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 235 records · Page 13Linked to original sources
PubMed1988

The use of freeze-dried allografts in the management of global rotator cuff tears.

Massive or global tears of the rotator cuff with loss of tendon substance and retracted cuff remnants pose a challenging surgical and rehabilitation problem. In seven patients, global cuff tears were reconstructed with freeze-dried rotator cuff allografts. Five of the seven patients had other significant debilitating medical problems. Three patients had received four steroid injections, one patient had six injections, and the remaining three patients had two injections in or about the affected shoulder. Five of the seven patients had their pain relieved. Only two patients had significant improvement in shoulder function after anterior acromioplasty and allografts. Freeze-dried rotator cuff allografts do not appear to be of significant value in the surgical management of chronic massive rotator cuff tears.

Aged↗
PubMed1986

Ultrasonographic evaluation of the rotator cuff and biceps tendon.

Ultrasonography of the rotator cuff and biceps tendon was investigated in 106 patients who had been referred for arthrography of the shoulder. Both the sensitivity and the specificity of ultrasound in detecting a tear of the rotator cuff were 91 per cent. The predictive value of a negative sonogram was 95 per cent and the predictive value of a positive sonogram was 84 per cent. Ultrasonography proved to be superior to arthrography in the examination of the normal and abnormal biceps tendon. Sonographically detectable effusions from the tendon sheath of the biceps were present in 19 per cent of this population of patients. This finding was statistically highly associated (90 per cent) with rotator cuff tears and other soft-tissue abnormalities of the shoulder. Based on these results, it appears that ultrasonography can be used as the initial imaging test for many patients with suspected abnormalities of the rotator cuff or biceps tendon.

Adolescent↗
PubMed1975

Rotator cuff tears in rheumatoid arthritis.

Rotator cuff tear secondary to chronic synovitis eroding the rotator cuff tendon is a complication of rheumatoid arthritis that has received little attention. Patients with such tears have a long history of active rheumatoid disease preceding the sudden onset of increased unilateral shoulder pain and immobility. The physician may interpret this change as indicating a joint infection or rheumatoid flare, and initiate a drastic change in the patient's therapy. Shoulder arthrography reveals the correct diagnosis. Appropriate treatment consists of heat, rest, range of motion exercises, and repeated intra-articular injection of steroids.

Aged↗
PubMedDate not supplied

Age-related prevalence of rotator cuff tears in asymptomatic shoulders.

To determine the prevalence of rotator cuff tears in asymptomatic shoulders we conducted a prospective clinical and ultrasonographic study of 411 volunteers. We anticipated an age-dependent outcome and divided the patients into 4 age-groups. Overall, we found evidence of a rotator cuff tear in 23% of the patients. In group 1 (aged 50 to 59 years), 13% (22 of 167) of the patients had tears; in group 2 (aged 60 to 69 years), 20% (22 of 108) of the patients had tears; in group 3 (aged 70 to 79 years), 31% (27 of 87) of the patients had tears; and in group 4 (age > 80 years), 51% (25 of 49) of the patients had tears. An astonishingly high rate of rotator cuff tears in patients with asymptomatic shoulders was thus demonstrated with increasing patient age. At this stage it remains unclear, however, which parameters convert an asymptomatic rotator cuff tear into a symptomatic tear. As a result, rotator cuff tears must to a certain extent be regarded as "normal" degenerative attrition, not necessarily causing pain and functional impairment.

Aged↗
PubMedDate not supplied

Rotator cuff injury in contact athletes.

The causes and incidence of rotator cuff injuries in patients under the age of 40 has not been clearly established. The present study focuses on a group of 10 male contact athletes with rotator cuff injuries related to trauma sustained during football (ages from 24 to 36 years). Symptoms included pain and dysfunction in all 10 patients and a positive shrug sign in 8 of 10. The diagnoses for these patients were two isolated contusions, five partial-thickness tears, and three full-thickness tears. Surgery was performed on all patients after nonoperative treatment failed. Three partial-thickness tears were arthroscopically debrided. One full-thickness and two partial-thickness tears were repaired using the arthroscopically assisted miniarthrotomy technique. An open repair was performed in two patients. Two isolated rotator cuff contusions were arthroscopically debrided. The average followup was 21 months. Nine of 10 athletes returned to active participation in football, 7 of these at their preinjury levels. The diagnosis of rotator cuff injury should be considered in a contact athlete who has persistent shoulder pain, impingement signs, weakness, and a positive shrug sign. Arthroscopic debridement of the subacromial space followed by debridement or repair of rotator cuff tears, as clinically indicated, resulted in a marked improvement in function and rapid return to sport for these patients.

