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 37 records · Page 2Linked to original sources
PubMed1996

Proteoglycans of human rotator cuff tendons.

Rotator cuff and biceps tendons that appeared grossly normal were procured from adult cadavers without a history of shoulder problems. These tendons were analyzed for the amount and type of glycosaminoglycan, type of proteoglycan, and histology. When compared with the distal/tensional region of biceps tendon, the glycosaminoglycan content of supraspinatus, infraspinatus, and subscapularis tendons was 2.5-fold higher and the glycosaminoglycan content of the proximal/compressed region of biceps tendon was 3-fold higher. The ratio of hyaluronic acid to chondroitin sulfate/dermatan sulfate in all three cuff tendons was approximately 1. Rotator cuff tendons contained large proteoglycan similar to aggrecan, as demonstrated by sodium dodecyl sulfate-polyacrylamide gel migration elution from Sepharose CL-4B, and content of both chondroitin sulfate and keratan sulfate chains. Both decorin and biglycan were also present, as demonstrated by migration in sodium dodecyl sulfate-polyacrylamide gels and core protein immunoreactivity. In contrast decorin was the only proteoglycan prominent in distal/tensional regions of biceps tendon. Histological analysis showed layers of loosely organized alcian blue-stained material running between the longitudinal collagen fiber bundles. The proteoglycan content of rotator cuff tendons was similar to fibrocartilage in tendons that have been subjected to compressive loads in situ. This suggests that cells of normal adult rotator cuff tendons have adapted to loads distinct from pure tension. However, the histological organization did not resemble mature fibrocartilage. The increased amount of proteoglycan in rotator cuff tendons may serve to separate and lubricate collagen bundles as they move relative to each other during normal shoulder motion.

Adult↗
PubMed2006

Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs.

PURPOSE: As arthroscopic rotator cuff surgery has advanced, new techniques have emerged to maximize the biomechanical strength of the repair construct. The double-row repair has been recommended as a means of increasing the contact area of the repaired rotator cuff to the native bone bed. This study attempts to sequentially examine and measure the rotator cuff footprint (in vivo) before cuff repair, after an initial lateral-row repair (before the medial-row sutures are tied), and finally, after the double-row repair. In this way, the rotator cuff footprint of single- and double-row repairs can be quantified and compared. METHODS: Between October 2004 and February 2005, 26 patients were enrolled in the study. These patients had rotator cuff tears that were amenable to double-row repair by means of performing the lateral-row repair before the medial-row repair. After preparation of the greater tuberosity footprint, the native footprint was measured in the medial-to-lateral direction. Next, the medial-row anchors and sutures were passed through the cuff (but not tied), and then the lateral row was secured via suture anchors and the arthroscope was reinserted into the intra-articular space. A depth gauge was introduced through the repaired cuff (lateral row only), and the residual bare footprint was measured. The medial row was then tied, and the cuff was again visualized from the intra-articular position to measure any remaining bare footprint. RESULTS: The mean footprint measured 17.0 +/- 1.9 mm from medial to lateral. After repair of the lateral row, the mean residual uncovered footprint measured 9.0 +/- 2.0 mm. This constituted a 52.7% +/- 9.2% uncovered area after a single lateral-row repair. After the medial row was secured, there were no remaining residual deficits of the cuff footprint. CONCLUSIONS: After an isolated lateral-row repair, 52.7% +/- 9.2% of the rotator cuff footprint remains uncovered. On average, the double-row repair offered over twice the footprint coverage yielded by a single-row repair. CLINICAL RELEVANCE: The arthroscopic shoulder surgeon should be aware of the enhanced footprint coverage offered by double-row rotator cuff fixation as opposed to single-row rotator cuff fixation.

Arthroscopy↗
PubMed1993

[Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff].

