Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of impingement.
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Adult↗
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[Reconstruction technics for ruptured rotator cuff].
The principal signs for the diagnosis of a ruptured rotator sheath are a painful arch and painful, restricted movement of the shoulder joint. The diagnosis is confirmed by arthrography. Surgical reconstruction is indicated only if prior conservative treatment has been unsuccessful. A variety of approaches to the rotator sheath are advocated. Of these, the posterior-superior incision described by Debeyre et al. is particularly worthy of consideration. This approach is especially suitable for more extensive ruptures. It is described here with modifications, including the various fixation methods used for rupture of the rotator sheaths in the authors' own patients. The results obtained by the authors are classified and compared with opinions expressed in the literature. It is emphasized that the procedure described is particularly suitable for reconstruction of ruptured rotator sheaths.
Adult↗
Differential expression of cytokines and nitric oxide synthase isoforms in human rotator cuff bursae.
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Adult↗
The effects of concentric versus eccentric isokinetic strength training of the rotator cuff in the plane of the scapula at various speeds.
This study compares the effects of three modes of isokinetic resistance training at the shoulder--concentric, eccentric, and a combination of both concentric and eccentric, with a group that received no training at all. Twenty-eight healthy volunteers (male and females), 18 to 36 years of age, with no history of shoulder pathology, were randomly assigned to one of four groups; concentric training, eccentric training, a combination of both concentric and eccentric training, or control (no training). Testing and training of the dominant shoulder was performed on an isokinetic dynamometer. All subjects were pretested and post-tested both concentrically and eccentrically for humeral internal/external rotation and abduction at speeds of 60 degrees/sec and 120 degrees/sec. Each training session consisted of a total of twelve sets of ten maximal repetitions, and was repeated three times a week for four weeks. The absolute and percent difference in peak force and peak torque for each group between the pretest and post-test was calculated for each combination of position, mode, and speed. A significant difference between the concentric/eccentric group and the eccentric group was found for abduction (p < 0.05). The eccentric group showed a significantly greater increase from the pretest to post-test for absolute differences in peak force and peak torque compared to the concentric/eccentric group (p < 0.05).
Adolescent↗
Imaging of the rotator cuff: an arthrographic pitfall.
We present a case where MRI and arthrography of the shoulder reports provided seemingly conflicting data. The subsequent findings at arthroscopy revealed a potential pitfall in arthrographic interpretation.
Aged↗
Removal of calcific deposits of the rotator cuff tendon using an intra-articular ultrasound probe.
Calcific tendonitis is a difficult condition to treat. In this report we describe a new technique for imaging the deposit in complicated cases. Previously the patient had an unsuccessful operation due to difficulty in visualising the deposit. An ultrasound probe was inserted arthroscopically and the calcification detected and then removed, this was later confirmed on external ultrasound.
Adult↗
Pseudoaneurysm after interscalene block for a rotator cuff repair.
We present a case of a 68-year-old female patient who had an interscalene nerve block (ISB) complicated by compression of her brachial plexus by a pseudoaneurysm. The complication occurred after the patient received an ISB as anesthesia for an outpatient shoulder procedure. Review of this complication should alert surgeons to consider this diagnosis as a possibility in patients with postoperative pain and/or neurologic compromise after receiving an ISB.
Aged↗
Single-tendon tears of the rotator cuff. Evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears.
Successful surgical treatment of single-tendon tears, which involve the supraspinatus or the subscapularis requires careful attention to technical details. In supraspinatus tears, careful mobilization and secure repair of the tendon will usually give a good outcome. In subscapularis tears, the diagnosis is not difficult if one carefully evaluates the patient for the classic pathognomonic findings of such a tear. If the tear is confirmed by CT or MR imaging and an acute repair is performed, the outcome is usually satisfactory.
Arthroscopy↗
Calcific tendinitis of the rotator cuff with trochiteal osteolysis. A rare clinical radiologic complication.
Among cases of calcific tendinitis that are unresponsive to any type of non-surgical treatment, the authors report 3 cases, out of a total of 32 submitted to surgery, that presented with an osteolytic cavity filled with calcium salts in the insertional region of the supraspinous tendon. These patients presented with pain that they had been experiencing for an average of 4 years, with acute recurrent episodes. When this pathology can be determined radiographically, early surgery is recommended, considering that any type of non-surgical treatment is destined to fail.
