.

Collagen Diseases↗
PubMed1996

Rotator cuff strain: a post-traumatic mimicker of tendonitis on MRI.

OBJECTIVE: To determine whether there is a subset of young patients (< 35 years) with acute, post-traumatic insults to the rotator cuff which mimic the early stages of impingement. DESIGN AND PATIENTS: One hundred and ninety-seven consecutive shoulder MR images were retrospectively reviewed, and the results of 83 clinically correlated. Two observers independently evaluated the location of intra-tendon signal and adjacent bone marrow abnormalities on T1- and T2-weighted images. These findings were correlated with age, history of trauma, and surgical or clinical follow-ups. RESULTS: Patients younger than 35 years had signal intensity that was more localized in atypical locations (posterior aspect of the supraspinatus tendon), more commonly associated with marrow abnormalities (presumed bone bruise), and more often associated with trauma. Younger patients also were less likely to require surgery, especially if they showed bone bruises. This differentiated them from older patients (> 45 years), who demonstrated more widespread signal within the tendon, rare bone bruises, and more frequent surgery. CONCLUSIONS: Localized tendon signal in atypical locations of the supraspinatus tendon, particularly when associated with bone bruise and young age, suggests the possibility of a post-traumatic strain.

Adult↗
PubMed2004

Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises.

STUDY DESIGN: Prospective single-group repeated-measures design. OBJECTIVES: To quantify electromyographic (EMG) muscle activity of the infraspinatus, teres minor, supraspinatus, posterior deltoid, and middle deltoid during exercises commonly used to strengthen the shoulder external rotators. BACKGROUND: Exercises to strengthen the external rotators are commonly prescribed in rehabilitation, but the amount of EMG activity of the infraspinatus, teres minor, supraspinatus, and deltoid during these exercises has not been thoroughly studied to determine which exercises would be most effective to achieve strength gains. METHODS AND MEASURES: EMG measured using intramuscular electrodes were analyzed in 10 healthy subjects during 7 shoulder exercises: prone horizontal abduction at 100 degrees of abduction and full external rotation (ER), prone ER at 90 degrees of abduction, standing ER at 90 degrees of abduction, standing ER in the scapular plane (45 degrees abduction, 30 degrees horizontal adduction), standing ER at 0 degrees of abduction, standing ER at 0 degrees of abduction with a towel roll, and sidelying ER at 0 degrees of abduction. The peak percentage of maximal voluntary isometric contraction (MVIC) for each muscle was compared among exercises using a 1-way repeated-measures analysis of variance (P<.05). RESULTS: EMG activity varied significantly among the 7 exercises. Sidelying ER produced the greatest amount of EMG activity for the infraspinatus (62% MVIC) and teres minor (67% MVIC). The greatest amount of activity of the supraspinatus (82% MVIC), middle deltoid (87% MVIC), and posterior deltoid (88% MVIC) was observed during prone horizontal abduction at 100 degrees with full ER. CONCLUSIONS: Results from this study provide initial information to develop rehabilitation programs. It also provides information helpful for the design and conduct of future studies.

Adult↗
PubMed1994

Shoulder instability caused by rotator cuff lesions. An in vitro study.

Although many clinical and experimental studies have been published on shoulder instability, little is known about the relationship between degenerative changes of the cranial part of the rotator cuff and shoulder instability. The fact that some cuff lesions cause few symptoms and do not progress, while others are not only incapacitating but also progress to massive ruptures and cuff arthropathy, is still not well understood. In this study the motion patterns of the intact joint, and changes induced by a division of the supraspinatus tendon alone or of the supra- and infraspinatus tendons, were investigated in cadaver specimens. The results demonstrate that a one tendon lesion does not influence the motion pattern, whereas a two tendon lesion induces significant changes compatible with instability of the glenohumeral joint.

Adult↗
PubMed2003

The effects of various therapeutic measures on shoulder range of motion and cross-sectional areas of rotator cuff muscles after baseball pitching.

