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The results of a new operative technique of reconstruction of the rotator cuff are described in 112 cases. The principle of the method is the restoration of the anatomy in order to restore function. Results so far have been encouraging, as 80% of the patients have benefited from the operation.
Calcifying tendinitis (TC) of the rotator cuff is a transient shoulder disease with a high rate of spontaneous resorption of the deposit. Therefore, primary treatment should be conservative. In cases of persistent pain despite conservative treatment, extracorporeal shock wave therapy (ESWT) can be performed as an alternative minimally invasive method. Various short-term studies have demonstrated the efficiency of ESWT for TC. To evaluate the short- and long-term results, complications, and the number of operations avoided by ESWT, a prospective study with 115 patients was performed over a period of 4 years. The patients had received high-energy ESWT once (group A: n = 56) or twice (group B: n = 59). Six months after therapy, 47% in group A and 77% in group B showed evidence of disappearance or disintegration of the calcium deposits. Pain relief was achieved in 45% of group A and 53% of group B. Four years after treatment, 20% of the patients had undergone surgery on the involved shoulder. Of the remaining patients, 59% (68 patients) were seen for follow-up. Subjectively, 78% of group A and 87% of group B judged the treatment to be successful. X-ray examination revealed complete or partial resorption of the calcium deposit in 93% in both groups. The Constant score increased from 45 before treatment to 88 in group A and 85 in group B after treatment. ESWT was successful for about 70% of the treated patients with no long-term complications seen.
The signal intensity patterns of rotator cuff lesions at magnetic resonance (MR) imaging were evaluated in 80 patients who had surgical correlation and in 13 asymptomatic individuals (14 shoulders). Six cadaver shoulders were examined with MR, and histologic correlation was obtained in four. All studies were performed at 1.5 T with a flexible circular surface coil. The accuracy of MR imaging in detection of full-thickness cuff tears (31 patients) was 0.95 and of partial thickness tears (16 patients), 0.84. The most common and accurate pattern for full-thickness cuff tears (22 of 31 tears) was a region of intense signal seen on T2-weighted images. Less often the torn region consisted of an extremely degenerated and attenuated tendon with moderate signal intensity or was obscured by low-signal-intensity scar. The intense signal pattern on T2-weighted images was also accurate, although a less common finding (seven of 16 cases), in the diagnosis of partial tears. Tendinitis was recognized as focal or diffuse regions of increased signal intensity or a nonhomogeneous pattern of increased signal often associated with tendinous enlargement. In some patients, manifestations of subacromial-subdeltoid bursitis was present. Tendon degeneration was also manifested as regions of increased signal intensity. Some similarity and overlap of signal patterns of partial interstitial tears, tendinitis, and tendon degeneration are observed.
Forty-two consecutive patients in whom an impingement of rotator cuff tear had been treated with greater tuberosity osteotomy and repair were evaluated by relief of pain, return of range of motion and strength of shoulder. The oriental acromion is thin and easy to break during the traditional acromioplasty procedures. When the decompression is achieved by osteotomy on the greater tuberosity which is the common location of cuff tear, not only is adequate decompression achieved but also the coracoacromial ligament is preserved. Comparison of the results of greater tuberosity osteotomy with those of previous acromioplasty studies shows they are mostly similar. At present, these techniques can be recommended for use by Chinese orthopaedic surgeons who have to deal with the typical oriental bony structures.
This study analyses the results of 30 surgical repairs of the rotator cuff. The basic problem was degenerative pathology in which medical treatment had been tried previously in all cases. The type of treatment was based upon preoperative evaluation and arthro-CT scan in particular. Results were invariably good, with regression of pain and recovery of activity. Muscle power was significantly correlated with the value of the tendon repaired, this being reflected overall by incomplete recovery.
An experience of 13 cases of short rotator muscles advancement is reported. These procedures were found to be available in treatment of rotator cuff avulsions with retraction, when anatomical reinsertion or shoe-lace suture after Mclaughlin appeared to be impossible. The authors had performed advancement of the supraspinatus alone in 10 cases and simultaneous advancement of supra-, infraspinatus and teres minor in 3 cases. Only one poor result was obtained that can't but confirm a most high efficacy of the procedures described.
Among various studies reporting the outcome of surgical repairs of rotator cuff tears, comparisons are very difficult because of the absence of a classification system. A proposed classification system takes into account the extent of the tear, its topography in the sagittal and frontal planes, the trophic quality of the muscle, and the integrity of the long head of the biceps. The new classification system exploits the advances in diagnostic imaging and is useful in the assessment of nonoperatively treated patients.
