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PubMed1981

[Injuries of the rotator cuff of the shoulder - experiences in diagnosis and treatment (author's transl)].

Arthrography is an established method to verify injuries of the rotator cuff of the shoulder. In this paper referring about 32 patients with 34 cuff injuries the results after operation (16 patients) and conservative treatment (18 patients) are compared. The following statements based on our experiences are possible: If conservative treatment is without result, operation should be done within 8 weeks after the accident. - Because of the danger of exostoses at the point of the osteotomy of the acromion which includes the restriction of movement, the transacromial approach is not advisable. - If there is only a small space between the acromion and the humeral head resection of the coracoacromial ligament is an advisable method for better admittance to the shoulder joint. - A sufficient treatment in the postoperative phase is of great importance for a good functional result.

Diagnosis, Differential↗

PubMed1998

Rotator cuff tendinopathy and subacromial impingement syndrome.

Subacromial impingement syndrome is one of the most frequently seen causes of shoulder pain. The symptoms are often vague and may be difficult to differentiate from other shoulder problems. The purpose of this paper is to provide the clinician with a more thorough understanding of this entity by reviewing the pertinent anatomy and underlying etiology. Suggestions are made to aid in establishing the diagnosis, and treatment recommendations are proposed.

Adrenal Cortex Hormones↗

PubMed1995

[Roentgen morphometry of the shoulder in diseased rotator cuff. Value of plain roentgen examination in comparison with arthroscopy].

A comparison between the pathomorphological substrate and the X-ray morphometry of the shoulder joint was made with 482 arthroscopically treated patients. Radiological parameters and indices for the prediction of the development of the impingement-syndrome were developed from this comparison. With these parameters and indices is it possible to predict the pathomorphological substrate and to differentiate between subacromial and coracoidal impingement.

Acromioclavicular Joint↗

PubMed2004

Bursoscopic evaluation for degree of rotator cuff tear using an air-infusion method.

This article presents a method of bursoscopic examination with use of a glenohumeral air-infusion technique for the detection of full-thickness tears hidden by bursal tissue. We inflated the glenohumeral joint with 50 to 60 mL of air while simultaneously observing the joint with bursoscopy for the detection of air bubble leakage. The air-infusion technique is valuable in detecting full-thickness tears and useful for evaluating the patency of repair.

Air↗

PubMed1995

[Double-contrast tomographic arthrography and double-contrast CT arthrography in rotator cuff lesions].

Arthrotomography is a good method for the evaluation of incomplete or complete tears of the supraspinatus tendon, the assessment of the size of tears and the quality of the nonruptured part. CT arthrography is useful in the evaluation of the subscapularis tendon and the labral-capsular components. It depends on the clinical symptoms and the result of primary arthrography whether both methods are performed in one session or not. Based on the experience of 1200 arthro(tomo)graphy and axial CT arthrography examinations, the procedure and results in our institution are reported.

Adult↗

PubMed1992

The strength of surgical repairs of the rotator cuff. A biomechanical study on cadavers.

Using 26 cadaver shoulders, we produced a standard defect in the supraspinatus tendon and performed one of three types of repair. Their strength was found by testing in tension the force required to produce a gap of 3 mm, then 6 mm, and finally total disruption of the repair. The use of a polyethylene patch to spread the forces over the lateral bone surface and of extra sutures to grasp the tendon end raised by 2.6 times the load at which a 3 mm gap in the repair occurred and by 1.7 times the load to failure.

Aged↗

PubMed1988

Persistent hemarthrosis of the shoulder joint with a rotator-cuff tear in the elderly.

Three elderly patients developed persistent hemarthrosis of the shoulder joint without having suffered injury. Complete tears of the rotator cuff, attrition of the undersurface of the acromion, and instability were noted in the affected shoulders. Synovial fluids examined from two patients contained many alizarin red S-positive microspheroids. The synovium obtained at surgery from two patients showed hypervascularity, vasodilatation, and severe degenerative changes of collagenous tissues. The tendon of the m. supraspinatus showed infiltrations of multinucleated giant cells around calcified deposits consisting of hydroxyapatite crystals. Anatomical and mechanical derangements, and possible biological reactions following phagocytosis of hydroxyapatite crystals, may have contributed to the persistent hemorrhage in the shoulder joints.

Acromion↗

PubMed2002

The mechanical effects of suture anchor insertion angle for rotator cuff repair.

