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PubMed1988

Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera.

In 200 shoulders from cadavera, we studied the pathological changes on the undersurface of the acromion as associated with tears of the rotator cuff. After radiographic and histological analysis, we found that in the specimens that had a partial tear of the cuff the undersurface of the acromion was almost intact. Although a lesion in the anterior one-third of the undersurface of the acromion was always associated with a tear of the cuff, the reverse was not true. We concluded that the pathogenesis of most of the tears probably is a degenerative process.

Acromion↗
PubMed2006

Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?

AIM: The purpose of the trial was to evaluate the efficacy of suprascapular nerve block (SSNB) to relieve the shoulder pain, ameliorate recovery after physiotherapy and reduce disability due to a rotator cuff tendinitis (RCT). A prospective, randomized, comparison cross over investigation was performed in the setting of a large inpatient rehabilitation unit with more than 200 admissions annually. METHODS: A total of 40 potential study subjects, who complained of shoulder pain from a RCT, were enrolled and randomly assigned to standard rehabilitation treatment plus SSNB (Group A) or to standard rehabilitation treatment alone (Group B). The UCLA shoulder rating scale was used to assess the shoulder mobility on admission and discharge, and to calculate the percentage of potential improvement achieved during rehabilitation (effectiveness). A pain visual analogic scale was used to serially assess pain. At the end of the trial, a self-report questionnaire evaluated whether patients could sleep and achieve activity of day life carry out everyday activities better than they could before treatment. RESULTS: Forty patients suffering from RCT entered the study. Those receiving nerve block from the beginning of the treatment in addition to standard rehabilitation therapy reported significantly less pain during physiotherapy and better final outcomes. During treatment with SSNBs, patients reported a more significant reduction in the intensity of pain and a better reduction of pain during sleep and rehabilitation exercises in comparison to with the standard therapy alone. A statistically significant inverse correlation was found between shoulder pain and mobility. CONCLUSIONS: The results indicate that combining nerve block with standard rehabilitative therapy may improve the final outcome of painful RCT. It decreased the severity and frequency of the perceived pain, improved the compliance with physiotherapy, restored more normal sleep patterns, and increased compliance with the rehabilitation program. This result proves to be an effective, safe and inexpensive therapeutic option for patients suffering from painful disabling shoulder tendinitis.

Chi-Square Distribution↗
PubMed1989

[Rotator cuff lesions: evaluation with RM and US].

Physical and instrumental examination of the patients with an "aching shoulder" is often difficult and a positive out-come of surgical treatment may be impaired by the late diagnosis of long-standing rotator cuff lesions causing tendon adhesions and muscle atrophy. The authors report the results obtained in 25 selected patients with an aching shoulder examined with arthrography, real-time ultrasound (US) with a 5 MHz linear probe, and high-field (1.5 T) Magnetic Resonance (MR) imaging. Arthrography was able to demonstrate a cuff tear in 14/25 cases; US detected signs of tear in 14/25 (1 false negative); MR imaging showed a cuff lesion in 16/25 patients, and in one case allowed a partial cuff tear to be demonstrated, which had not been visualized with arthrography. MR imaging could also demonstrate other signs of periarticular pathologies (tendinitis, longhead of biceps inflammation, and bursitis) that may represent the early stages of the inflammatory-degenerative process underlying most of cuff lesions. The high diagnostic accuracy of US (95%) is stressed in the detection of cuff tears, in patients with an aching shoulder; as for questionable cases at US, MR imaging is indicated as a valid alternative to arthrography, which is more invasive and less accepted by the patients.

Arthrography↗
PubMed1983

Sub-deltoid bursitis due to calcific tendonosis of the rotator cuff: a case report.

A case was reported at this private Chiropractic Office of a 50 year old white female with acute pain in the right anterior shoulder. Physical, neurological, and roentgenologic examinations revealed a diagnosis of calcific tendonosis of the right rotator cuff muscles with resultant Sub-Deltoid bursitis. A conservative regimen of therapy was instituted which included immobilization, physical therapy, manipulation, and eventually rehabilitative exercises.

Bursitis↗
PubMed2006

A probabilistic model of glenohumeral external rotation strength for healthy normals and rotator cuff tear cases.

