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PubMedDate not supplied

Mechanical environment associated with rotator cuff tears.

A simplified 2-dimensional finite element model was used to investigate the stress environment in the supraspinatus tendon. The extrafibrillar matrix and collagen fiber were modeled with fiber-reinforced composite elements. The stress was evaluated at humeroscapular elevation angles of 0 degree, 30 degrees, and 60 degrees. Two acromion conditions were simulated. In the first set of conditions there was no subacromial impingement. In the second set there was subacromial impingement of the bursal side. Impingement was simulated by producing a 1-mm indentation on the bursal surface, an indentation similar to the type of impingement associated with deltoid contraction. The results demonstrated that subacromial impingement generates high stress concentrations in and around the critical zone. Such high stress could initiate a tear; tears that result from stress point to an extrinsic mechanism. However, we found that high stress and potential tears caused by impingement may occur on the bursal side, the articular side, or within the tendon. This result is unaccounted for by traditional mechanical models in which only bursal-sided partial tears are initiated by subacromial impingement.

Aged↗

PubMed2006

Arthroscopic transosseous suture anchor technique for rotator cuff repairs.

The skin is incised 1 to 2 cm distal to the lateral portal. A transosseous tunnel is created through the greater tuberosity by a sharp penetrator, entering 1.5 to 2 cm distal to the top of the greater tuberosity. The penetrator exits medially, between the tip of the greater tuberosity and the articular surface of the humeral head, in the middle of the footprint. The first anchor, a 5-mm Spiralok (DePuy Mitek, Norwood, MA) is placed at the penetrator's exit site on the footprint. Using a specially designed suture leader, the lateral limb of the suture in the anchor, which passes through the previously created transosseous tunnel, is taken from the anchor and pulled out. The other suture end is passed through the supraspinatus tendon. The second suture, placed superficially in the anchor, is passed from the anchor through the supraspinatus tendon, as a mattress suture. If more anchors are required, the procedure should be repeated. The transosseous suture limb and the suture limb that is passed through the supraspinatus tendon are tied through the lateral portal. The knot tying is then performed with a sliding Delimar knot. The mattress suture, passing through the supraspinatus tendon, is tied through the anterior lateral portal. The knot tying procedure is repeated depending on the number of anchors.

Arthroscopy↗

PubMed2004

Grammont's reverse shoulder prosthesis for rotator cuff arthropathy. A retrospective study of 32 cases.

The authors have retrospectively studied a series of 32 reverse shoulder prostheses implanted in 30 patients by the same surgeon between 1992 and 2000. The mean age was 71 years; 26 patients were female, 4 were male. Thirteen patients (14 prostheses) were clinically and radiologically examined at follow-up; 9 patients (10 prostheses) were questioned by telephone and their radiological records were studied. With a mean follow-up of 31 months, 92 % (22/24) were entirely satisfied with the operation. The mean Constant score for the 14 shoulders which were clinically evaluated at follow-up was 60/100. There was one failure, related with glenoid loosening. These findings are in line with the good short-term results previously reported with this prosthesis. Glenoid notching is a well-known problem with the reversed prosthesis; it may lead to implant failure. We noted such an image in 50 % of our patients. In several cases however, the radiological finding was more suggestive of osteophytic formation than of real bony erosion, an observation that has not been reported before. The image remained stable over time and did not lead to glenoid loosening within the time limits of the study. Nevertheless, notching remains a concern with respect to the long-term survival of these implants which should therefore, in our opinion, be used only in elderly patients. Whether improved technique or design modification can address this issue still has to be established.

Aged↗

PubMed2000

Muscle sizes and moment arms of rotator cuff muscles determined by magnetic resonance imaging.

Biomechanical models which require information on, e.g., joint torque and muscle force are useful in the estimation of when and how mechanical overload of the musculoskeletal system may lead to disorders. The aim was to study the reliability and validity of magnetic resonance imaging (MRI) to quantify muscle sizes and moment arms by MRI and to test selected anthropometric measures as predictors of muscle sizes and moment arms. A total of 20 healthy Scandinavian women (age 22-58 years) participated in an MRI scanning of their dominant shoulder. With a PC-based program the reliability and the validity of the MRI measurements was estimated to be high, and mean anatomical cross-sectional areas (ACSA) and muscle lengths were measured to be 4.0, 9.8 and 12.1 cm(2) and 12.0, 12.6 and 12.8 cm for m. supraspinatus, m. infraspinatus and m. subscapularis, respectively. Volumes were calculated to be 48.8, 125.1 and 153.6 cm(3). Moment arms were measured with the upper arm in a neutral position and in a functional position of 34 degrees abduction for m. supraspinatus only, and were 2.4 and 2.6 cm. Physiological cross-sectional area (PCSA) and its fiber force component were estimated from dissected fiber length and pennation angle. MRI volume and PCSA were 1.4-1.7 times higher than dissection data, primarily because of age differences. No external anthropometric measures were found to be predictors of volumes or moment arms.

Adult↗

PubMedDate not supplied

[Work capacity of housewives with complete laceration of the rotator cuff].

