Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Rotator Cuff”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed1995

Morphology of the torn rotator cuff.

The morphological characteristics of shoulders with torn rotator cuffs were determined using 41 embalmed specimens. The following parameters were measured in the supraspinatus (SSP), infraspinatus (ISP) and subscapularis (SSC) muscles: the length, thickness and width of the extramuscular tendon; the length of the intramuscular tendon; the length and width of a tear, if present, muscle fibre length; and muscle volume. The cross-sectional area (CSA) of the tendon was measured on the photographic image of slices of the tendon using an image analysis system, and the CSA of the muscle was calculated by dividing the muscle volume by muscle fibre length. The rotator cuff was intact in 11 shoulders. A partial-thickness tear of the cuff was present in 12 shoulders, a full-thickness tear of the SSP in 11 shoulders, and a full-thickness tear of more than 2 tendons in 7. Overall incidence of full-thickness tears of the rotator cuff was 44%, and that of partial-thickness tears 29%. With increase of tear size, the functional tendon length (extramuscular tendon length plus tear length) increased by a statistically significant amount in the SSP, ISP and SSC, whereas muscle fibre length decreased in SSP and ISP. It is concluded that the increased functional tendon length and decreased muscle fibre length are the main morphological changes that make the rotator cuff a physiologically abnormal unit. Surgical repair of the torn cuff would be expected to improve these anatomical changes and restore the kinetics of the glenohumeral joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Outcome of rotator cuff repair.

From 710 consecutive open rotator cuff repairs by a single surgeon, the results of 667 were available for detailed analysis. Patient-assessed outcomes and the ability to perform specific activities of daily living, employment, and recreation were correlated with independent nonstructural variables including age, sex, workers' compensation status, and revision surgery status. The study shows that patient self-assessment of satisfaction is very high, with 87.5% of all respondents pleased overall. Detailed assessment is provided of certain subgroups that are more likely to report worse results after surgery. These include patients on workers' compensation, those undergoing revision surgery, and those younger than 55 years of age. Information presented here may be useful during preoperative counseling for rotator cuff repairs, to ensure realistic patient expectations.

Activities of Daily Living↗
PubMed2000

Rotator cuff injuries.

Different types of rotator cuff injuries frequently present to Accident and Emergency departments and minor injury units but can be difficult to differentiate clinically. This brief case study describes the examination and diagnosis of related shoulder injuries, specifically rotator cuff tears/disruption and calcifying supraspinatus tendinitis. The relevant anatomy and current therapies for these injuries is also discussed to enable the emergency nurse practitioner to have a greater understanding of the theory surrounding their diagnosis and treatments.

Braces↗
PubMed2006

Rotator cuff injuries in the contact athlete.

Rotator cuff injuries in contact athletes are typically a result of a different mechanism than that seen with older patients or overhead athletes. This unique mechanism along with the extreme demands of these athletes presents special challenges to the surgeon. Special consideration should be given to in-season rehabilitation to allow the athlete to continue to compete if possible. When this is not possible, or for the out-of-season athlete with a rotator cuff injury requiring surgery, special consideration must be given to obtaining the strongest repair possible. The goal in all aspects of treatment is returning the athlete to full participation safely while minimizing recurrent injury or disability during the recovery process.

Arthroscopy↗
PubMed1983

Rotator cuff tear. Diagnosis and treatment.

Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended as a means of minimizing a progression of symptoms and findings. It was more important to achieve adequate tension in the cuff tissues than to obtain a water-tight closure. Even patients with old complete tears may obtain good results from reconstruction of the rotator cuff. However, merely closing a rotator cuff tear will not permit a good functional result if the ability of the muscles to contract adequately is lost forever. This group of patients rarely achieves full restoration of muscle strength in their operated shoulders, primarily due to muscle atrophy. In shoulders previously operated on, functional results were not as good as in those cases operated on for the first time. Avoidance of interposed soft tissue grafts and restoration of a direct continuity of viable rotator cuff tissue to its bony insertion are recommended whenever possible, to achieve the optimum functional result. In those patients with arthritis of the glenohumeral joint or permanent long-standing nonfunctional rotator cuff muscle, the results of reconstruction were poor. A carefully supervised postoperative rehabilitation program is essential for optimum results.

Acromion↗
PubMed2006

Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.

