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PubMed2006

Arthroscopic transosseous reinsertion of the rotator cuff.

OBJECTIVE: Arthroscopic reinsertion of the supraspinatus and infraspinatus tendons by means of imitation of an open transosseous reinsertion technique. INDICATIONS: Tears in the tendon cuffs of the supraspinatus and infraspinatus muscles. Patients < 75 years of age. CONTRAINDICATIONS: Retracted tendons that cannot be sufficiently mobilized to provide a tension-free reinsertion. Tears of the tendon cuff of the subscapsularis muscle. SURGICAL TECHNIQUE: The free edges of the tendons are sparingly resected. The tendon attachment site on the greater tuberosity is freed of soft tissue and decorticated using an arthroscopic bone burr. A full-radius burr is used to drill insertion sites for the sutures in the tuberosity. A hollow needle is inserted percutaneously to puncture the free edges of the tendon for a single reinsertion suture. The hollow needle is then fed through the greater tuberosity to the lateral portal. The suture is guided through the needle and advanced via a working cannula. If the tear is > 2 cm in width, a mattress suture should be placed via another channel in the bone. This is to provide plane contact of the tendon to the reinsertion site. POSTOPERATIVE MANAGEMENT: Restriction of movement using a shoulder bandage for 6 weeks after the operation. RESULTS: In the 75 patients treated using a single suture, there was an improvement compared to the related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).

Adult↗
PubMed2002

Calcific tendinitis of the rotator cuff as a cause of drooping shoulder.

We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.

Calcinosis↗
PubMed2001

Technical note: The quadrant technique for arthroscopic treatment of rotator cuff calcifications.

Reliable intraoperative localization of the calcium deposit is the most demanding and often time-consuming part of arthroscopic surgery for calcifying tendinitis of the rotator cuff. A new technique is described to intraoperatively localize calcium deposits based on preoperative ultrasonographic identification and subsequent assignment to a defined quadrant lateral of the acromion edge. The technique requires only a partial subacromial bursectomy, making the procedure less invasive and faster to perform.

Journal Article↗
PubMedDate not supplied

[Extracorporeal shockwave therapy in tendionosis calcarea of the rotator cuff: comparison of different treatment protocols].

AIM OF THE STUDY: Extracorporeal shock wave therapy (ESWT) is a new therapeutic procedure for chronically painful calcifying tendinitis of the rotator cuff. The therapy may vary with the number of applied impulses or with impulse energy. Shock waves with an energy of 0.04 to 0.12 mJ/mm2 define low-dose ESWT, in contrast to high-dose ESWT (> 0.12 mJ/mm2). The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT could be effective if the total amount of applied energy was similar. METHOD: Fifty patients were assigned at random to 2 groups. The treatment consisted of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). The patients were examined at 6 weeks, 3 and 6 months after treatment. X-rays were performed at each visit. RESULTS: The Constant Score improved from 64.5 to 77.5 (group 1) and from 67.2 to 79.4 (group 2) before and 6 months after treatment (p < 0.05). The values on the visual analog scale which ranges from 0 (no pain) to 100 (maximal pain) improved from 76.8 to 48.8 (group 1) and from 75.4 to 45.6 (group 2) before and 6 months after treatment respectively. The final results for both Constant Score and visual analog scale were obtained after 3 months. X-rays showed a complete or subtotal calcific resorption in 8 (group 1, 32%) and 12 (group 2, 48%) patients. CONCLUSION: Extracorporeal shock wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.

Adult↗
PubMed1981

The use of DMSO in tennis elbow and rotator cuff tendonitis: a double-blind study.

Over a 1-yr period, 102 patients with a clinical diagnosis of either medial or lateral epicondylitis (tennis elbow) or rotator cuff tendonitis were treated with topical applications of dimethyl sulfoxide (DMSO). A double-blind controlled study was carried out on these patients in the private practice of an orthopaedic surgeon to determine the efficacy of this material in the treatment of these two common clinical conditions. Beneficial effects were assessed with respect to improvement in pain, tenderness or swelling, and increase in the range of motion. Forty patients were treated for each of the two ailments; patients treated with the 70% DMSO aqueous solution did not receive any more beneficial effect from the drug than patients who received 5% DMSO aqueous placebo solution.

Adult↗
PubMed1990

A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis.

A prospective double blind placebo controlled study was carried out to compare the effects of subacromial injection of triamcinolone and oral diclofenac in patients with rotator cuff tendinitis over a 4-week period. Both forms of treatment were superior to placebo in reducing pain, improving active abduction and reducing functional limitation. Triamcinolone showed the greatest effect in these respects, and was significantly superior to diclofenac when patients showing improvements in all 3 variables together (responders) were considered.

Administration, Oral↗
PubMed1985

Rotator cuff repair with carbon filament. A preliminary report of five cases.

Carbon filament-polylactic acid (CPA) is useful in closing large and massive tears of the rotator cuff. CPA was not used to fill a large gap between the cuff edge and raw bone. In the small number of shoulders (five) repaired with CPA, the best results were obtained in first-time operations. In two patients who had total acromionectomies, the functional results were poor, as expected. CPA-assisted cuff repairs have not yet been shown to be significantly better than repairs with conventional techniques.

Acromion↗
PubMed1981

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, ad neutral protease with rotator cuff defects. III. Morphologic and biochemical studies of an excised synovium showing chondromatosis.