OBJECTIVE: The aim of the this study is to evaluate the work capacity of housewives with full thickness tear of the rotatory cuff (FTTRC). METHODS: Twenty-five subjects have been studied. The FTTRC was located un the right shoulder in 16 cases, in the left shoulder in 5 cases and was bilateral in 4 patients. All patients were female; the average age was 72.4 +/- 4 (range 62-81). The Assessments were made using the Constant Scale, the Groningen Activity Restriction Scale and the Simon's Test. RESULTS: The result of this study confirmed that none of the housewives was able to carry out the houseworks quite independently and with no effort. 16% of the patients did the houseworks with great effort while 84% was helped in making some activities. Help is necessary for the usual housework and heavy domestic works (washing glasses, using vacuum cleaner to clean the floor). Patient's relatives provided help in 76.2% of cases while 23.8% were assisted by maid. Help was occasional in 33.3% of cases, continuous in 52.3% and full in 14.4% of patients. Disability resulting from FTTRC is heavier in subjects where electrical household appliances are not used (p < 0.05) and in subjects who feel deep pain (p < 0.05). The active movements of shoulder, local shoulder pain and level of use of upper limbs do not affect domestic works. CONCLUSIONS: These study showed that FTTRC reduces work capacity of house wives. These disease is more preventing heavy domestic works.

Age Factors↗

PubMed2006

Engaging needles: a simple technique for arthroscopic side-to-side rotator cuff repair.

We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using a tendon stripper. Once satisfactory placement of 2 guide pins convergently is done, create a closed-end socket in the lateral femoral condyle with an adequate sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples using a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement from intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage.

Anesthesia, General↗

PubMed2001

The role of high-resolution ultrasonography in management of calcific tendonitis of the rotator cuff.

This article predicts the possibility of resorption of the calcific plaques in the shoulder using high-resolution ultrasonography (HRUS) and color Doppler ultrasound (CDUS), and evaluates the therapeutic effect of US-guided fine-needle multiple punctures of the calcific plaque. A total of 100 patients with calcific tendenosis were divided into 3 groups: In group 1, patients having chronic shoulder pain received conservative treatment; in group 2, patients having acute exacerbation of shoulder pain also received conservative treatment; and group 3 patients received US-guided fine-needle multiple punctures or aspiration. In CDUS, all images were classified as grade 0 (no color flow signals), grade 1 (weak spotty color flow signal), grade 2 (few rod-like color flow signals), grade 3 (many rod-like or linear color flow signals). In the follow-up study, marked improvement of patients' clinical condition with more than 50% size reduction of calcific plaque was defined as an effective treatment. There was no significant difference between group 1 and group 3 (p = 0.558) in CDUS, but there was a significant difference between group 1 and group 2 (p = 0.000), and group 2 and group 3 (p = 0.000) on the basis of classification of grade < 1 and grade > or = 1. There was also significant difference in the follow-up result of effective management between group 1 and group 3 (p = 0.000), and group 1 and group 2 (p = 0.000). In conclusion, HRUS with CDUS proved to be a good modality in evaluating the possibility of resorption of shoulder calcification and, if CDUS > or = grade 1 in calcific tendonitis, we highly recommend conservative treatment with regular follow-up. On the other hand, if CDUS < grade 1, fine-needle repeated puncture could be considered as an effective alternative treatment.

Adult↗

PubMed2003

Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial.

CONTEXT: Extracorporeal shock wave therapy (ESWT) has been used to treat calcific tendonitis of the shoulder, but trials of ESWT for this purpose have had methodological deficiencies and thus there is limited evidence for its effectiveness. OBJECTIVE: To determine whether fluoroscopy-guided ESWT improves function, reduces pain, and diminishes the size of calcific deposits in patients with chronic calcific tendonitis of the shoulder. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, randomized, placebo-controlled trial conducted between February 1997 and March 2001 among 144 patients (of 164 screened) recruited from referring primary care physicians, orthopedic surgeons, and sports physicians in 7 orthopedic departments in Germany and Austria. INTERVENTIONS: Either high-energy ESWT, low-energy ESWT, or placebo (sham treatment). The 2 ESWT groups received the same cumulative energy dose. Patients in all 3 groups received 2 treatment sessions approximately 2 weeks apart, followed by physical therapy. MAIN OUTCOME MEASURES: The primary end point was the change in the mean Constant and Murley Scale (CMS) score from baseline to 6 months after the intervention. Secondary end points were changes in the mean CMS scores at 3 and 12 months, as well as changes in self-rated pain and radiographic change in size of calcific deposits at 3, 6, and 12 months. RESULTS: Of 144 patients enrolled, all completed treatment as randomized and 134 completed the 6-month follow-up. Both high-energy and low-energy ESWT resulted in significant improvement in the 6-month mean (95% confidence interval [CI]) CMS score compared with sham treatment (high-energy ESWT: 31.0 [26.7-35.3] points; low-energy ESWT: 15.0 [10.2-19.8] points; sham treatment: 6.6 [1.4-11.8] points; P<.001 for both comparisons). Patients who received high-energy ESWT also had significant 6-month CMS improvements compared with those who received low-energy ESWT (P<.001). We found similar results for both the 3-month and 12-month CMS comparisons, as well as for self-rated pain and radiographic changes at 3, 6, and 12 months. CONCLUSIONS: Both high-energy and low-energy ESWT appeared to provide a beneficial effect on shoulder function, as well as on self-rated pain and diminished size of calcifications, compared with placebo. Furthermore, high-energy ESWT appeared to be superior to low-energy ESWT.