BACKGROUND: Treatment of irreparable rotator cuff tears remains controversial. Latissimus dorsi transfer to the greater tuberosity has been proposed for the treatment of irreparable tears associated with severe functional impairment and chronic, disabling pain. METHODS: Sixty-seven patients with sixty-nine irreparable, full-thickness tears of at least two complete tendons were managed with latissimus dorsi transfer and were reviewed clinically and radiographically after an average of fifty-three months. The study group included fifty-two men and fifteen women, with an average age of sixty-one years. Thirteen patients also had deficient subscapularis function preoperatively. Outcome measures included the Constant and Murley score and the Subjective Shoulder Value. Osteoarthritis and acromiohumeral distance were measured on standardized radiographs. RESULTS: The mean Subjective Shoulder Value increased from 28% preoperatively to 66% at the time of follow-up (p < 0.0001). The mean age and gender-matched Constant and Murley score improved from 55% to 73% (p < 0.0001). The pain score improved from 6 to 12 points (of a possible 15 points) (p < 0.0001). Flexion increased from 104 degrees to 123 degrees , abduction increased from 101 degrees to 119 degrees , and external rotation increased from 22 degrees to 29 degrees (p < 0.05). Abduction strength increased from 0.9 to 1.8 kg (p < 0.0001). There was a slight but significant increase in osteoarthritic changes (from stage 0.8 to stage 1.3; p = 0.0002). In shoulders with a negative preoperative lift-off test, significant improvements were observed in terms of both function and pain, and strength doubled from 1.0 to 2.0 kg (p = 0.0001), but osteoarthritic changes progressed from stage 0.7 to stage 1.1 (p = 0.0006). In shoulders with poor subscapularis function, no improvement in these parameters was observed. CONCLUSIONS: Latissimus dorsi transfer durably and substantially improves chronically painful, dysfunctional shoulders with irreparable rotator cuff tears, especially if the subscapularis is intact. If subscapularis function is deficient, the procedure is of questionable benefit and probably should not be used.

Acromion↗
PubMedDate not supplied

A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears.

This prospective study was undertaken to compare the ability of clinical estimation, diagnostic ultrasonography, magnetic resonance imaging, and arthroscopy to estimate the size of rotator cuff tears. Estimates of rotator cuff tear size were compared with the findings at open operation in 33 consecutive patients with a presumptive diagnosis of rotator cuff tear. Arthroscopy estimates of rotator cuff tear size correlated best with actual tear size (Pearson correlation coefficient r = 0.92; P <.001). Magnetic resonance imaging (r = 0.74; P <.001) was similar to ultrasonography (r = 0.73; P <.001). Estimates of rotator cuff tear size after clinical assessment alone had weaker correlation coefficients (r = 0.41; P =.02) than the other methods. Each method underestimated rotator cuff tear size by 12%, 30%, 33%, and 38%, respectively. No method was able to determine the size of partial-thickness rotator cuff tears (r < 0.02).

Aged↗
PubMed2002

The derotation sign for perioperative diagnosis of significant partial-thickness rotator cuff tears.

PURPOSE: To describe and evaluate a simple perioperative test (the derotation sign) that differentiates significant (grade 3) partial-thickness and small full-thickness rotator cuff tears from insignificant (grades 1 and 2) partial-thickness rotator cuff tears and intact rotator cuffs. TYPE OF STUDY: Sensitivity and specificity study. METHODS: A study was conducted of 123 patients who underwent shoulder arthroscopy for chronic symptomatic rotator cuff disease, each of whom was subjected to a derotation test under general anesthesia. Specifically, the glenohumeral joint was rapidly distended with fluid just before arthroscopy. One of 3 possible observations was made: (1) the arm rotated internally only, (2) the arm initially rotated internally and then externally rotated (positive derotation sign), or (3) the arm did not rotate at all. Arthroscopic findings were then correlated with the derotation test. RESULTS: Forty-one shoulders had no arm rotation on derotation testing; all had rotator cuff tears greater than 2 cm in size. Forty-two shoulders with impingement and no rotator cuff tears, as well as 23 shoulders with grade 1 or grade 2 partial-thickness rotator cuff tears showed internal rotation only. Seventeen shoulders had a positive derotation sign; all of these had either a grade 3 partial-thickness or a small full-thickness (<1 cm) rotator cuff tear. CONCLUSIONS: The derotation test is useful in the perioperative differentiation of functionally intact rotator cuffs from those with significant tears. The derotation sign is specific for the diagnosis of grade 3 partial-thickness and/or small (<1 cm) full-thickness rotator cuff tears.

Adolescent↗
PubMed2003

Complications of rotator cuff surgery in which bioabsorbable anchors are used.