AIM: The purpose of this study was to investigate the effects of various therapeutic measures on the shoulder range of motion (ROM) and muscle cross-sectional area (mCSA) of rotator cuff muscles after baseball pitching. METHODS EXPERIMENTAL DESIGN: a mode of therapeutic measures was classified in 4 groups; the control (CON), ice treatment (IT), light shoulder exercise (LSE) and ice treatment with LSE (ILSE) groups. Each therapeutic measure was performed after pitching. PARTICIPANTS: 7 healthy, skilled baseball pitchers. MEASURES: ROM and mCSA were measured before pitching, immediately after pitching, at the time of the therapeutic measure, and 24 hours after pitching. Shoulder ROM at 90 inverted exclamation mark of abduction included internal rotation (IROM), maximum internal rotation (IMROM), external rotation (EROM) and maximum external rotation (EMROM). RESULTS: In all groups, both IROM and IMROM were significantly decreased after pitching compared with the pre-exercise values and conversely both EROM and EMROM were significantly increased. The mCSA of all rotator cuff muscles were increased significantly after pitching. For IMROM, ILSE showed a significant recovery at the post-therapeutic measure compared with the others and at 24 hours after pitching compared with IT, respectively. For IROM, both LSE and ILSE showed significant recovery compared with CON at the post-therapeutic measure. For the mCSA of external muscles, ILSE showed a greater decrease at the post-therapeutic measure than the others, and at 24 hours after pitching than CON. CONCLUSION: This study suggested the possibility that ILSE was more effective to recover ROM and decrease mCSA than the other methods.

Adult↗
PubMed1999

[The sensitivity and specificity of sonographic examination in detection of rotator cuff tear].

Sonographic examination was performed in 72 patients (74 shoulders) suffering from different shoulder diseases. The results were correlated with findings obtained during subsequent surgery in 57 patients (58 shoulders) and arthrography in 15 cases (16 shoulders). Rotator cuff tear was proved during surgical procedure in 37 patients (38 shoulders). The sensitivity and specificity of ultrasonography in detection of cuff tear was 98.2% and 90% respectively. In case of partial cuff tear ultrasonography had lower sensitivity--50% while specificity was 96.3%. In detection of supraspinatus tendon tear the ultrasound sensitivity was 100% and specificity 95.6%, in case of infraspinatus tear sensitivity was 66.7% and specificity 94% while for subscapularis tear these values were equal 75% and 98.1%. The size of sonographically estimated cuff defect correlated properly with intrasurgical measurement in 76.3% of all cases.

Adolescent↗
PubMed1984

Pulsed electromagnetic field therapy of persistent rotator cuff tendinitis. A double-blind controlled assessment.

The value of pulsed electromagnetic fields (PEMF) for the treatment of persistent rotator cuff tendinitis was tested in a double-blind controlled study in 29 patients whose symptoms were refractory to steroid injection and other conventional conservative measures. The treated group (15 patients) had a significant benefit compared with the control group (14 patients) during the first 4 weeks of the study, when the control group received a placebo. In the second 4 weeks, when all patients were on active coils, no significant differences were noted between the groups. This lack of difference persisted over the third phase, when neither group received any treatment for 8 weeks. At the end of the study 19 (65%) of the 29 patients were symptomless and 5 others much improved. PEMF therapy may thus be useful in the treatment of severe and persistent rotator cuff and possibly other chronic tendon lesions.

Clinical Trials as Topic↗
PubMed1986

Arthrography of the shoulder after operative repair of the torn rotator cuff.

Double-contrast shoulder arthrograms were performed in 20 patients at an average of 30 months after operative repair of a torn rotator cuff. In 18 out of 20 shoulders the contrast medium leaked into the subacromial bursa indicating a defect in the rotator cuff. Despite this, 17 patients had complete relief of pain and 15 had a full range of shoulder elevation. The results suggest that a completely watertight closure is not essential for a good functional result, and that arthrography may not be helpful in the investigation of failure of repair.

Adult↗
PubMed1992

[Nuclear magnetic resonance tomography and sonography in diagnosis of lesions of the rotator cuff].

The diagnostic value of MRI and ultrasound in the examination of 37 patients with chronic shoulder pain is compared. All the results were controlled or by arthroscopy/arthrotomy or by arthrography. Ruptures and degenerative changes of the rotator cuff and degenerative lesions could be detected with a high sensibility. The ultrasound examination as a fast, reproducible diagnostic method has now become part of the routine diagnosis. The MRI produces exacter information about the extent of the lesions; but it will be reserved for special questions.

Arthroscopy↗
PubMedDate not supplied

Results of latissimus dorsi and teres major transfer to the rotator cuff in the treatment of Erb's palsy.

A retrospective study of the results of latissimus dorsi and teres major transfer in the treatment of Erb's palsy was conducted in 10 patients. All patients underwent release of the pectoralis major and transfer of the latissimus dorsi and teres major tendons to the rotator cuff at a mean age of 7 years and 2 months. Range of motion, patient satisfaction, and presence of any complications were evaluated postoperatively at a mean of 3 years. Active shoulder abduction improved from a mean of 72 degrees preoperatively to 136 degrees postoperatively. Postoperative shoulder active external rotation averaged 64 degrees. Subjectively, all patients participating in a questionnaire thought use of the operated-on extremity had improved since surgery. All but one patient were satisfied with the final outcome. Complications included one hypertrophic scar. Transfer of the latissimus dorsi and teres major to the rotator cuff in treatment of persistent Erb's palsy improves shoulder abduction and external rotation and results in a high degree of patient satisfaction.

