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Results for “Rotator Cuff Injuries”

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At least 199 records · Page 11Linked to original sources
PubMed1991

The effect of arm position and capsular release on rotator cuff repair. A biomechanical study.

A cadaver study was performed to determine the effect of arm position and capsular release on rotator cuff repair. Artificial defects were made in the rotator cuff to include only the supraspinatus (small) or both supraspinatus and infraspinatus (large). The defects were repaired in a standard manner with the shoulder abducted 30 degrees at the glenohumeral joint. Strain gauges were placed on the lateral cortex of the greater tuberosity and measurements were recorded in 36 different combinations of abduction, flexion/extension, and medial/lateral rotation. Readings were obtained before and after capsular release. With small tears, tension in the repair increased significantly with movement from 30 degrees to 15 degrees of abduction (p < 0.01) but was minimally affected by changes in flexion or rotation. Capsular release significantly reduced the force (p < 0.01) at 0 degree and 15 degrees abduction. For large tears, abduction of 30 degrees or more with lateral rotation and extension consistently produced the lowest values. Capsular release resulted in 30% less force at 0 degree abduction (p < 0.05).

Arm↗
PubMed2005

Outcome of open rotator cuff repair. An analysis of risk factors.

The aim of this study was to evaluate the long-term functional outcome of full thickness rotator cuff tears treated by open repair and acromioplasty and to determine various factors affecting the outcome. This is a prospective clinical study on 42 patients who underwent full thickness rotator-cuff repair by a single surgeon between 2000 and 2003. The mean follow-up was 26 months. In patients with massive rotator cuff tear (n = 15), increase in the mean postoperative Constant score was significantly less compared to patients with small and moderate tears (p < 0.01). In patients older than sixty years, the improvement in postoperative Constant score was significantly less compared to the rest of the patients (p < 0.001). However, the postoperative Constant score significantly improved from the preoperative score in all patient groups (p < 0.0001). There was a significant negative correlation with size of cuff tear, age of the patient and Constant-Murley score (p < 0.05). Body mass index, smoking, gender, and the duration of symptoms did not have a significant effect on either Constant-Murley score or visual analogue score. We conclude that older patients and those with massive rotator cuff tear could benefit from surgical intervention, although not as much as younger patients and those with small/moderate size cuff tears.

Adult↗
PubMed2006

[Arthro-C-scan analysis of rotator cuff tears healing after arthroscopic repair: analysis of predictive factors in a consecutive series of 167 arthroscopic repairs].

PURPOSE OF THE STUDY: Arthroscopic repair of rotator cuff tears is a well described technique with good clinical results. The purpose of this work was to use the arthro-CT-scan to evaluate tendon healing after arthroscopic repair and search for epidemiological, anatomic and technical factors predictive of tendon healing. MATERIAL AND METHOD: This prospective consecutive series included 167 non-randomized shoulders. All patients underwent a preoperative assessment using the crude Constant score and a standard x-ray protocol to evaluate cuff status. Cuff repairs were all performed arthroscopically. The crude Constant score was used to follow patients. A control arthroscan was obtained in 148 patients. RESULTS: Mean patient age was 59 years, 46% men and 77% dominant side. Mean duration of symptoms before repair was nine months. The tears resulted from trauma in 28%, including 9% occupational accidents. The preoperative mean crude Constant score was 52.4 (range 15-77). An isolated tear of the supraspinatus was observed in 68%. Frontal retraction of the supraspinatus was distal in 74%. In 29 cases, reduction was difficult. The quality of the tendon was considered normal in 56 cases and non-anatomic repair was necessary in six. At last follow-up (19 months on average) the mean crude Constant score was 80 (range 49-95). Arthro-CT-scan was performed to control healing in 148 patients and revealed anatomic healing in 69, defective healing in 27, and repeated tears in 52 shoulders. Factors predictive of healing were: tear less than six months old, sedentary occupational activity, non-dominant side, young patient, female gender, isolated small non-retracted tear of the supraspinatus, normal appearance of an easily reduced tendon, and good bone quality. DISCUSSION: Time from tear to repair was long in this series. Tendon and muscle changes occurring after the injury could explain in part the healing failures. CONCLUSION: But this study confirmed good functional and anatomic results given by arthroscopic repair of rotator cuff tears.

Accidents, Occupational↗
PubMed2004

Superior labrum, anterior-posterior lesions and biceps injuries: diagnostic and treatment considerations.