OBJECTIVE: This study assessed the utility of MRI in patients with new or persistent pain after surgery with bioabsorbable rotator cuff anchors. SUBJECTS AND METHODS. Three musculoskeletal radiologists prospectively reviewed MRIs of 30 patients with pain after rotator cuff repair with fixation by rotator cuff anchors. Each radiologist described the location of the rotator cuff anchors and whether the supraspinatus tendon was intact or not. MRI findings were correlated with second-look arthroscopy. Consensus MRI interpretations by the three radiologists were obtained retrospectively. RESULTS: Of the 30 patients, nine had dislodgement of the rotator cuff anchors from the humeral head along with a full-thickness supraspinatus tendon retear. The dislodged rotator cuff anchor position could be determined on coronal and sagittal MRIs, providing the orthopedic surgeon a preoperative map for tendon reattachment and retrieval of the dislodged rotator cuff anchor. Four patients had loose rotator cuff anchors but intact supraspinatus tendons. Three patients had supraspinatus tendon retears, but the rotator cuff anchors were intact. In all 16 patients, arthroscopic findings confirmed MRI findings. Fourteen patients had intact rotator cuff anchors and intact supraspinatus tendons on MRI. Of these 14 patients, five had second-look arthroscopy confirming MRI findings. CONCLUSION: MRI is useful in the assessment of patients with persistent or new-onset pain after supraspinatus tendon repair with rotator cuff anchors. MRI provides a presurgical map for second-look arthroscopy to assess retear of the supraspinatus tendon and also aids in retrieval of dislodged rotator cuff anchors.

Absorbable Implants↗
PubMed2005

Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears.

BACKGROUND: Biceps long head tendon lesion is commonly associated with rotator cuff tendon pathology. This study is to determine the pathologic spectrum of biceps long head tendon in surgical cases with complete full thickness rotator cuff tear. METHODS: Between 1993 and 2002, 122 complete rotator cuff tears with surgery were included for the analysis. During surgery, biceps long head tendon was grossly examined or evaluated via arthroscopy. A simplified classification was used to describe the biceps lesion. RESULTS: 50 (41%) patients had type 1 lesion (tendinitis), 10 (8%) patients had type 2 lesion (subluxation), 12 (10%) patients had type 3 (dislocation), 15 (12%) patients had type 4 (partial tear), and 6 patients (5%) had type 5 (complete rupture). The remaining 29 patients (24%) did not have obvious pathology. All chronic rotator cuff tear (> 3 months) were associated with biceps tendon pathology. A rotator cuff tear greater than 5 cm as determined at surgery was strongly associated with an advanced biceps lesion. CONCLUSION: Biceps tendon injuries are associated with complete rotator cuff tears and there may be a causal relationship due to the impingement that occurs. Early identification and repair of rotator cuff lesions may prevent further deterioration of the biceps tendon.

Adult↗
PubMed2006

The incidence of rotator cuff disease in smoking and non-smoking patients: a cadaveric study.

The etiology of rotator cuff disease is multifactorial. One theory behind the high incidence of rotator cuff tears in the shoulder is that the supraspinatus/infraspinatus tendon contains a zone of relative avascularity in the area proximal to its insertion at the greater tuberosity. Tobacco smoking is known to contribute to microvascular disease, and it can be hypothesized that smoking tobacco further compromises the vascular supply to the supraspinatus/infraspinatus tendon, thus increasing the incidence of tendinous pathology in the rotator cuff. This article evaluates the rotator cuffs of 72 shoulders in 36 cadavers and compares the incidence of macroscopic and microscopic disease within the rotator cuff tendon. Microscopic evaluation of the accompanying lung tissue from the respective cadaver also was performed. As a result, we were able to determine the presence or absence of a smoking history or emphysema from each cadaver as it related to rotator cuff disease in the shoulder. Of the 36 shoulders that exhibited macroscopic rotator cuff tears, 23 were from cadavers with a history of smoking compared to only 13 from cadavers with no history of smoking. Furthermore, the presence of advanced microscopic rotator cuff pathology (Grade 3 or 4 fibrous degeneration) was more than twice as likely in the cadavers with a history of smoking (22/32) compared to only 10 of 32 shoulders from cadavers with no history of smoking. While none of this data was statistically significant due to the insufficient number of subject cadavers, strong trends were noted in these findings.

Acromion↗
PubMed2006

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial [NCT00128076].

BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (alpha = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. DISCUSSION: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.

Arthroscopy↗
PubMed2004

Difference in isokinetic torque acceleration energy of the rotator cuff: competitive male pitchers versus male nonathletes.

Rotator cuff function is critical to the overhead athlete. Rotator cuff power is felt to be important in the overhead athlete during the throwing motion. Little research exists regarding torque acceleration energy (TAE) in overhead athletes. Twenty-five males were divided into 2 groups consisting of overhead athletes (pitchers) (n = 12) and nonoverhead athletes (controls) (n = 13). All participants were given a concentric velocity spectrum isokinetic test at speeds of 60 degrees (1.05 r), 180 degrees (3.16 r), and 300 degrees.s(-1) (5.26 r) to both the dominant and nondominant shoulder internal and external rotators. Significant differences were found for all internal rotator TAE scores (p = 0.000-0.016), at each of the 3 velocities, when comparing dominant to nondominant arms of both overhead athletes and nonoverhead athletes. Only 60 degrees.s(-1) (1.05 r) was found to be different during external rotation TAE testing of the overhead athletes (p = 0.027) but was not found in the control subjects. Post hoc analysis revealed no differences between dominant or nondominant TAE scores when comparisons were made between overhead athletes and controls. Results may reveal that power of the rotator cuff muscles may not be a critical component of the overhead throwing motion.