Brachial Plexus Neuropathies↗
PubMed2005

[Postoperative results after arthroscopic treatment of rotator cuff calcifying tendonitis, with or without associated glenohumeral exploration].

PURPOSE OF THE STUDY: Arthroscopic treatment of calcifying tendonitis usually includes a glenohumeral exploration first, followed by deposit removal via a bursal approach. The aim of this study was to analyze the relevance of a systematic glenohumeral exploration during arthroscopic treatment of calcified tendonitis of the rotator cuff. MATERIAL AND METHODS: Sixty-four consecutive patients treated by arthroscopic removal of calcific deposits in the rotator cuff were studied retrospectively. All patients had had at least six months of medical treatment. The treatment involved a glenohumeral approach in 32 patients (group GH) and an isolated bursal approach in 32 (group B). Both groups were similar with regard to epidemiological data and deposit aspect. In all cases, the deposit was removed from the bursal side and the cuff was not sutured. Assessment included duration of pain after surgery, Constant score, and x-ray aspect at six months follow-up and the delay for return to work. RESULTS: In the GH group, degenerative changes were noted on the labrum in three cases and a partial tear of the supraspinatus in two. No lesions noted in the glenohumeral joint required specific treatment. Postoperatively, the average duration of pain was significantly higher in group GH than in group B (11 weeks versus 6 weeks, p < 0.05) with a significant latency in return-to-work (12 weeks versus 5 weeks, p < 0.05). At six months follow-up, there was no difference between the groups for Constant score and deposit disappearance. DISCUSSION: Systematic exploration of the glenohumeral joint is not relevant in the arthroscopic treatment of calcified tendonitis and has a negative effect. Considering these results and those previously published in the literature, we recommend using an isolated bursal approach for arthroscopic calcifying tendonitis removal.

Adult↗
PubMed1988

Acromioplasty for impingement with an intact rotator cuff.

This is a retrospective review of 108 patients who underwent decompressive anterior acromioplasty for chronic impingement in the absence of a full thickness rotator cuff tear. Before operation, all the patients had had shoulder pain for at least one year despite conservative treatment. At operation, the rotator cuff tendons were explored and were intact. Anterior acromioplasty, followed by rehabilitation was successful in 87% of patients. The operation was less successful in women, in those who had diminished movement before operation, who were involved in worker's compensation claims, and whose pain followed direct trauma. Appropriate selection of patients is considered the key to success.

Acromion↗
PubMed2006

Imaging in evaluating the rotator cuff.

Multiple modalities are available for imaging the shoulder, including radiography, arthrography, computed tomography (CT), CT arthrography, ultrasound (US), magnetic resonance (MR) imaging, and MR arthrography. Each of these modalities has advantages and disadvantages in the evaluation of shoulder structures. This article discusses imaging of the rotator cuff of the shoulder with a primary focus on evaluation by MR imaging and MR arthrography.

Arthrography↗
PubMedDate not supplied

Rotator cuff defect healing: a biomechanical and histologic analysis in an animal model.

Rotator cuff tears are one of the most common causes of pain and disability in the upper extremity. With the use of an animal model, we studied the healing response of a controlled defect in the normal supraspinatus tendon and in a tendon with a reduced intrinsic healing capacity. In 36 Sprague-Dawley rats, defects (2 mm x 2 mm) were created in the supraspinatus tendons bilaterally. To model a tendon with an intrinsically reduced capacity to heal, the tissue adjacent to the defect area in the left shoulder was treated with in situ freezing. The contralateral tendon was not frozen. After 3 (n = 12), 6 (n = 12), and 12 (n = 12) weeks, animals were killed and underwent histologic (n = 4 from each group) and biomechanical (n = 8 from each group) evaluation. An additional group of untreated animals served as a normal control group. On histologic evaluation 78% of tendons had persistent defects (defined as incomplete closure of the defect site). Over time, the tissue from both groups demonstrated an improved histologic grade but did not reach normal levels, even at 12 weeks. No histologic differences were found between defect healing in normal tendons and in those treated with in situ freezing. On biomechanical evaluation there were also no significant differences between treatment groups. Over time, an improvement occurred in tissue properties, indicating that some healing of the defects had occurred. However, these tissue properties remained an order of magnitude lower than those of normal control tendons. These findings indicate that there is an active but inadequate repair response to the defect in the rat supraspinatus tendon, which is not significantly worsened by in situ freezing of the tissue around the defect. This model has applications toward the study of techniques to improve or accelerate cuff defect healing.

Animals↗