The authors studied the results of the arthroscopic treatment of the chronic calcifying tendinitis within a multi-center study of the French Society of Arthroscopy. 112 patients were available for the study. All shoulders had a preoperative radiographic clinical and radiographic evaluation. At follow up, functional results were assessed, using the Constant score, and X rays allowed to appreciate the acromial shape and the calcific deposit aspect. Several arthroscopic procedures were used on the calcification (respect or removal), and the coracoacromial arch (respect, ACL release or acromioplasty). This study found an objective success rate of 89 per cent and a patient subjective satisfaction rate of 82 per cent. Based on follow up radiographs, 88 per cent of the patients had a complete disappearance of the calcific deposit. There were no recurrence, no secondary rotator cuff tear. The results were not correlated with the age of the patients, or with the radiographic aspect (type, size, localization) of the calcification. The results were correlated with the arthroscopic procedure: they were better when the calcification had been removed (superior to deposit respect). Associated acromioplasty gave no better results: it was only considered as necessary when the calcification was not found (12 per cent). The greatest care must be taken in the surgical indication for this pathology because of a high rate of spontaneous resorption. The authors conclude that the arthroscopic surgery is a very effective method for chronic calcific tendinitis, compared to open procedure.

Adult↗
PubMed1994

Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis.

OBJECTIVES: To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS: Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons (supraspinatus and subscapularis tendons, n = 53) were obtained during open shoulder surgery to repair shoulder lesions (age range 38-80 years). Glycosaminoglycans were extracted by papain digestion and analysed by cellulose acetate electrophoresis, the carbazole assay for uronic acid and the dimethylmethylene blue dye-binding assay for sulphated glycosaminoglycans. Some digests were analysed for keratan sulphate by 5D4 monoclonal antibody ELISA. Soluble proteoglycans were extracted in 4M guanidine hydrochloride and analysed by 4-15% SDS PAGE. RESULTS: The mean (SD) sulphated glycosaminoglycan (GAG) content of the normal cadaver supraspinatus tendon was 12.3 (4.3) micrograms/mg dry weight, between three and ten times greater than in the common biceps tendon [1.2 (0.6) micrograms/mg dry weight]. The major GAG was chondroitin sulphate [6.9 (2.6) micrograms/mg dry weight], with a smaller proportion of dermatan sulphate [2.5 (1.2) micrograms/mg dry weight]. In contrast, the common biceps tendon contained predominantly dermatan sulphate [0.8 (0.2) microgram/mg dry weight] with less chondroitin sulphate [0.2 (0.2) microgram/mg dry weight]. There was no difference in the concentration of hyaluronan in these tendons [9.3 (2.8) micrograms/mg dry weight and 10.8 (4.3) micrograms/mg dry weight respectively] and there was no significant change of hyaluronan with age. Keratan sulphate was a small but significant component of the supraspinatus tendon [0.43 (0.33) microgram/mg dry weight, n = 25], whereas there was little or none in the common biceps tendon [0.04 (0.05) microgram/mg dry weight, n = 8] and there was no significant change across the age range. In the supraspinatus tendon, there was a significant decrease in total glycosaminoglycan, chondroitin sulphate and dermatan sulphate with age (p < 0.001), whether expressed relative to the tendon dry weight or total collagen content, and no change in the relative proportion of the different GAG types. There was, however, a large degree of variation within the samples. Supraspinatus tendons from patients with chronic tendinitis had a significantly increased concentration of hyaluronan [30.4 (10.1) micrograms/mg dry weight, p < 0.001], chondroitin sulphate [8.4 (1.8) micrograms/mg dry weight, p < 0.05] and dermatan sulphate [3.8 (1.1) micrograms/mg dry weight, p < 0.001] compared with normal cadaver supraspinatus tendons, although the keratan sulphate content was not significantly different [0.18 (0.05) microgram/mg dry weight]. CONCLUSIONS: The normal supraspinatus tendon has the proteoglycan/glycosaminoglycan of tendon fibrocartilage, which it is suggested is an adaptation to mechanical forces (tension, compression and shear) which act on the rotator cuff tendons in the shoulder, although other factors such as reduced vascularity, low oxygen tension and the influence of local growth factors may also be important. This functional adaptation may have important consequences for the structural strength of the supraspinatus tendon and to influence the ability of the tendon to repair after injury. The glycosaminoglycan composition of tendon specimens from patients with chronic tendinitis is consistent with acute inflammation and new matrix proteoglycan synthesis, even in relatively old tendon specimens and after at least one injection of corticosteroid.