Proximal biceps tendon rupture, biceps tendinitis, and medical biceps subluxation are injuries that occur alone and in association with other pathologic conditions of the shoulder. The literature describes various strategies for imaging and treating these biceps tendon complex injuries but offers no clear consensus on a gold-standard approach. The keys to successful treatment are an accurate diagnosis, identification of associated pathologic conditions, and assessment of functional limitations of the injury.

Arm Injuries↗
PubMed1995

[Magnetic resonance arthrography. Preliminary experience in study technic and main diagnostic applications].

In the study of osteoarticular conditions, MRI makes a definite diagnostic improvement, even though some problems are still to be solved. Thus, on the basis of their arthrographic experience, the authors experimentally applied this technique to MRI, to assess the actual feasibility of MR arthrography. Forty-three patients were selected to undergo MR examinations after the intraarticular injection of 15-20 ml paramagnetic contrast agent (Gd-DTPA), with 0.25% saline solution. Before MR arthrography every patient underwent a baseline MR arthrography exam. Normal anatomy was better depicted with MR arthrography. In all cases, even small lesions and other structural changes missed at baseline MRI were demonstrated. Therefore, in agreement with previous arthrographic and CT arthrographic reports, we believe MR arthrography to be a simple technique improving MR diagnostic capabilities in selected cases.

Ankle Joint↗
PubMed1988

Sonographic evaluation of the rotator cuff.

This article emphasizes the utility of ultrasound examination in the diagnosis of rotator cuff disease. A complete description is given of the way in which ultrasound examination of the shoulder is performed, the illustrations demonstrating normal anatomy as well as staging of the disease. The use of ultrasound in this setting can help to prevent a great deal of the pain associated with shoulder injury by establishing the nature and stage of injury before rotator cuff tear occurs.

Humans↗
PubMed1995

Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears.

This study documents the sensitivity and specificity of a clinical test to aid in the diagnosis of superior glenoid labral lesions. The anterior slide test, a method of applying an anteriorly and superiorly directed force to the glenohumeral joint, was performed on several groups of athletes. These included symptomatic athletes with isolated superior labral tears, rotator cuff tears, and instabilities, and asymptomatic athletes with rotational deficits. In addition, non-throwing athletes were tested. The sensitivity of the test was 78.4%, and the specificity was 91.5%. This study shows that the anterior slide test can be used in the clinical examination, in that it has high specificity for superior labral lesions, but not enough sensitivity to be the sole diagnostic criterion for these lesions.

Adolescent↗
PubMed2000

[Shoulder injury in general practice].

Injuries to the shoulder and shoulder-girdle represent a demanding diagnostic and therapeutic challenge. The complex and minimally constrained anatomic construction of the joints is critical. Although a large majority of the injuries are relatively trivial it is essential to recognize critical lesions that deserve intensive investigation and appropriate treatment. In view of the severity of the consequences of particular injury patterns this article focuses on fractures of the proximal humerus, gleno-humeral dislocations and on acute ruptures of the rotator cuff. In particular, attention will be drawn on fractures with avascular head fragment, primarily undisplaced fractures of the anatomic neck, unrecognized posterior dislocation and on under diagnosed acute ruptures of the rotator cuff. The key issue for a secure diagnosis are a precise physical examination and an adequate conventional radiologic investigation. Both aspects are discussed with practically relevant suggestions.

Arthroscopy↗
PubMedDate not supplied

An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test.

The purpose of this technical note is to introduce the ramp test and explain this arthroscopic technique. The ramp test is used to test the integrity of the soft tissue restraint to intra-articular subluxation of the long head of the biceps tendon. Injury to the soft tissue restraint, the hidden lesion, has been proposed as occurring in conjunction with a full-thickness rotator cuff tear. Both cadaveric dissections and arthroscopic patient assessments were conducted to develop the ramp test. In this study, 17 patients also presented with refractory anterior shoulder pain and underwent arthroscopy to further characterize the ramp test. An abnormal examination result showed that the long head of the biceps tendon translated medially and inferiorly across the humeral head. In addition, this subgroup of 17 patients all had an abnormal ramp test but did not have a full-thickness rotator cuff tear. The ramp test is now applied to all arthroscopic procedures by the senior author, and we recommend its use for arthroscopic confirmation of intra-articular subluxation of the long head of the biceps tendon. Thus, we advocate that an abnormal ramp test result indicates pathology and warrants the surgical removal of the long head of the biceps tendon from the glenohumeral joint.