The reigning paradigm of musculoskeletal modeling is to construct deterministic models from parameters of an "average" subject and make predictions for muscle forces and joint torques with this model. This approach is limited because it does not perform well for outliers, and it does not model the effects of population parameter variability. The purpose of this study was to simulate variability in musculoskeletal parameters on glenohumeral external rotation strength in healthy normals, and in rotator cuff tear case using a Monte Carlo model. The goal was to determine if variability in musculoskeletal parameters could quantifiably explain variability in glenohumeral external rotation strength. Multivariate Gamma distributions for musculoskeletal architecture and moment arm were constructed from empirical data. Gamma distributions of measured joint strength were constructed. Parameters were sampled from the distributions and input to the model to predict muscle forces and joint torques. The model predicted measured joint torques for healthy normals, subjects with supraspinatus tears, and subjects with infraspinatus-supraspinatus tears with small error. Muscle forces for the three conditions were predicted and compared. Variability in measured torques can be explained by differences in parameter variability.

Computer Simulation↗
PubMed1986

Shoulder-muscle strength and range of motion following surgical repair of full-thickness rotator-cuff tears.

Postoperative measurements of the range of motion and muscle strength of the shoulder and ratings of pain and the ability to perform daily activities were made in fifty-eight patients (sixty-three shoulders) who had a repair of a full-thickness rotator-cuff tear. Postoperatively, the patients had an average of 126 degrees of active flexion of the shoulder and an average of 130 degrees of active abduction. Passive motion averaged 21 degrees more than active motion. The strength of the abductor muscles of the shoulder averaged approximately 86 per cent of normal. Most patients reported marked relief of pain and rated themselves as having mild or no deficits in their ability to perform daily activities. The length of the cuff tear significantly affected the functional results. Short tears (less than 2.5 centimeters) were associated with greater strength and range of motion than were long tears. Fifteen of the nineteen patients who were unable to work preoperatively because of the shoulder returned to work after surgery, but not necessarily to the same type of work that they had done before the onset of the problem with the shoulder.

Acromion↗
PubMed1987

Impingement syndrome in the absence of rotator cuff tear (stages 1 and 2).

Impingement syndrome affects a wide range of today's active population with various pathologies and presentations. Tendinitis can cause further subacromial loading, unless specific attention is directed at interrupting this disorder. Today's emphasis in high-risk populations, such as pitchers and swimmers, is on prophylaxis. Once symptoms occur, the majority can be successfully managed with nonoperative measures. Prolonged failure of conservative care prior to rotator cuff tear requires surgical decompression with predictable success in most. Results can be optimalized if strict attention is paid to patient selection, surgical technique, and a carefully supervised rehabilitation program following surgery.

Combined Modality Therapy↗
PubMed1980

[Traumatic lesions of the capsula and tendons of the shoulder joint, rupture of the rotator cuff, strain fractures (author's transl)].

Traumatic lesions of the soft tissues in the region of the rotatory cuff of the shoulder and disinsertion of the tendons in the region of the shoulder joint are rare. They are seen in older patients and--without injury--in tendons which are damaged through degeneration. The diagnosis of such disinsertions is very difficult. Therefore, special diagnostic methods are described. Disinsertions, strain fractures and traumatic lesions of the rotator cuff can be treated surgically. The operation should be done only in case of adequate indication. Function, age and clinical symptoms should be carefully considered.

Adolescent↗
PubMed1997

Roles of deltoid and rotator cuff muscles in shoulder elevation.

OBJECTIVE: The objective of this study was to measure abduction moment arms of the supraspinatus, subscapularis, infraspinatus, and deltoid (anterior, middle, and posterior portions) muscles during humeral elevation in the scapular plane (abduction). DESIGN: Moment arms were measured by conducting an in vitro experiment. BACKGROUND: The moment arm of a muscle represents its mechanical advantage, which is an important determinant of muscle function. METHODS: Measurements were made on 10 fresh frozen cadaveric specimens. Tendon excursions were measured as the humerus was elevated in the plane of the scapula. The principle of virtual work was used to estimate the muscle moment arm of each muscle by computing the slope of the tendon excursion versus joint angle relationship. RESULTS: Moment arms were affected by joint angle in a non-linear fashion. The anterior deltoid, middle deltoid, subscapularis, and infraspinatus muscles had abduction moment arms throughout most of the range of motion studied. The posterior deltoid had an adduction moment arm. Internal and external humeral rotation affected the elevation moment arms of all six muscles. CONCLUSIONS: Abduction moment arm magnitudes of the muscles studies vary throughout the arc of elevation. This study was limited by considering broad muscles to have a single line of action. RELEVANCE: The positive elevation moment arms of the infraspinatus and subscapularis muscles indicate that they can elevate the arm in addition to acting as stabilizers. Thus this study suggests a biomechanical explanation for the clinical success of conservative treatment for rotator cuff tears.