Twelve matched pairs of humerii were instrumented with suture anchor at 90 degrees, 75 degrees, 45 degrees, and 30 degrees relative to the cortical border at the junction of the greater tuberosity and articular surface. Two fixtures were inserted into each specimen at different angles and loaded to failure. Suture anchors failed at an average of 171, 219, 169, and 192 N with 90 degrees, 75 degrees, 45 degrees, and 30 degrees insertion angles, respectively. No statistical difference was detected between groups (P=.08). Although previous authors have prescribed angles < or =45 degrees to improve pull-out strength, the current in vitro data does not support these recommendations.

Adult↗

PubMedDate not supplied

Double-echo MPGR imaging of the rotator cuff.

T2-weighted gradient recalled (T2*) sequences are often used in place of T2 sequences when imaging the shoulder. The main advantages of these sequences are the decreased imaging time, the better demonstration of cartilage disorders, and the added tissue information that can be garnered due to the increased sensitivity to magnetic susceptibility with T2* sequences. Unfortunately, one drawback of T2* sequences that is less apparent with spin-echo techniques is the sensitivity of tissue close to the surface coil to undergo diffusely increased signal throughout an area in close proximity to the coil (coil-burnout). This phenomenon is a very bothersome artifact that can obscure tissue differentiation in this area. Fluid detection, especially in the subacromial bursa, can be especially difficult to diagnose in the presence of coil-burnout. We describe MR imaging of the shoulder using double-echo T2-weighted multiplanar gradient recalled sequences, which allow better evaluation of shoulder pathology.

Humans↗

PubMed2006

Tendon retracts more than muscle in experimental chronic tears of the rotator cuff.

We released the infraspinatus tendons of six sheep, allowed retraction of the musculotendinous unit over a period of 40 weeks and then performed a repair. We studied retraction of the musculotendinous unit 35 weeks later using CT, MRI and macroscopic dissection. The tendon was retracted by a mean of 4.7 cm (3.8 to 5.1) 40 weeks after release and remained at a mean of 4.2 cm (3.3 to 4.7) 35 weeks after the repair. Retraction of the muscle was only a mean of 2.7 cm (2.0 to 3.3) and 1.7 cm (1.1 to 2.2) respectively at these two points. Thus, the musculotendinous junction had shifted distally by a mean of 2.5 cm (2.0 to 2.8) relative to the tendon. Sheep muscle showed an ability to compensate for approximately 60% of the tendon retraction in a hitherto unknown fashion. Such retraction may not be a quantitatively reliable indicator of retraction of the muscle and may overestimate the need for elongation of the musculotendinous unit during repair.

Animals↗

PubMed2003

Mechanical factors in the initiation and propagation of tears of the rotator cuff. Quantification of strains of the supraspinatus tendon in vitro.

Differential strain has been proposed to be a causative factor in failure of the supraspinatus tendon. We quantified the strains on the joint and bursal sides of the supraspinatus tendon with increasing load (20 to 200 N) and during 120 degrees of glenohumeral abduction with a constant tensile load (20 to 100 N). We tested ten fresh frozen cadaver shoulders on a purpose-built rig. Differential variable reluctance extensometers allowed calculation of the strain. Static loading to 100 N or more increased strains on the joint side significantly more than on the bursal side. During glenohumeral abduction an increasing and significant difference in strain was measured between the joint and bursal sides of the supraspinatus tendon, which reached a maximum of 10.6% at abduction of 120 degrees. The joint side strain of 7.5% reached values which were previously reported to cause failure. Differential strain causes shearing between the layers of the supraspinatus tendon, which may contribute to the propagation of intratendinous defects that are initiated by high joint side strains.

Aged↗

PubMed1983

Rotator cuff tear measurement by arthropneumotomography.

Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size of the tear and the quality of the remaining cuff than did plain arthrograms.

Contrast Media↗

PubMed2001

Radiographic diagnosis of rotator cuff tear based on the supraspinatus muscle radiodensity.

OBJECTIVE: To evaluate the supraspinatus muscle radiodensity on the outlet view as an indication of a tendon tear. DESIGN AND PATIENTS: Plain radiographs and magnetic resonance imaging (MRI) examinations were obtained on both shoulders of 40 subjects aged 23-70 years, including 13 asymptomatic volunteers and 27 patients. Two readers analyzed the superior contour and the heterogeneity of the supraspinatus muscle radiodensity and compared them with the MRI findings. RESULTS AND CONCLUSION: Significant concordances (P < 0.001) were found between the assessments of the superior contour and the heterogeneity of the muscle radiodensity, respectively, on plain radiographs and MR images. For the diagnosis of a full-thickness tear, the analysis of the superior contour and the heterogeneity of the muscle radiodensity reached an accuracy of 85% and 80% respectively. Stepwise discriminant analyses showed low to moderate benefit of considering the contour and the heterogeneity simultaneously. The inter- and intraobserver agreement ranged from moderate to good. We conclude that on the outlet view, modifications in the superior contour and heterogeneity of the supraspinatus muscle radiodensity suggest a full-thickness tear.