Adult↗
A prospective functional outcome study of shoulder arthroplasty for osteoarthritis with an intact rotator cuff.
Prospective pain relief and functional outcome data were obtained on 65 shoulder arthroplasties in 55 patients. Thirty-seven total shoulder arthroplasties (TSAs) and twenty-eight hemiarthroplasties were followed up for a mean of 4.3 years (range, 2-8 years). The mean age was 63 years. Pain scores on a visual analog scale improved from a preoperative mean of 64 to 12 postoperatively. TSA and hemiarthroplasty postoperative scores did not differ significantly, but TSA patients started with a worse preoperative score and improved more. Five other visual analog scale scores improved, including function and quality of life. There were similar relationships between TSAs and hemiarthroplasties in each instance (poorer preoperative scores and more improvement). The American Shoulder and Elbow Surgeons Shoulder Score Index improved from 39 to 88 with surgery. The hemiarthroplasty group improved from a mean of 42 to 84, and the TSA group improved from 37 to 91. Although the numerical differences were small, the superiority of TSAs with regard to final score and rate of improvement was statistically significant. Patients with the poorest preoperative scores improved the most, regardless of prosthesis type. Mean active forward elevation improved from 100 degrees to 147 degrees, external rotation improved from a mean of 7 degrees to 39 degrees, and internal rotation improved by a mean of 3 spinal segments. These measures did not differ between TSA and hemiarthroplasty patients. One implant failure was treated with revision from TSA to hemiarthroplasty. Radiographic parameters characterizing component position and offset were measured, but none was found to predict outcome. The results suggest a modest superiority of TSA over hemiarthroplasty in the medium term. Because both TSA and hemiarthroplasty provide considerable and nearly comparable improvement, the long-term risks of glenoid wear and loosening need to be clearly defined before a definitive conclusion can be reached regarding the differential indications for these two procedures.
Aged↗
Some peculiarities of the rotator cuff muscles.
The authors studied the origin, course and insertion as well as some peculiarities of RC muscles on 25 cadaverous fixed limbs. They discovered that RC muscles exchange muscle bundles and are secured by synovial sheaths. They described the articular muscles in all of the observed muscles, including the deltoid muscle, which significantly stretch the capsule of the glenohumeral joint. They expressed the opinion that the subscapular bursa enhances motions in the shoulder joint. Due to the possibilities of arthroscopic diagnostic and treatment methods, they are convinced that more attention must directed to this issue from both the morphological and functional perspective.
Aged↗
Cell and matrix changes associated with pathological calcification of the human rotator cuff tendons.
The causative mechanism of tendon calcification ('calcifying tendinitis') is unknown. In this report, pathological human tendon samples were examined to give morphological and ultrastructural detail of the calcified regions and these findings were compared with those from normal tendon. Selected specimens were cryosectioned to enable histochemical and immunohistochemical comparison of the occurrence and distribution of specific matrix molecules in diseased and normal tendon tissues. The lack of collagen type II and alkaline phosphatase in the pathological regions suggests that the calcification process is not mediated through an endochondral transition. In contrast, the pathological areas were characterised by widespread labelling for chondroitin-4-sulphate/dermatan sulphate and intense pericellular localisation of chondroitin-6-sulphate.
Adult↗
Changes in bone mineral density of the proximal humerus in Koreans: suture anchor in rotator cuff repair.
This study was conducted to obtain data concerning suture failure by identifying the change in bone mineral density in the proximal humerus relative to age and gender. Bone mineral density of the greater tuberosity, humeral head, and surgical neck of the proximal humerus was measured in 175 individuals (74 men and 101 women) aged >40 years. Compared to individuals in their 40s, the bone mineral density of the greater tuberosity of the humerus for women in their 70s showed a 42% decrease and in men a 43% decrease. It is therefore recommended that cadavers used for subsequent research on the fixation strength of suture anchors undergo bone mineral density analysis.
Absorptiometry, Photon↗
Tendon graft substitutes-rotator cuff patches.