Calcinosis↗

PubMed1989

[Radiographic signs of rotator cuff tears in the shoulder].

In 42 patients affected by disruption of the whole layer of the shoulder rotator collar the authors compared radiographic changes on a simple radiograph in anterior-posterior projection with operation findings. The proliferative changes on the large trochanter of humerus and the humeroacromial distance were decisive for prognosis of the operation therapy for the disrupted collar. The patients with a shorter humeroacromial distance were affected, after the operation, by a worse external rotation of the arm, worse extension and muscular strength of the arm in the extension position. Radiographic changes observed on the shoulder together with other factors are decisive for the strategy of conservative and operation therapy.

Adult↗

PubMed1985

[Expert testimony on rotator cuff rupture].

In giving an expert opinion, it is difficult to differentiate between the two possible causes of damage of the rotator cup, degeneration and trauma. After description of the anatomical problems, different causes for degenerative changes, especially of the supraspinatus tendon, are discussed. Various possibilities of accidents are analysed if they can cause damage of the rotator cup. The special conditions of the private accident insurance are discussed.

Accidents↗

PubMedDate not supplied

[Rotator cuff rupture. Surgical results in relation to the approach].

This paper presents the results of surgery in a total of 43 cases of rupture of rotator muscle sheaths which were followed up. Surgery was carried out from a saber-cut incision (n = 24) and from a transacromial approach (n = 19). The follow-up period for the first group was 42.2 months, for the second 14.3 months. The procedures employed were, almost without exception, the Schuhnestel or continuous suture and transosseous fixation after McLaughlin. In Group I the results were very good and good in 22 patients (91.6%); results in two shoulders were poor. In Group II the results were somewhat poorer, with 76.5% very good and good results; this is attributable principally to the much shorter follow-up period. The poor results are analyzed. The coraco-acromial ligament was severed or resected in 22 cases. Neer acromioplasty is now performed routinely. The surgical approach appears to have no decisive influence on the result. Advantages and disadvantages of the various approaches are described. A particularly important factor is the small therapeutic team (surgeon and physiotherapist).

Adult↗

PubMedDate not supplied

[Lesions of the rotator cuff and acromioclavicular joint. Data of arthrography. Apropos of 2 cases].

Arthrography using an opaque medium to explore the shoulder in two cases demonstrated rupture of the rotator muscles sheath associated with a communication into the acromioclavicular joint. Rupture of the sheath allows direct contact between the humeral head and the capsule of the acromioclavicular joint which becomes eroded progressively. Recent studies have produced data indicating participation of the acromioclavicular joint in the natural history of deteriation of the sheath of the rotator muscles.

Acromioclavicular Joint↗

PubMedDate not supplied

Concentric versus eccentric isokinetic strengthening of the rotator cuff. Objective data versus functional test.

Twenty-two male and female college varsity tennis players trained for 6 weeks, one group using eccentric isokinetic internal and external shoulder rotation, and the second group using concentric isokinetic internal and external shoulder rotation. Subjects pretested and posttested both concentrically and eccentrically, so that training overflow and specificity could be examined. Three maximally hit tennis serves made before and after training, which were analyzed by high speed cinematography to obtain ball velocity, served as a functional performance measurement. Statistical analysis of peak torque (newton meters) and peak torque to body weight ratio have revealed significant concentric strength gains (P less than 0.005) in the concentric as well as the eccentric training groups. Eccentric strength gains were demonstrated by the concentric training group at selected speeds (P less than 0.05 and P less than 0.005) but were not generated in the eccentric group at the P less than 0.05 significance level. Functional test analysis shows an increase in maximal serve velocity at a significance level of P less than 0.005 in the concentric training group, with no significant (P greater than 0.01) increases in the eccentric group.

Female↗

PubMed1996

Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement--an anatomic study.

OBJECTIVE: The purpose of the study was to investigate the relationship of the distal supraspinatus tendon to the coracoacromial arch on radiographs and MR imaging at various shoulder positions. MATERIALS AND METHODS: Radiopaque and gadolinium-impregnated markers were sutured to the distal aspect of the supraspinatus tendon and along the coracoacromial ligament in three cadavers. While varying positions of the shoulder, we obtained gross anatomic visualization, radiographs, and MR images. RESULTS: Impingement of the distal aspect of the supraspinatus tendon between the acromion and the greater tuberosity of the humerus was well visualized during forward flexion and abduction of more than 30 degrees. Shoulder impingement was best seen at 60 degrees forward flexion, 60 degrees abduction, and internal rotation. CONCLUSION: MR imaging of different shoulder positions may help reveal the pathogenesis of shoulder impingement syndrome.

Aged↗

PubMed1971