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At least 1,351 records · Page 75Linked to original sources
PubMed1990

[Factors affecting the surgical results of treatment of rotator cuff tears in the shoulder].

The work presents the outcomes of clinical, radiological and mathematical analyses of 42 patients with the rupture of the whole width of the cuff of shoulder rotators treated operatively. The group comprised 34 male and 8 female patients, the average age 55.5 years. The mean period between the operation and final clinical evaluation was 23 months. According to the method chosen for the evaluation of the results by means of 100-point score acceptable result was achieved in 90 per cent of cases (excellent in 64 per cent, good in 26 per cent). Double t-test showed that significantly participating in the results were the following factors: the period between the origin of complaints and operation (p less than 0.001), degenerative changes of the greater tubercle of humerus (p less than 0.001), atrophy of supraspinatus muscle and infraspinatus muscle (p less than 0.001), the degree of difficultness of the patient's work (p less than 0.005), indication for operation (pain, limited range of motion) (p less than 0.025). According to the mathematical analysis these factors independently influenced the final results.

Female↗
PubMed1993

[Fibrous frame of the rotator cuff. The concept of fibrous lock].

MRI assessment of shoulder suggests the presence of a strong fibrous structure in the depth of the supra spinatus muscle. An anatomical study has been performed in 20 fresh human shoulders. There was a very strong fibrous frame within the anterior part of the supra spinatus m. and within the upper part of the sub scapularis. The upper part of the infra spinatus m. contained a significant fibrous reinforcement too so as in the teres minor m. The authors describe fibrous structures around the rotator interval, which constitute an antero-superior Fibrous Lock of the scapulo humeral joint and may help the repair of the full thickness tears of the rotator cuff.

Cadaver↗
PubMed2002

Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography.

OBJECTIVE: To use color Doppler ultrasonography to evaluate the morphology and vascularity of calcific tendonitis and to predict the formative and resorptive phases of the calcification. METHODS: Ninety-four patients with shoulder calcification on plain radiographs were enrolled in this study. Ultrasonography of the shoulder was focused on the rotator cuff. Color Doppler ultrasonography was applied in the calcific region. Patient symptoms were graded as painless, mild, moderate, and severe. The calcific plaques were classified as arc-shaped, fragmented or punctate, nodular, and cystic types. Color Doppler ultrasonographic signals were graded 0 to 3. The formative and resorptive phases of calcification were categorized by patient symptoms; acute onset of moderate or severe pain indicated the resorptive phase. RESULTS: The calcific plaques appeared arc shaped in 59 patients (20 painless, 19 mild, and 20 moderate), fragmented or punctate in 27 (2 painless, 3 mild, 20 moderate, and 2 severe), nodular in 6 (1 moderate and 5 severe), and cystic in 2 (severe). There was a significant difference between the morphology of the calcific plaques and clinical symptoms (P < .01). On color Doppler ultrasonography, grade 0 signals were found in 28 patients (22 painless and 6 with mild pain); grade 1 in 18 (16 mild and 2 severe); grade 2 in 41 (all moderate); and grade 3 in 7 (all severe). The correspondence between color Doppler ultrasonographic findings and clinical symptoms was excellent (P < .01). CONCLUSIONS: High-resolution ultrasonography with color Doppler imaging could differentiate the formative and resorptive phases of the calcification and could be used as a follow-up modality in calcific tendonitis of the shoulder.

Calcinosis↗
PubMed2006

Inflammatory infiltrate of the edges of a torn rotator cuff.

There is still considerable controversy as to whether or not the inflamed margins of a cuff tear should be excised during surgical suture. We have tried to discover whether anti-inflammatory drugs used before surgical treatment could resolve this issue. Thirty-eight patients were randomly either treated with an anti-inflammatory drug for 2 weeks or not. During the subsequent arthroscopic repair, a few fragments of supraspinatus edge were excised and examined microscopically. No significant differences emerged among samples belonging to the two groups. In all cases, we observed inflammatory infiltrate-lined tear edges. Fibrocytes and newly formed vessels were detected near the margin. Dystrophic calcifications were observed in both groups. Away from the edge, the tendon appeared hypocellular; containing areas with myxoid or fatty degeneration. Our study demonstrates that an anti-inflammatory drug is unable to resolve the inflammatory infiltrate. This failure is probably related to the poor blood supply to the cuff, which, in cases of rupture, is deprived of vessels coming from the humeral periosteum. Further studies are needed to understand how to eliminate the inflammatory process and clarify whether it might inhibit cuff healing and give rise to re-tearing of the sutured cuff.