Acromion↗
PubMed2002

[Arthroscopic-assisted mini-open rotator cuff repair].

OBJECTIVES: New alternatives have been developed in rotator cuff repair with advances in arthroscopic techniques. We evaluated retrospectively the results of our patients who underwent arthroscopic-assisted mini-open rotator cuff repair. METHODS: Arthroscopic subacromial decompression and mini-open repair were performed in 31 patients (8 males, 23 females; mean age 54.3 years; range 38 to 71 years) with rotator cuff tear in which the tendon tear had not been excessively retracted (till glenoid) and the muscle had not undergone fatty degeneration. Patients below 40 years of age were considered for surgery, while those between 40 to 60 years were initially treated with a rehabilitation program to relieve pain and gain motion before surgery. Surgery was reserved until after failure with a three-month rehabilitation program in patients above 60 years. Evaluations were based on physical and radiographic examinations and Constant scores. The mean follow-up period was 24.4 months (range 12 to 37 months). RESULTS: Twenty-five patients (81%) achieved excellent or good results and six patients (19%) had satisfactory results. The mean Constant score was 84.6. One patient developed joint stiffness unresponsive to conservative treatment. Arthroscopic capsular release followed by a heavy exercise program enabled him to return to his former sports activity level within three months. CONCLUSION: Arthroscopic-assisted repair is a superior alternative in rotator cuff surgery in selected cases because it enables the shoulder surgeon to preserve deltoid attachment and to prepare the torn tendon for an easy repair. It may result in shortened hospital stay, decreased postoperative pain, and an accelerated rehabilitation.

Adult↗
PubMed2003

Prognostic indicators for outcome following rotator cuff tear repair.

PURPOSE: To examine the prognostic indicators associated with outcome following rotator cuff surgery. METHODS: A retrospective evaluation of records on 1120 shoulders (1067 patients) with rotator cuff tear treated by surgery was performed. Preoperative, intra-operative and postoperative factors were analysed by Kendall's Tau-b correlation analysis and logistic regression analysis. RESULTS: Positive correlations were seen between the type of tear and the number of tendons involved, retraction, age, degeneration, subacromial bone spur, surgical technique, preoperative and postoperative muscle power, surgical outcome, and preoperative abduction on Kendall's Tau-b analysis. There was a positive correlation seen between degenerative change and age, number of tendons involved, retraction, preoperative pain, tear type, and preoperative musclepower on logistic regression analysis. Additionally, positive correlations were seen between good surgical postoperative outcome and postoperative activities of daily living, preoperative pain, postoperative muscle power, preoperative activities of daily living, tear type, preoperative external rotation, preoperative muscle power, number of tendons involved, preoperative pain, and duration of symptoms. CONCLUSION: Ageing was found to be the major factor in progressive degeneration of the rotator cuff, and should be considered the single most important contributing factor in the pathogenesis of rotator cuff tears. In addition, degenerative tendonopathy appeared the primary pathology in rotator cuff tear, preceding hypertrophic spur formation. Rotator cuff tears are therefore unlikely to be initiated by impingement; rather, they develop as an intrinsic degenerative tendonopathy.

Adolescent↗
PubMed2006

Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought.

PURPOSE: In throwing athletes, partial rotator cuff tears are usually located posterior to the site of the common rotator cuff tears seen in the general nonthrowing population. However, they sometimes have tears located around the anterior aspect of the supraspinatus tendon. In this study we investigated the characteristics of anterior rotator cuff tears in throwing athletes. We then compared several factors between anterior tears and posterior tears to investigate those related to the presence of anterior tears or the occurrence of such tears. METHODS: We divided 37 athletes with partial rotator cuff tears into those with anterior tears (n = 17) and those with posterior tears (n = 20). The clinical profile, range of motion and joint laxity with patient under general anesthesia, and operative findings were retrospectively compared between the 2 groups. RESULTS: Among the 17 anterior rotator cuff tears, 12 tears were confined to the anterior one third of the supraspinatus tendon. Interestingly, concealed intratendinous degenerative tears were found in 6 shoulders. These appeared to be very shallow articular-side tears located around the attachment of the greater tuberosity, but severe tears were exposed after resection of the residual capsular portion of the tendon. Posterior capsular tightness was significantly related to the occurrence of anterior tears, whereas a greater tuberosity notch was significantly related to posterior tears. CONCLUSIONS: Anterior rotator cuff tears are not uncommon in throwing athletes, and a concealed type of tear was a representative lesion. Different mechanisms may be involved in the development of anterior and posterior rotator cuff tears resulting from throwing injuries. Posterior capsular tightness might influence the occurrence of anterior tears. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Athletic Injuries↗
PubMed2005

Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair.