The authors suggest transfer of teres major muscle for a detached and atrophic infraspinatus muscle in irreparable rotator cuff tears. Original studies were done on cadavers. In the period between November 1993 and June 1994, we used this technique on 6 patients. Those patients were evaluated with the Constant-Murley test and improved from an average of 40 points (minimum 27 to maximum 54) before surgery to an average of 62 points (minimum 47 to maximum 78) after surgery. Active external rotation recovered 35 degrees in abduction and 24 degrees in adduction. The teres major transferred on great tuberosity is able to restore continuity of the cuff and to depress the head of the humerus. It is important to re-educate the transferred muscle because it initially contracts more in adduction and internal rotation than in external rotation. One patient was very satisfied and 5 patients were satisfied after surgical treatment.
OBJECTIVE: To investigate the diagnostic value of sonography (SG) and magnetic resonance imaging (MRI) in the assessment of full-thickness rotator cuff tears (RCTs). METHODS: Twenty-one consecutive, otherwise healthy patients with noninflammatory unilateral chronic (>3 months) shoulder complaints due to a possible full-thickness RCT were studied (9 women and 12 men, mean +/- SD age 56 +/- 12). According to standardized procedures, SG was performed by both a radiologist and a rheumatologist, and MRI was evaluated by 2 radiologists. All assessors were blinded to the patient's diagnosis. Within 3 weeks after SG and MRI, arthroscopy was performed. SG, MRI, and arthroscopy results were scored as negative or positive for the presence of a full-thickness RCT. The result of surgical inspection was used as the "gold standard." RESULTS: For full-thickness RCTs, the sensitivity was 0.81 for SG and 0.81 for MRI. The specificity was 0.94 for SG and 0.88 for MRI. The positive predictive value was 0.96 for SG and 0.91 for MRI. The negative predictive value was 0.77 for SG and 0.74 for MRI. Accuracy was 0.86 for SG and 0.83 for MRI. CONCLUSION: Full-thickness RCTs can be identified accurately by both SG and MRI. Because of its low cost and because it can be performed in the rheumatology unit, SG seems to be a promising diagnostic tool for use by the rheumatologist.
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The purpose of this study was to evaluate the outcome after subcoracoid pectoralis major transfer for anterior-superior shoulder instability in massive rotator cuff insufficiency. Fourteen patients underwent subcoracoid pectoralis major transfer for this debilitating surgical complication. At a mean 17.5-month follow-up, there were 11 satisfactory and 3 unsatisfactory results. Nine of the patients were satisfied with the procedure and would repeat the operation under similar circumstances. Pain scores, as measured on a visual analog scale, decreased from 6.9 to 3.2 postoperatively. Mean forward flexion increased from 24.4 degrees to 60.8 degrees. American Shoulder and Elbow Society functional outcome score increased from 27.2 preoperatively to 47.7 postoperatively. Thirteen of the fourteen patients had improved humeral head containment and improved ability to perform activities of daily living at waist level. A subcoracoid pectoralis major muscle transfer has a low complication rate and is a viable option in this difficult patient population, with better results than those previously reported.
The aim of this study was a better understanding of the role of the vascular supply as a pathogenic factor in rotator cuff disease. Twenty-five shoulders from unembalmed cadavers were studied after injection of the upper limb aa. with barium sulfate. The predominant arteries were the vessels of the subscapularis m. These branches originated from the axillary a. the anterior circumflex humeral a., and the posterior circumflex humeral a. The supraspinatus m. was supplied by the suprascapular a. but the acromial branch of the thoracoacromial a. supplied the tendon of the supraspinatus. The infraspinatus and teres minor tendons were vascularised by the ascending branches of the posterior circumflex humeral a. The tendon of the long head of the biceps brachii m. was supplied by a branch termed the "arcuate artery" and by a branch we describe derived from the brachial a. at the level of the latissimus dorsi tendon and travelling in a true mesotendon. There is a very real critical zone, with a lesser blood-flow, 1.5 cm from greater tubercle, situated mainly at the supraspinatus tendon. This is a convergence zone of the anterior and posterior circumflex humeral aa., the suprahumeral a. and the thoracoacromial a. The histologic studies confirmed the poor vascularity of this critical zone.
Magnetic resonance imaging (MRI) has proved to be an excellent diagnostic tool in evaluating the musculoskeletal system. This article illustrates one particular facet of musculoskeletal MRI: investigation of the rotator cuff tendon complex.
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