Aged↗
PubMed1985

Surgery for full-thickness rotator-cuff tears.

We reviewed the cases of 100 patients who were operated on for a tear of the rotator cuff and found significant improvements in pain in all of them and in function in the majority of patients. The size of the cuff tear did not significantly affect the results, although patients with a smaller tear tended to fare slightly better.

Acromion↗
PubMed1987

Isokinetic strength of the shoulder after repair of a torn rotator cuff.

The strength of the shoulder was measured isokinetically in forty patients who had undergone surgical repair of a torn rotator cuff. Thirty-three patients were tested six months postoperatively and twenty-four, after a year. There was an increase in strength between the two intervals (p less than 0.05) for abduction measured at 180 degrees per second, external rotation measured at 60 and 180 degrees per second, and flexion measured at 60 degrees per second. On the average, strength reached 80 per cent of normal in abduction and 90 per cent of normal in external rotation at one year postoperatively. Strength of forward flexion reached 75 per cent of normal. In seventeen patients with paired data (recorded at both six and twelve months), an increase in strength (p less than 0.05) was found for each motion and speed that was tested. Patients who had a small tear scored higher than those who had a large tear, but not to a significant degree. Whether the operation was done on the dominant extremity or on the non-dominant one did not appear to affect the results, nor did the timing of the repair after injury.

Adult↗
PubMed1999

Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis.

Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from -13 to 50), the control-group improved 8.37 points (SD 14.56, range from -20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.

Acupuncture Analgesia↗
PubMedDate not supplied

A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests.

Careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. A number of tests have been described that are claimed to improve diagnostic accuracy by specifically examining one component of the shoulder complex. Many of these tests are eponymous, and there is confusion about not only how to perform them but also what conclusion to draw from the results. This article attempts to clarify the tests used to examine the rotator cuff by presenting them as described by the original authors with the additional aim of providing a source for those wishing to refresh their knowledge without the need to refer to the original source material.

Humans↗
PubMed2001

Anterior superior instability with rotator cuff tearing: SLAC lesion.

Anterosuperior instability of the shoulder may occur from a variety of pathologic lesions. We describe a specific entity, the SLAC (superior labrum, anterior cuff) lesion that involves an association of anterior-superior labral tear with a partial supraspinatus tear. We retrospectively isolated a group of 40 patients with this lesion. The presenting complaints, physical examination findings, surgical findings, and results were isolated. Overhead activities were the most common etiology; load and shift instability testing and whipple rotator cuff testing were the most common physical examination findings. Surgical repair was successful in 37 of the 40 patients. The SLAC lesion is a definable clinical entity with predictable history, examination, surgical pathology, and satisfactory results from surgery.

Adolescent↗
PubMed1999

Geographic variations in the rates of operative procedures involving the shoulder, including total shoulder replacement, humeral head replacement, and rotator cuff repair.

BACKGROUND: Although geographic variations in the rates of orthopaedic procedures have been well documented, considerable controversy remains regarding the factors that drive these variations, particularly the role of the availability of orthopaedic surgeons. Moreover, little attention has been specifically focused on variations in the rates of commonly performed shoulder procedures. METHODS: The current study documents state-to-state variations in the rates of total shoulder replacement, humeral head replacement, and rotator cuff repair and examines factors that might account for these variations. The regional incidences of these three procedures were analyzed with use of the Health Care Financing Administration Medicare database (MEDPAR, 1992). The rates were age-adjusted, and variations were measured with use of high:low ratios, variation coefficients, and systematic components of variation. Potential causes of variation were analyzed with use of Spearman and partial correlations as well as with Poisson regression. RESULTS: Rates for the three procedures that were studied varied from one state to another by as much as tenfold. Humeral head replacement had the lowest rate of variation according to all three measures. All three procedures were performed less often in states that were more densely populated. With the numbers available for study, no consistent, significant relationship was found between the density of orthopaedists and shoulder surgeons and the rates of any procedure. CONCLUSIONS: The striking variations that were noted for these commonly performed procedures showed that there is a clear need for well designed clinical research to further define the factors that account for the variations and to examine the effectiveness and appropriate indications for the procedures.

Aged↗