BACKGROUND: Reestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength. HYPOTHESIS: A double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair. STUDY DESIGN: Controlled laboratory study. METHODS: In 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data. RESULTS: Gap formation for the double-row repair was significantly smaller (P < .05) when compared with the single-row repair for the first cycle (1.67 +/- 0.75 mm vs 3.10 +/- 1.67 mm, respectively) and the last cycle (3.58 +/- 2.59 mm vs 7.64 +/- 3.74 mm, respectively). The initial strain over the footprint area for the double-row repair was nearly one third (P < .05) the strain of the single-row repair. Adding a medial row of anchors increased the stiffness of the repair by 46% and the ultimate failure load by 48% (P < .05). CONCLUSION: Footprint reconstruction of the rotator cuff using a double-row repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair. CLINICAL RELEVANCE: To achieve maximal initial fixation strength and minimal gap formation for rotator cuff repair, reconstructing the footprint attachment with 2 rows of suture anchors should be considered.

Biomechanical Phenomena↗
PubMed1999

Experimental rotator cuff repair. A preliminary study.

BACKGROUND: The repair of chronic, massive rotator cuff tears is associated with a high rate of failure. Prospective studies comparing different repair techniques are difficult to design and carry out because of the many factors that influence structural and clinical outcomes. The objective of this study was to develop a suitable animal model for evaluation of the efficacy of different repair techniques for massive rotator cuff tears and to use this model to compare a new repair technique, tested in vitro, with the conventional technique. METHODS: We compared two techniques of rotator cuff repair in vivo using the left shoulders of forty-seven sheep. With the conventional technique, simple stitches were used and both suture ends were passed transosseously and tied over the greater tuberosity of the humerus. With the other technique, the modified Mason-Allen stitch was used and both suture ends were passed transosseously and tied over a cortical-bone-augmentation device. This device consisted of a poly(L/D-lactide) plate that was fifteen millimeters long, ten millimeters wide, and two millimeters thick. Number-3 braided polyester suture material was used in all of the experiments. RESULTS: In pilot studies (without prevention of full weight-bearing), most repairs failed regardless of the technique that was used. The simple stitch always failed by the suture pulling through the tendon or the bone; the suture material did not break or tear. The modified Mason-Allen stitch failed in only two of seventeen shoulders. In ten shoulders, the suture material failed even though the stitches were intact. Thus, we concluded that the modified Mason-Allen stitch is a more secure method of achieving suture purchase in the tendon. In eight of sixteen shoulders, the nonaugmented double transosseous bone-fixation technique failed by the suture pulling through the bone. The cortical-bone-augmentation technique never failed. In definite studies, prevention of full weight-bearing was achieved by fixation of a ten-centimeter-diameter ball under the hoof of the sheep. This led to healing in eight of ten shoulders repaired with the modified Mason-Allen stitch and cortical-bone augmentation. On histological analysis, both the simple-stitch and the modified Mason-Allen technique caused similar degrees of transient localized tissue damage. Mechanical pullout tests of repairs with the new technique showed a failure strength that was approximately 30 percent of that of an intact infraspinatus tendon at six weeks, 52 percent of that of an intact tendon at three months, and 81 percent of that of an intact tendon at six months. CONCLUSIONS: The repair technique with a modified Mason-Allen stitch with number-3 braided polyester suture material and cortical-bone augmentation was superior to the conventional repair technique. Use of the modified Mason-Allen stitch and the cortical-bone-augmentation device transferred the weakest point of the repair to the suture material rather than to the bone or the tendon. Failure to protect the rotator cuff post-operatively was associated with an exceedingly high rate of failure, even if optimum repair technique was used. CLINICAL RELEVANCE: Different techniques for rotator cuff repair substantially influence the rate of failure. A modified Mason-Allen stitch does not cause tendon necrosis, and use of this stitch with cortical-bone augmentation yields a repair that is biologically well tolerated and stronger in vivo than a repair with the conventional technique. Unprotected repairs, however, have an exceedingly high rate of failure even if optimum repair technique is used. Postoperative protection from tension overload, such as with an abduction splint, may be necessary for successful healing of massive rotator cuff tears.