Adult↗

PubMed2006

Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip.

PURPOSE: To compare a standard suture material with a newer material using multiple arthroscopic knot configurations and to evaluate the biomechanical performance of a new sliding-locking knot compared with 4 surgical standards. TYPE OF STUDY: Controlled laboratory study. METHODS: Five knots were evaluated (Weston, Tennessee, Duncan, SMC, and the new San Diego knot) using 2 suture materials, No. 2 Ethibond (Ethicon, Somerville, NJ) or No. 2 Fiberwire (Arthrex, Naples, FL). Eight samples were tested for each knot-suture configuration. Samples were pretensioned to 10 N and then loaded from 10 to 45 N for 1,000 cycles. Intact knots were loaded to failure. RESULTS: Fiberwire had significantly higher load-to-failure (276 +/- 24 N) compared with Ethibond (111 +/- 13 N) (P < .001), although there was no significant difference as a function of knot configuration. Of the 40 Fiberwire knots, 3 failed by early slippage during cyclic loading and 8 slipped at very low tension during load-to-failure. None of the Ethibond knots and none of the San Diego knots failed by early slippage. CONCLUSIONS: Surface characteristics and suture construction affect the tendency for knot slippage. CLINICAL RELEVANCE: Surgeons should understand the impact of handling characteristics, frictional properties, and ultimate failure load when selecting suture materials and knots for arthroscopic repair.

Arthroscopy↗

PubMed1997

MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors.

PURPOSE: To evaluate accuracy in interpretation of shoulder magnetic resonance (MR) images and interobserver agreement and to characterize the types of errors. MATERIALS AND METHODS: Five radiologists with varying experience independently and retrospectively twice interpreted the MR images of 222 symptomatic patients who underwent both MR imaging and shoulder arthroscopy. The first interpretation was a blind review; the second was with knowledge of the arthroscopic findings. RESULTS: For full-thickness tears, the sensitivity, specificity, and accuracy were 84%-96%, 94%-98%, and 92%-97%, respectively, and for partial tears, 35%-44%, 85%-97%, and 77%-87%, respectively. There was no statistically significant difference between readers in the detection of partial or full-thickness tears. There was a statistically significant difference between readers in the no-tear category. Cohen kappa values generally indicated improved interobserver agreement proportional to the readers' experience (full-thickness tears, 0.731-0.881; partial tears, 0.168-0.443). CONCLUSION: Diagnosis of a full-thickness tear can be learned to a high degree of accuracy. Despite the radiologist's level of experience and knowledge of the arthroscopic findings, the sensitivity for diagnosis of partial tears is poor.

Adolescent↗

PubMed2006

[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].