Synovial tissue excised from the unstable right shoulder joint of a patient with an absent rotator cuff, severe glenohumeral joint degeneration, and hydroxyapatite-containing microspherules, collagen types I, II, and III, active collagenase, and neutral protease in the joint fluid showed extensive osteochondromatosis histologically. Electronmicroscopy revealed calcific foci in microvilli which could easily escape into the adjacent joint space through areas denuded of synovial cells. Fibrocytes demonstrated intensive pinocytotic activity of unknown significance. Energy dispersive analysis showed elemental ratios consistent with hydroxyapatite. A literature review suggested some relationships between the various pathologic lesions present in this joint. Whether similar synovial changes exist in the opposite shoulder joint of this patient and in 3 other subjects with nearly identical clinical, radiographic, and joint fluid findings is not known.

Aged↗
PubMedDate not supplied

Chronic rotator cuff impingement in the throwing athlete.

Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability.

Adolescent↗
PubMed1990

Pathology and pathogenesis of bursal-side rotator cuff tears viewed from en bloc histologic sections.

Histologic sections from 12 en bloc surgical specimens were studied in order to clarify the pathogenesis of bursal-side rotator cuff tears (BSRCTs). The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. There were eight men and four women, with an average age of 48.7 years. Trauma was noted in three instances. All patients exhibited clinical evidence of subacromial impingement, which was confirmed at surgery. Histologic sections were stained with azan or hematoxylin and eosin. All the tears developed from within 1 cm of the insertion. The depth of the tears varied from a superficial flap to a nearly full-thickness tear. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. At the site of insertion and in the distal stump, local disruptions of the normal four layers of enthesis and areas of hypervascularity were observed in all sections. The proximal stumps were rounded, retracted, and avascular, with abundant chondrocytes. No active repair was noted in the proximal stumps. The pathogenesis of BSRCTs appears to be related to: (1) a combination of aging and precarious vascularity of the tendon, (2) repetitive movements of the arm at above-horizontal levels, (3) injury, and (4) especially subacromial-tendon impingement.

Acromion↗
PubMed1989

Rotator cuff surgery.

The surgical concepts and techniques presented here are superior to the traditional techniques that I used previously. The primary goal is to restore health to the rotator cuff. The new techniques of glenohumeral joint exposure and the augmentation tendon patch graft have expanded the possibilities of surgical shoulder care. The concept of primary impingement and traditional acromioplasty techniques warrant strong cautions.

Athletic Injuries↗
PubMed1981

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects.

Four women, aged 63 to 90 years old, presented with mildly painful shoulders of decreased mobility or stability. Radiographic evidence of a complete tear of the fibrous rotator cuff was present in 7 of 8 shoulder joints. Microspheroids containing hydroxyapatite crystals were seen by scanning electronmicroscopy in 12 of 13 synovial fluid samples. All synovial fluids showed activated collagenase and neutral protease activity. This constellation of findings represents a heretofore undescribed syndrome which we have designated "Milwaukee shoulder."

Aged↗
PubMed1981

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. II. Synovial fluid studies.

Hydroxyapatite crystals in spheroid-shaped masses 1.9-15.6 micrometer in diameter were found in 12 of 13 synovial fluids obtained from the shoulder joints of 4 patients with rotator cuff tears and glenohumeral osteoarthritis. Two of 16 control joint fluids also showed these particles. Collagen types I, II and III were identified in the joint fluid pellets from 3 of the 4 patients, and fibers with typical collagen periodicity were also seen on transmission electronmicroscopy. Collagenase and neutral protease activities were found in fluids from 5 joints in 3 patients, whereas active collagenase was found in only 1 of 10 fluids from rheumatoid arthritis patients and in none of 3 fluids from patients with osteoarthritis. Neutral protease activities were present in several rheumatoid joint fluids. These findings are compatible with the hypothesis of an enzymatic release of hydroxyapatite crystals from the synovium and endocytosis by synovial macrophage-like cells with subsequent crystal-stimulated release of collagenase and neutral protease into the joint fluid, completing a pathogenetic cycle.

Aged↗
PubMedDate not supplied

Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up.

The effectiveness of arthroscopic surgery, supervised exercises, and placebo was compared in 125 patients with rotator cuff disease (impingement syndrome stage II) in a randomized clinical trial. The median age was 48 years, and the median duration of complications was 1 to 2 years. The treatments were arthroscopic subacromial decompression performed by 2 experienced surgeons, an exercise regimen supervised for 3 to 6 months by 1 experienced physiotherapist, or 12 sessions of detuned soft laser (placebo) for 6 weeks. The criterion for success was a Neer shoulder score > 80. Fifteen (50%) and 11 (22%) of the patients randomized to placebo and exercises, respectively, had surgery during the 2 1/2-year follow-up period and were classified as having failure with the treatments. The success rate was higher (P < .01) for patients randomized to surgery (26 of 38) and exercises (27 of 44) compared with the placebo group (7 of 28). The odds ratio for success after surgery compared with exercises was 1.5 (95% confidence interval 0.6 to 3.7; P = .49). Including all patients who underwent operation, the success rate in those not on sick leave (19 of 21) before surgery was higher compared with those on sick leave (18 of 36) (adjusted odds ratio 5.6 [1.2 to 29.2]). Similar results were observed for patients not receiving versus those receiving regular pain medication before surgery (adjusted odds ratio 4.2 [1.2 to 15.8]).

Adult↗