Animals↗
PubMed1994

[Criteria for legal assessment of rotator cuff rupture].

The judgement of the correlation between an accident and a rotator cuff tear has an important role in legal and private accident insurance. Owing to the high morbidity of degenerative alterations and ruptures of the rotator cuff tendons, the causality of an acute traumatic rupture can be difficult to demonstrate, which means assessments are often controversial. In a retrospective study we evaluated 25 orthopaedic assessments and tried to find rules for an objective estimation. The judgement of correlation between trauma and rotator cuff tear should be based on four pillars: history, trauma mechanism, initial findings and course of the functional deficit. Possible mechanisms of traumatic rupture are discussed from various angles. Important clinical findings, e.g. a functional supraspinatus deficit, should be fully documented. X-Rays of both shoulders can lead to indirect demonstration of preexistent changes in the rotator cuff. Sonographic evaluation can show up the rotator cuff tear and demonstrate signs of acute injury. After persistent pain and functional deficit, in a few cases operative and microscopic findings will lead to a correct estimate of causality. Because of the diagnostic uncertainty a 20-point score is introduced for retrospective assessment of the history (2 points), trauma mechanism (3 points), initial clinical, radiological and sonographic findings (10 points) and course of functional deficit (5 points) to evaluate the role of trauma in rotator cuff tears. Using this score trauma can be classified as the main or partial cause or as irrelevant to the pathogenesis of rotator cuff tears.

Adult↗
PubMedDate not supplied

Relationship between the lateral acromion angle and rotator cuff disease.

One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78 degrees, with a range from 64 degrees to 99 degrees. Eight shoulders had angles less than or equal to 70 degrees, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p < 0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p < 0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I--flat, II--curved, and III--hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p = 0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease.

Acromioclavicular Joint↗
PubMedDate not supplied

Management of partial-thickness rotator cuff tears.

Partial-thickness tearing of the rotator cuff is common; however, relatively little is written on the subject. We reviewed 39 patients with partial-thickness rotator cuff tears who underwent acromioplasty, debridement of the abnormal tissue, and tendon suturing. Follow-up averaged 55 months (range 13 to 132 months). Twenty-three (59%) patients had an excellent result, 10 (26%) patients had a satisfactory result, and 6 (15%) patients had an unsatisfactory result. Four of the six patients with unsatisfactory results had also had unsuccessful previous surgery. Thirty-five (90%) patients rated their response to surgery as either much improved or improved. No complications occurred, and to date no reoperations have been required. Diagnosis of partial-thickness rotator cuff tears can be challenging. Magnetic resonance imaging supplies the most complete information about tendon structure. Conservative treatment is reasonable for most partial-thickness tears. When surgical treatment is indicated, acromioplasty, debridement, and tendon repair are effective.

Adult↗
PubMed2005

Arthroscopic side-to-side rotator cuff repair.

PURPOSE: To study the results of arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suture technique without fixation to bone. TYPE OF STUDY: Case series study of the long-term results of patients who underwent purely arthroscopic rotator cuff repair with a side-to-side suturing technique. METHODS: A retrospective review was performed of patients who underwent arthroscopic repair of full-thickness rotator cuff defects. Patients with full-thickness rotator cuff tears repaired in a side-to-side fashion without anchoring the repair to bone were selected. Patients were evaluated using a modified UCLA shoulder scoring system. The data collected were analyzed to determine the outcome in patients with a 4- to 10-year follow-up. RESULTS: A total of 105 arthroscopic rotator cuff repairs were performed in 104 patients between February 1990 and February 1996. Forty-two patients had a full-thickness tear of the rotator cuff that was repaired using a purely side-to-side suturing technique. The mean UCLA score of all patients in this group was 33; 23 patients reported excellent results, 18 good results, and 1 poor result according to the UCLA scoring system. CONCLUSIONS: In this series, 98% of patients qualified as a good to excellent result according to the UCLA shoulder score. This study shows that patients with a full-thickness defect of the rotator cuff tendon with anatomy amenable to side-to-side closure may be effectively treated with a purely arthroscopic repair using only a side-to-side suturing technique with excellent long-term clinical results. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed1987

[Sonography as a screening method in suspected rupture of the rotator cuff].

