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PubMedDate not supplied

The vacuum arthrogram in the shoulder: correlation with rotator cuff disease.

Plain radiographs of the shoulder can demonstrate a vacuum arthrogram delineating the articular surfaces. In a review of 122 consecutive arthrograms with radiographic contrast injections, there were 25 vacuum arthrograms on the preceding plain films. We have found the presence of a vacuum arthrogram to be an accurate predictor of an intact rotator cuff, with a specificity of 0.98 and a positive predictive value of 0.96.

Humans↗
PubMed2002

A randomized controlled trial comparing 2 instructional approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery.

STUDY DESIGN: A prospective unblinded randomized clinical trial. OBJECTIVES: To compare the effectiveness of 2 types of home program instruction, videotape versus personal instruction by a physical therapist, on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear. BACKGROUND: Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs. Therefore, assessing the effectiveness of different methods of home program instruction is important. METHODS AND MEASURES: Patients who consented to undergo surgical repair were randomly assigned to either a videotape or personal instruction group. A self-reported compliance log categorized subjects as fully compliant, partially compliant, or noncompliant. The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12, 24, and 52 weeks postoperatively. The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time, were assessed by 2 separate 2x3x4 multiple analyses of variances (MANOVAs), 1 for each outcome measure (alpha = 0.025). RESULTS: Neither MANOVA was significant and the null hypotheses were not rejected. The main effect of time (number of weeks postsurgery) was significant across all time intervals for both outcome measures (P < 0.0005). CONCLUSIONS: With a therapist available for questions, patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes.

Adult↗
PubMedDate not supplied

Electromyographic analysis of the deltoid and rotator cuff muscles in persons with subacromial impingement.

The purpose of this study was to compare subjects with subacromial impingement and subjects with normal shoulders with respect to muscle activity. Fifteen subjects in each group were studied by means of fine-wire electromyography. The middle deltoid and rotator cuff muscles were evaluated during isotonic scaption from 30 to 120 degrees. Overall, the impingement group demonstrated decreased mean muscle activity in comparison with the group of normal subjects. The magnitude of diminished activity was statistically significantly different (P < .05) during the 30- to 60-degrees arc for the infraspinatus, subscapularis, and middle deltoid muscles; in addition, the infraspinatus muscle demonstrated significantly depressed activity during the 60- to 90-degrees arc. In the impingement group, the supraspinatus and teres minor revealed a diminution of muscle function in comparison with shoulders in the normal group; the difference was not significant. This study demonstrates that muscle activity in subjects with impingement is most notably decreased in the first arc of motion. Also of clinical relevance is the fact that the inferior force vector (from the infraspinatus and subscapularis) is less functional in subjects with impingement than is the superior compressive vector (from the supraspinatus). Thus, humeral head depression during the critical first portion of elevation may be insufficient in people with subacromial impingement.

Adult↗
PubMed1993

Posterior superior impingement of the rotator cuff on the glenoid rim as a cause of shoulder pain in the overhead athlete.

A case of impingement of the deep surface of the supraspinatus tendon on the posterior superior rim of the glenoid and mild anterior laxity has been presented. The partial-thickness tear of the undersurface rotator cuff tendon, degenerative tear of the posterior superior labrum, and osteochondral impression fracture of the humeral head have been documented. The purpose of this case report is to present the pathological findings associated with posterior superior glenoid rim impingement and emphasize its role as a cause of shoulder pain in the overhead athlete. In addition it is important to stress the fact that shoulder pain in the overhead athlete may be multifactorial.

Adult↗
PubMed2000

Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders.

BACKGROUND: The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes. Despite their neurologically intact shoulder joint musculature, high-level and low-level paraplegics have different degrees of trunk and pelvic stability available to them during activities of daily living (ADL). This fundamental functional anatomical difference between high-level and low-level paraplegics had not previously been related to the diagnosis of RCD in a non-athletic long-term paraplegic population. METHODS: A descriptive cross sectional study was undertaken to demonstrate the differences in the prevalence of clinically diagnosed RCD in a high-level (n=22) and a low-level (n=20) group of persons with long-term paraplegia. Any perceived differences were then related to the functional anatomical variations between the two groups. Inferences were made based on factors predisposing to RCD known to exist among both able-bodied and paraplegic athletes. The 42 subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) to establish the presence or absence of shoulder pain and the Musculoskeletal Function Assessment (MFA) instrument to determine differences in functional ability and perceived degree of difficulty within five categories of ADL. Each participant underwent a clinical examination using validated provocative clinical tests and isometric muscle strength ratio testing. RESULTS: There was a higher prevalence of RCD in the high-level group (P=0.009) which correlated with decreased trunk control (P=0.009). Differences in ability to perform functional tasks were not shown to be greater in the high-level group, although there was a higher degree of perceived difficulty in ADL. Muscle strength imbalances between the shoulder adductors and abductors were shown to be greater in the high-level group. CONCLUSIONS: The results of this study suggest that the functional anatomical differences that exist within paraplegia contribute to the propensity of high-level paraplegic persons to suffer from RCD. These findings send a clear message to service-providers that greater acknowledgement of the differences in trunk postural control specific to the level of thoracic SCI is required. This may have implications for the prescription of wheelchairs, assistive devices and instruction for alternative ADL techniques to this specific population.

Adult↗
PubMed2002

Results of the latissimus dorsi and teres major tendon transfer on to the rotator cuff for brachial plexus palsy at birth.

Brachial plexus palsy at birth remains a serious problem. Although most cases resolve during the first few months by spontaneous regeneration, several operations have been used to correct the residual deformity. In the present study we describe the results of the latissimus dorsi and teres major tendons transfer on to the rotator cuff to improve shoulder function. Six patients were included in the study: three girls and three boys; four right shoulders, and two left. The types of palsy were four Erb's palsy (C5, C6) and two C5-C7 palsy. The median age at the time of operation was 11 years and 1 month and the median follow-up period was 54.2 months. Median preoperative passive external rotation was 51 degrees, and active abduction 67 degrees. Median postoperative active external rotation was 72 degrees, and postoperative active abduction 109 degrees. This procedure increased the ranges of external rotation and abduction, and provided considerable improvement in shoulder function.

Adolescent↗