PURPOSE OF THE STUDY: The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. MATERIAL: Three groups of materials were used. Materials for the first and second groups were provided by the Department of Anatomy, First Faculty of Medicine, Charles University. The first group included 10 specimens (five left and five right humeral bones) obtained at routine anatomical dissection. The second group contained 110 so-called dry preparations from the collections of the Department of Anatomy and the third group comprised nuclear magnetic resonance (NMR) scans of 20 patients. To show spatial relationships between the proximal and the distal humerus, another coil was applied to the epicondylar region in addition to the one placed over the proximal humerus. METHODS: The first group material was used to study proximal humerus morphology and to determine reference points for the other two groups. The points were constructed to make seven planes perpendicular to the axis of the proximal humeral metaphysis. Based on the reference points, parameters of the proximal humerus were assessed in the defined planes also in the other two groups. We measured angles between the reference points and the transepicondylar line or the humeral head axis. The vertex of each angle was always placed in the point of intersection of the metaphyseal axis and the given transverse plane. Reference points of the greater tubercle were marked on the medial margin continuous with the intertubercular groove, on the lateral margin of the lesser tubercle and in the "deepest" place of the intertubercular groove. We also measured humeral head retroversion and the position of maximal bony mass of both the greater and the lesser tubercle (this parameter can be used with advantage for optimal insertion of screws in proximal humerus reconstruction). RESULTS: The angle between the medial margin of the greater tubercle and the humeral head axis was on average 164.8 degrees on the left side and 163.2 degrees on the right side; the angle between the great tubercle margin and the transepicondylar line was 137.0 degrees on the left humerus and 137.7 degrees on the right humerus. The lateral margin of the lesser tubercle and the humeral head axis formed on average an angle of 124.4 degrees and of 122.6 degrees on the right and the left side, respectively. The intertubercular groove/ humeral head axis relationship was 143.4 degrees and 144.8 degrees for the left and the right humerus, respectively, and the intertubercular groove/transepicondylar line angle was 115.6 degrees for the left and 119.5 degrees for the right humerus. The humeral head axis and the transepicondylar line made an angle of 27.8 degrees for the left and 25.3 degrees for the right humerus. These values corresponded to the angle of the humeral head retroversion. The reference point of maximal bony mass of the greater tubercle and the humeral head axis made an angle of 181.1 degrees and of 180.2 degrees for the left and the right humerus, respectively; between this point and the lesser tubercle was an angle of 120.2 degrees for the left and 126.9 degrees for the right humerus. DISCUSSION: One of the most important parameters in restoring shoulder function by alloplasty is humeral head retroversion. If this is not correct, ventral or, less frequently, dorsal instability of the shoulder may result. The correct setting of retroversion is guided by the transepicondylar line or several specific landmarks on the greater and the lesser tubercle of the humerus. Another important factor is the correct reconstruction of anatomic position of the greater and the lesser tubercle in relation to the insertion of rotator cuff muscles into the humeral head. Relationships of diaphyseal, metaphyseal and humeral head axes have been reported in the relevant literature dealing with proximal femoral morphology. None of the reports, however, has dealt with tubercular angles and position of the maximal body mass, which is a decisive factor for insertion of screws fixing the prosthetic stem. CONCLUSIONS: The values provided here can be used for a more precise construction of implants for shoulder replacement. The method of three-dimensional presentation of the proximal humerus may aid in a more exact implantation procedure during shoulder arthroplasty. An optimal position of the implant can also be based on parameters obtained from the healthy contralateral shoulder joint.

Anthropometry↗

PubMed2006

Repair of large supraspinatus rotator-cuff defects by infraspinatus and subscapularis tendon transfers in a cadaver model.

Transosseous repair of a supraspinatus tendon (SSP) defect (Patte size II) can be difficult if the tendon is retracted and the muscle atrophied. In this situation alternatives are margin convergence techniques, local tendon transfers or distant tendon transfers in massive tears. The object of this study was to compare two local tendon transfers in terms of the feasibility of the shift, the area covered by the shift and the force needed to accomplish the shift. Thirteen fresh-frozen cadaver shoulders were used. First a supraspinatus defect extending to the apex of the humeral head (Patte size II) was created. Transosseous repair was attempted with the infraspintus (ISP) and with the subscapularis (SCP) in all cases; repair was successful in all ISP cases, while use of the SCP resulted in a successful repair in only 8 of the 13 (61.5%). A significantly (P=0.012) larger defect area was covered by the ISP transfer than by the SCP shift: 89.7+/-8.5% versus 31.2+/-31.1% of the original defect, respectively. The tensile force needed to accomplish the shift was significantly (P=0.004) lower when the ISP was used (15+/-11 N) than with the SCP (37.1+/-15 N). In this cadaver model the ISP shift proved more favourable than the SCP shift for covering a Patte size II SSP defect.

Aged↗

PubMedDate not supplied

Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area.

PURPOSE: To quantitatively determine the 3-dimensional (3-D) area of the original supraspinatus insertion and compare it with the repair-site area after 4 reconstructions of a simulated supraspinatus tear. TYPE OF STUDY: Ex vivo biomechanical study. METHODS: The outline of the original supraspinatus insertion was obtained in 10 human cadaveric shoulders using a 3-D digitizer. A supraspinatus tear was created and 4 repair techniques were evaluated: transosseous simple suture (TOS), transosseous mattress suture (TOM), suture-anchor simple suture (SAS), suture-anchor mattress suture (SAM). The 3-D outlines of the reconstructed supraspinatus insertion were digitized after each repair. The outlines of the original supraspinatus insertion and repair areas were superimposed onto humeral geometry obtained from a laser scanner, and surface areas were calculated. RESULTS: The original supraspinatus insertion area was larger than any of the repair-site areas (P <.05). On average, TOS provided a 20% larger repair-site area than the other repairs (P <.05). Repair-site areas were not different among TOM, SAS, or SAM repairs (P >.05) and covered 67% of the original supraspinatus insertion. CONCLUSIONS: None of the tested repairs restored the area of the original supraspinatus insertion. The larger repair-site area of the TOS repair suggests that this technique provides better potential for healing and, ultimately, greater strength of repair.

Aged↗