We have found ultrasonography of the shoulder in differentiating between normal rotator cuff and rotator cuff lesion according to trauma a very helpful method. In comparison to arthrography it is a quick and painless method without any risk. Whereas other authors report a sensitivity of 100% and a specificity of 94% in shoulder disease we recommend ultrasonography in acute shoulder trauma as a screening method. Pathological findings in ultrasonography will make the decision for arthrography easy. The major diagnostic pitfall is the calcified tendon of the rotator cuff.

Calcinosis↗
PubMed2006

The insertional footprint of the rotator cuff: an anatomic study.

PURPOSE: The purpose of this study was to define the entire rotator cuff footprint and relate it to known, easily identifiable landmarks as a guide for both open and arthroscopic rotator cuff repair. Anatomic: Gross and microscopic. METHODS: The myotendinous units of the rotator cuff and their insertions onto the humerus were dissected in 20 fresh-frozen cadavers. The separate tendon insertions were identified, and their length and width measured. The character and exact anatomy of the tendons were also noted. The entire insertion was measured and referenced to the articular surface, biceps groove, and bare area of the humerus. In a separate part of the study, 6 cadavers were decalcified and thin-sliced through the supraspinatus tendon insertion. This insertion was evaluated via scanning electron microscopy (SEM). RESULTS: Our findings demonstrated a consistent pattern at the insertion of the rotator cuff. The horseshoe-shaped insertion tapers away from the articular surface in a superior-to-inferior direction. Interdigitation of the muscle units may be noted, particularly between the supraspinatus and the infraspinatus. Average maximum insertional lengths and widths were as follows: subscapularis (SC): 40 x 20 mm; infraspinatus (IS): 29 x 19 mm; supraspinatus (SS): 23 x 16 mm; and teres minor (TM): 29 x 21 mm. The SC inserted on the lesser tuberosity adjacent to the biceps groove at the edge of the articular surface. It tapered away 18 mm at its inferior border. The SS inserted at the articular surface along its entire insertion from the bicipital groove to the top of the bare area. The IS wrapped the posterior border of the SS superiorly at the articular surface and tapered away inferiorly, framing the bare area. SEM microscopy showed the SS to be adherent to the edge of the articular surface medially. As it filled the sulcus, its lateral edge extended over the edge of the greater tuberosity. CONCLUSIONS: A consistent pattern was noted at the insertional anatomy of the rotator cuff. This anatomy was related to known, easily identifiable landmarks and may serve as a guide for evaluation of size, location, and propagation patterns of rotator cuff tears, as well as for their repair. CLINICAL RELEVANCE: Knowledge of the insertional anatomy of the rotator cuff can facilitate grading and repair of rotator cuff tears.

Cadaver↗
PubMed1991

[Reconstruction of massive rotator cuff rupture using a deltoid muscle flap].

In extensive rotator cuff tears with rupture of the supra- and infraspinatus muscles, we have obtained good and very good results persisting for 3 years or longer only in 40% of cases treated by resection and debridement, and in 25% of our cases the head of the humerus was found to be no longer centrally located in the joint socket on X-ray examination 10 years after treatment. It was therefore proposed that an active muscle flap taken from the anterior part of the deltoid muscle (part III according to Fick) should be used to span the trophic defect in the rotator cuff, being sutured into healthy tissue following freshening up. This seems logical, since the transferred muscle flap remains innervated and vascularized and also works synergistically with the rest of the rotator cuff. The flap interposed in this way between the greater tubercle of the humerus and the acromion functions in the same way as a double-bellied muscle and prevents displacement of the head of the humerus. In this way an active rotator cuff is produced, which also takes over the function of stabilizing the humeral head. After follow-up of at least 1 year (average 19 months), the result is aesthetically satisfactory in all 50 shoulders treated in this way; 47 are free of pain or painful only some of the time; in 32 active elevation of over 120 degrees is possible; 21 have symmetrical force ratios in elevation and 15 for outward rotation in 90 degrees abduction. All reconstructed shoulders were characterized by fatigability in elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1995

[Arthroscopic treatment possibilities of the rotator cuff].

Many open operative procedures of the rotator cuff can be done arthroscopically, especially impingement lesions, partial and complete ruptures of the rotator cuff, osteoarthritis of the acromioclavicular joint and calcific tendinitis.

Acromioclavicular Joint↗