Journal Article↗
PubMedDate not supplied

Rotator cuff function during a golf swing.

A study of bilateral shoulder muscle activity during the golf swing was undertaken using electromyography and high-speed photography. Understanding of the muscle firing patterns could lead to injury prevention and development of appropriate training and conditioning regimens. The swings of seven adult male right-handed professional golfers without shoulder problems were examined. Indwelling electrodes were inserted into the supraspinatus, subscapularis, infraspinatus, latissimus dorsi, pectoralis major, anterior deltoid, middle deltoid, and posterior deltoid on the right side. Each subject was allowed to warm up until he felt comfortable. Films of each subject were taken at 450 frames per second. The swing was broken into four segments to which electromyographic signals were synchronized electronically. The EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity obtained. All tests were repeated on the left side for each subject. Results indicate that all portions of the deltoid were inactive on the right side throughout the swing. The deltoid was likewise inactive on the left except for a brief spurt from the anterior portion during the milliseconds immediately preceding ball contact. Of the rotator cuff muscles, on the left the supraspinatus fired at a low level throughout the swing, as did the infraspinatus. The latter had a slightly larger burst of activity immediately after ball contact. The subscapularis was more active than any other muscle throughout the swing. The cuff muscles on the right side showed as much activity overall as those on the left. In addition, the latissimus dorsi and pectoralis major seemed to provide power bilaterally, with marked activity during the acceleration phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

[Impact of fatty degeneration of the suparspinatus and infraspinatus msucles on the prognosis of surgical repair of the rotator cuff].

PURPOSE OF THE STUDY: Rupture of the cuff tendons can induce a fatty degeneration of cuff muscles. In 1989 the authors proposed a grading in 5 stages of this degeneration based on CT scan. The purpose of this study was to determine whether this degeneration had an influence on anatomical and clinical results after surgical repair of the cuff. MATERIAL AND METHODS: Seventy-four patients operated for a ruptured cuff had prospectively a pre-operative CT scan grading of muscular degeneration, and a post-operative anatomical control by opaque arthrography at about 10.5 months follow-up. Forty-four patients were males and 30 were females. The mean age at operation was 58.7 (40 to 75). Fifty-two ruptures were large involving the supraspinatus and infraspinatus in 17 cases, the supraspinatus and the subscapularis in 20 cases and all three tendons in 15 patients. Twenty-two ruptures were smaller and involved only the supraspinatus. To repair the cuff, it was necessary to advance the supraspinatus muscle in 28 cases and both supra and infraspinatus in 24 cases. No patient was lost for follow-up, and 51 of the 56 having more than one year of follow-up (mean 3 years, maximum 7.5 years) were evaluated according to Constant and Murley score. Two reoperated patients were excluded from the final analysis. RESULTS: Complete supraspinatus tears after repair recurred in 16 cases (22 p.cent). No infraspinatus rupture occurred after 32 infraspinatus repairs. Re-tears were observed only when a muscular advancement had been performed. Except in one case, re-tears occurred only when supraspinatus and/or infraspinatus were degenerated. The mean Constant score at revision for 49 patients was 66.6 points. According to this scoring system, 67.3 p.cent had a satisfactory result, 24.5 p.cent a fair result, and 8.2 p.cent a bad result. The mean score of the 39 patients having a continent cuff was 67.4 points, and was not significatively better than that of the patients with a re-tear (63.7 points). The best results were noted for the postero-superior tears (74.6 points). The type of repair had no significative influence on the final Constant score. The best improvements in external rotation were observed when a double advancement was performed. The stage of fatty degeneration, particularly of the infraspinatus, had an influence on the final range of motion, particularly in external rotation, and on the final strength. DISCUSSION: The fatty degeneration of supra and infraspinatus is an important prognostic factor of the anatomical and functional results after surgical repair of the cuff. More-over, when it is present, the surgeon may have some difficulties to close the tear during surgery. This study confirms that it is probably better to operate rotator cuff tears before the appearance of irreversible muscular damage, particularly when the lesions extend posteriorly to the supraspinatus.

Adipose Tissue↗