Arthroscopy↗
PubMed2004

Acute shoulder injuries.

The shoulder is the most mobile joint in the human body. The cost of such versatility is an increased risk of injury. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. Clavicle fractures are among the most common acute shoulder injuries, and more than 80 percent of them can be managed conservatively. Humeral head fractures are less common and usually occur in elderly persons; 85 percent of them can be managed nonoperatively. Common acute soft tissue injuries include shoulder dislocations, rotator cuff tears, and acromioclavicular sprains. Acromioclavicular injuries are graded from types I to VI. Types I and II are treated conservatively, types IV to VI are treated surgically, and there is debate about the best approach for type III. Eighty percent of shoulder dislocations are anterior. Diagnosis of this injury is straightforward. The injury usually can be reduced by employing a number of nonsurgical techniques. Traumatic or acute rotator cuff tears can be managed conservatively or surgically, depending on the patient and the degree of injury.

Acromioclavicular Joint↗
PubMed2003

Arthroscopic evaluation and management of rotator cuff tears.

The development of arthroscopic techniques has provided the shoulder surgeon with new opportunities to improve the chances of salvaging these difficult rotator cuff tears while generally avoiding the potential disastrous consequences attendant to the open procedures. The arthroscope can be used to review and document the status of the joint and cuff, assess the tear pattern, debride damaged tissues, and smooth the acromion. In addition, a trained shoulder arthroscopist can mobilize the available tissues and repair any viable tendon to bone, without damage to the overlying muscles, through small cosmetic incisions in an outpatient surgery setting. If there proves to be an irreparable injury, debridement and bone smoothing can be readily performed, avoiding iatrogenic injury to the remaining healthy tissues, especially the deltoid muscle. The patient and the surgeon must accept that the arthroscope is merely a helpful surgical tool, a convenient method to visualize the anatomy without damaging other tissues. When one attempts to repair a massive cuff tear, even with the aid of the arthroscope, there are no miracles or magic involved and often the results are less than perfect. Fortunately, once one can see the relevant anatomy, the opportunities to safely repair the tissues are then unprecedented.

Arthroscopy↗
PubMed2005

Subscapularis tendon tears.

Pathology of the subscapularis tendon is both infrequently identified and not commonly considered as a major source of shoulder pain and dysfunction. Subscapularis tendon pathology can present as isolated tears; partial-thickness tears; anterosuperior tears, also involving the supraspinatus tendon; complete rotator cuff avulsion; and rotator interval lesions, in which instability of the long head of the biceps tendon may dominate the clinical presentation. Although an accurate physical examination is paramount, modalities such as arthroscopy, magnetic resonance imaging, and ultrasound have advanced knowledge of the spectrum of abnormalities involving the subscapularis tendon. Nonsurgical management may be effective for most partial tears. Surgically, open repair is more frequent than use of arthroscopic techniques. Tears of the subscapularis tendon portend a different prognosis than do supraspinatus tendon tears, especially when the injury is acute and diagnosis is delayed.

Arthroscopy↗
PubMed2006

Pathological muscle activation patterns in patients with massive rotator cuff tears, with and without subacromial anaesthetics.

A mechanical deficit due to a massive rotator cuff tear is generally concurrent to a pain-induced decrease of maximum arm elevation and peak elevation torque. The purpose of this study was to measure shoulder muscle coordination in patients with massive cuff tears, including the effect of subacromial pain suppression. Ten patients, with MRI-proven cuff tears, performed an isometric force task in which they were asked to exert a force in 24 equidistant intervals in a plane perpendicular to the humerus. By means of bi-polar surface electromyography (EMG) the direction of the maximal muscle activation or principal action of six muscles, as well as the external force, were identified prior to, and after subacromial pain suppression. Subacromial lidocaine injection led to a significant reduction of pain and a significant increase in exerted arm force. Prior to the pain suppression, we observed an activation pattern of the arm adductors (pectoralis major pars clavicularis and/or latissimus dorsi and/or teres major) during abduction force delivery in eight patients. In these eight patients, adductor activation was different from the normal adductor activation pattern. Five out of these eight restored this aberrant activity (partly) in one or more adductor muscles after subacromial lidocaine injection. Absence of glenoid directed forces of the supraspinate muscle and compensation for the lost supraspinate abduction torque by the deltoideus leads to destabilizating forces in the glenohumeral joint, with subsequent upward translation of the humeral head and pain. In order to reduce the superior translation force, arm adductors will be co-activated at the cost of arm force and abduction torque. Pain seems to be the key factor in this (avoidance) mechanism, explaining the observed limitations in arm force and limitations in maximum arm elevation in patients suffering subacromial pathologies. Masking this pain may further deteriorate the subacromial tissues as a result of proximal migration of the humeral head and subsequent impingement of subacromial tissues.