Over the past few years, many biologic patches have been developed to augment repairs of large or complex tendon tears. These patches include both allograft and xenografts. Regardless of their origins, these products are primarily composed of purified type I collagen. Many factors should be considered when choosing an augmentation patch including tissue origin, graft processing, cross-linking, clinical experience, and physical properties. The purpose of this article is to familiarize the sports medicine community with several tendon augmentation grafts: GraftJacket (Wright Medical Technology, Arlington, TN), CuffPatch (Organogenesis, Canton, MA, licensed to Arthrotek, Warsaw, IN), Restore (Depuy, Warsaw, IN), Zimmer Collagen Repair (Permacol) patch (Tissue Science Laboratories Covington, GA, licensed to Zimmer, Warsaw, IN), TissueMend (TEI Biosciences, Boston, MA, licensed to Stryker Howmedica Osteonics, Kalamazoo, MI), OrthoADAPT (Pegasus Biologics, Irvine, CA), and BioBlanket (Kensey Nash, Exton, PA).
Arthroscopy↗
Rotator cuff impingement due to enchondroma of the acromion.
We report the case of a patient with a long standing clinical history of subacromial impingement, in which plain radiographs and CT-scan revealed a well-circumscribed lucent lesion expanding the undersurface of the acromion. MRI showed the subacromial fat to be completely obliterated and the infraspinatus tendon deformed due to compression by a mass localised at the acromion. The acromial lesion was curetted, and histopathologic analysis was consistent with the diagnosis of enchondroma. Tumours located in the coracoacromial arch have been very rarely reported as a cause of subacromial impingement. To the best of our knowledge, this is the first description of subacromial impingement secondary to acromial enchondroma.
Acromion↗
Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report.
This study examined the effects of high-energy shock wave treatment on the course of calcifying tendinitis of the shoulder. Twenty patients were included in the protocol. Shock waves were applied to the calcifications with a lithotripter in two sessions of 2000 pulses each. The energy that produced the shock wave was 18 to 22 kV. Six and 12 weeks after treatment the subjective and functional state was assessed with the Constant score. All patients underwent radiographs and magnetic resonance imaging. At the 12-week follow-up evaluation 15 patients had a marked reduction of symptoms with an average of 30% improvement in the Constant score. Radiographs showed a complete elimination of the calcifications in seven patients, and in five cases a partial disintegration was seen. The overall morbidity was low; 14 patients had a transient subcutaneous hematoma. Magnetic resonance imaging did not show any lasting damage to bone or soft tissue.
Adult↗
Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff.
This study was designed to investigate the histologic expression of the rat's supra- and infraspinatus tendons in carrageenan-induced subacromial bursitis. Thirty-two rats received subacromial injections with carrageenan (n = 28) or saline (n = 4). The tendons were analysed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and immunofluorescent staining of fibronectin and fibrinogen. In the controls (saline x 10) and group A (carrageenan x 5) there were no changes in the tendons. In group B (carrageenan x 10) 3/8 rats showed macrophages between the collagen fibres and an increased staining of fibronectin. In group C (double dosis carrageenan) all rats had signs of fibrocartilaginous metaplasia in the supraspinatus tendon. In eight of these specimens even bony metaplasia was seen. The infraspinatus tendon showed fibrosis but no fibrocartilaginous metaplasia. The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.
Acromion↗
Fibronectin, MMP-1 and histologic changes in rotator cuff disease.
This study was designed to investigate human surgical specimens from patients with impingement (n = 16), ruptured supraspinatus tendons (n = 7), frozen shoulder (n = 2) and controls (n = 9) with respect to histological changes and the presence of fibronectin and Matrix metalloprotease-1 (MMP-1). The biopsy of the middle part of the supraspinatus tendons was analyzed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and Phospho Tungstic Acid Hematoxyline for visualization of fibrin. Immunofluorescent stainings for fibronectin and MMP-1 were performed. Histology and immunofluorescence were assessed blindly. Necrotic tendinous tissue and fibrin were found only in some specimens from ruptures. The staining for fibronectin was significantly increased among patients with a rupture. MMP-1 was, however, only infrequently found in specimens from patients with impingement and ruptures. Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens. In conclusion, necrotic tendinous tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.
Adult↗