Adolescent↗
PubMedDate not supplied

Contribution of the passive properties of the rotator cuff to glenohumeral stability during anterior-posterior loading.

The passive properties of the rotator cuff have been shown to provide some stability during anterior-posterior (AP) translation. However, the relative importance of the rotator cuff to joint stability remains unclear. The purpose of this study was to quantify the force contributions of the rotator cuff and of capsuloligamentous structures at the glenohumeral joint during AP loading. We hypothesized that the rotator cuff acts as a significant passive stabilizer of the glenohumeral joint and that its contribution to joint stability is comparable to the contribution made by the components of the glenohumeral capsule. A robotic/universal force-moment sensor testing system was used to determine both the multiple "degrees of freedom" joint motion and the in situ force carried by each soft tissue structure during application of an 89N AP load at 4 abduction angles. The percent contribution of the rotator cuff to the resisting force of the intact joint during AP loading was significantly greater during posterior loading (35% +/- 26%) than during anterior loading at 60 degrees of abduction (P < .05). The contribution of the rotator cuff (i.e., 29% +/- 16% at 30 degrees of abduction) was found to be significantly greater than the contributions of the capsule components during posterior loading at 30 degrees, 60 degrees, and 90 degrees of abduction (P < .05). However, no differences could be found between the respective contributions of the rotator cuff and the capsule components during anterior loading. The results support our hypothesis and suggest that passive tension in the rotator cuff plays a more significant role than other soft tissue structures in resisting posterior loads at the glenohumeral joint. The important role of the rotator cuff during posterior loading may be a result of the thin posterior joint capsule compared with the anterior capsule, which has several thickenings. This information increases our understanding of posterior stability at the glenohumeral joint during clinical laxity tests.

Biomechanical Phenomena↗
PubMed2003

Glenoid inclination is associated with full-thickness rotator cuff tears.

Anatomic factors, such as a hooked acromion, have been associated with rotator cuff disorders. Orientation of the glenoid relative to the scapula has been implicated in shoulder instability, but it has not been linked to rotator cuff disorders. The purpose of the current study was to test the hypothesis that superior inclination of the glenoid is associated with full-thickness rotator cuff tears. Glenoid inclination angles were measured from 16 shoulder radiographs of a convenience sample of eight cadavers in which one shoulder had an intact rotator cuff and the other shoulder had a full-thickness rotator cuff tear. Glenoid inclination angles for shoulders with rotator cuff tears were compared with contralateral normal shoulders using nonparametric statistical analysis. The glenoid inclination angle was greater in cadaver shoulders having full-thickness rotator cuff tears (98.6 degrees ) than in shoulders without tears (91.0 degrees ). A second experiment was done to assess the reliability of using 34 Grashey view radiographs from a clinical population to measure glenoid inclination angle. A method to measure the glenoid inclination on Grashey views was tested and was found to correlate with the inclination angles measured on cadaveric scapulae. Intrarater reliability of measurements from clinical Grashey views was 0.93, and interrater reliability was at least 0.88.

Aged↗
PubMed1993

Evaluation and treatment of the rotator cuff.

The use of the arthroscope for evaluation and treatment of rotator cuff problems is becoming more common. Technology has advanced to the point where we can now not only positively diagnose early rotator cuff problems, but successfully treat them; many times without open shoulder surgery. Arthroscopic cuff debridement and decompression are the mainstays of surgical prevention. Arthroscopic suture fixation of delaminated cuff tears or small rotator cuff avulsions is now possible. The miniopen rotator cuff approach is excellent for repairing most larger full-thickness tears. This article reviews all of these current topics and offers step-by-step surgical techniques used and recommended by the author.

Arthrography↗
PubMedDate not supplied

The results of the surgical treatment of breakage of the rotator cuff.

Sixteen patients affected with rotator cuff tears were treated by surgical repair and anterior acromioplasty, using superior of anteromedial approaches. The authors believe that acute and chronic massive ruptures causing significant functional failure must be surgically treated. Good results may be obtained if impingement signs of arthropathy are absent at surgery.

Acromion↗
PubMed1996

[Rupture of the rotator cuff].

The operative treatment of rotator cuff tears becomes more popular. New reliable diagnostic techniques improved operative procedures and as a very important fact the demanding of the patients to a normal function of the shoulder account for this development. Therefore every physician has to know exactly the reason, the clinical appearance and the course of this pathology. Beside conservative treatment, new operating techniques and the postoperative management will be shown.

Aged↗