Aged↗
PubMedDate not supplied

Arthroscopic labral debridement. A three-year follow-up study.

UNLABELLED: This is a retrospective review of 40 patients who underwent arthroscopic labral debridement of the shoulder. All patients were active participants in sports involving use of the shoulder. All patients presented with shoulder pain. Only 40% were found to have distinct glenohumeral instability on examination. At surgery, all patients had labral injury. Ten patients had anterosuperior labral tears, 20 had anteroinferior labral tears or detachments, and 10 had posteroinferior labral tears or detachments. Outcome was assessed at a minimum of 2 years (average, 43 months) postoperatively. Overall, only 7% of the patients had significant symptomatic relief at followup. However, 72% noted relief of symptoms during the 1st year after surgery, but there was deterioration over time. CONCLUSION: Arthroscopic labral debridement is not an effective long-term solution for symptomatic relief in the overhead athlete.

Adolescent↗
PubMed2004

Shoulder pain in sports.

Shoulder pain in athletic individuals is common, particularly in those sports that are upper limb dominant. It is important to make an accurate diagnosis so that appropriate treatment can be directed at the cause.

Athletic Injuries↗
PubMed1997

Arthrolysis of the shoulder for ruptures of the rotator cuff.

Complete repair of tears of the rotator cuff may be difficult, but with superior arthrolysis by the Apoil-Dautry technique the lesion in the cuff is not treated. We report 17 patients who had this procedure for large cuff defects. The outcome is directly related to the duration of symptoms, and we only had good results in a few patients, although intensive physiotherapy improves function. A wide debridement is needed, followed by intensive physiotherapy for the deltoid and shoulder stabilising muscles. We recommended that this technique should be used in elderly patients who will put less demand on their shoulders.

Aged↗
PubMed2004

Shoulder imaging in athletes.

Shoulder pain and injuries are common in athletes. Overhead athletes, in particular, place great demands on the shoulder and supporting structures. Magnetic resonance (MR) imaging is well suited to evaluation of the osseous structures and soft tissues of the shoulder and plays an important role in evaluation of shoulder pain in athletes. Primary extrinsic impingement is well evaluated on MR imaging as are the less common posterior superior glenoid impingement and subcoracoid impingement. Rotator cuff tendinosis as well as partial- and full-thickness tears are frequently encountered in the athletic shoulder. The biceps tendon and rotator interval capsular structures are important sources of shoulder pain. Glenohumeral instability that results from a traumatic event or atraumatic multidirectional recurrent instability is assessed. The biceps labral complex is a source of considerable anatomic variability and pathology.

Athletic Injuries↗
PubMed2003

[EMG analysis of shoulder muscles during preventive and therapeutic exercise in the overhead athlete].

Strengthening of the rotator cuff muscles in functional positions is one of the important demands in the prevention and rehabilitation of overhead athletes. The purpose of this study was to evaluate the influence of a new shoulder bar (SBT 1000) on the myoelectric activity of the deltoid muscle. Subjects included 12 healthy overhead athletes (control group) and 9 overhead athletes with subacromial pain syndrome (test group). Both groups performed bilateral internal and external shoulder rotations against resistance from a pulley. The position of 90 degrees abduction and elbow flexion was passively supported with the SBT 1000 and had to be actively hold without the SBT 1000. The electromyographic activity of the three heads of the deltoid was determined using surface electrodes. Rectified mean EMG data were analysed by three factor repeated measures ANOVA (group x bodyside x condition). Significant differences (p < 0,05) occurred between the conditions with and without SBT 1000 in all three heads of the deltoid. The percentage of reduction of muscle activity with the SBT 1000 in the dominant arm was 33 %, 29 % and 17 % for the anterior, middle and posterior head. No significant differences could be shown between control and test group or between the dominant and nondominant arm. With the SBT 1000 rotational shoulder exercise can be performed in a functional position with reduced involvement of the deltoid, which could be beneficial in prevention and rehabilitation of overhead athletes.

Adult↗