Adolescent↗
PubMed2000

MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval.

OBJECTIVE: We describe the MR anatomy of the subcoracoid bursa and findings associated with subcoracoid effusion. CONCLUSION: Fluid in the subcoracoid space, revealed on MR imaging of the shoulder, may lie in the subcoracoid bursa or the subscapularis recess (both structures can be distinguished with MR imaging). In our patients, subcoracoid effusions were often associated with anterior rotator cuff tears, including tears of the rotator interval.

Adult↗
PubMed2001

The presence of smooth muscle actin in fibroblasts in the torn human rotator cuff.

The rotator cuff frequently sustains athletic and occupational injury, often resulting in chronic pain and disability. However, despite the high incidence of such shoulder problems, the pathophysiology of rotator cuff injury and healing has not yet been fully elucidated. The notable finding of this study was the presence of a contractile actin isoform, alpha-smooth muscle actin (SMA), in nonvascular cells in all of the seven torn human rotator cuff specimens evaluated immunohistochemically. Up to 95% of cells in any one region, and over 95% of elongated cells found in association with crimped collagen, contained SMA. Most of the cells staining positive for SMA in these sections had morphological features of the fibroblast, though a small number were chondrocyte-like. Treatment of cells growing out from human rotator cuff explants with TGF-beta1 significantly increased the amount of SMA evaluated by Western blot analysis. PDGF-BB and IFN-gamma had no effect on the cell content of SMA. This is the first documentation of the presence of SMA-positive cells in the human rotator cuff tendon. SMA has been found in a number of other healing connective tissues including skin, ligament, meniscus, cartilage, and other types of tendon. Of importance are previous findings that SMA-positive cells can contract a collagen-glycosaminoglycan analog of extracellular matrix in vitro. The results of the present study thus suggest that SMA-containing cells could contribute to the retraction of the torn ends of a ruptured rotator cuff and play an important role in healing.

Actins↗
PubMed1994

Correlation between MRI and operative findings of the rotator cuff tear.

Rotator cuff disease is one of the most common causes of shoulder pain. Various methods have been used to evaluate this problem. In this study, we determine the accuracy of magnetic resonance imaging (MRI) of the shoulder in diagnosing the rotator cuff tear based on operative findings. Ten patients with a painful shoulder requiring operation received an MRI of the shoulder before surgery. A GE 1.5 Tesla MR scanner with a five-inch planar surface coil was applied and the diagnosis was confirmed by an experienced radiologist in the field of musculoskeletal MRI. All patients underwent surgery within two weeks of MRI examination. Nine of the 10 patients were shown to have rotator cuff tear by MRI. Among the nine MRI positive patients, eight were proven to have such lesions on operation (two massive tears, four moderate complete tears, and two bursal side tears). One false-positive result was found to be an adhesive capsulitis and supraspinatus tendinitis at operation. The remaining case, diagnosed as tendinitis by MRI, turned out to be a small incomplete tear on operation. Therefore, the sensitivity of MRI for rotator cuff tear in this study was 0.89. The overall accuracy was 80%. We concluded that MRI has a high accuracy in detecting the rotator cuff tear. False-positive and false-negative diagnoses were attributed to a severe tendinitis and an incomplete tear, respectively.

Adult↗
PubMed2003

Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff.

Recently, there has been an increased interest in the normal anatomy of the rotator cuff footprint and the re-establishment of the footprint during rotator cuff repair. Single-row suture anchor techniques have been criticized because of their inability to restore the normal medial-to-lateral width of the rotator cuff footprint. In this report, the authors describe a double-row technique for rotator cuff repair that re-establishes the normal rotator cuff footprint, increases the contact area for healing, and may potentially improve clinical results.

Arthroscopy↗
PubMedDate not supplied

MR evaluation of rotator cuff impingement: correlation with confirmed full-thickness rotator cuff tears.

OBJECTIVE: To clarify the efficacy of MRI for the evaluation of rotator cuff impingement beneath the coracoacromial arch, MRI findings were correlated with confirmed full-thickness rotator cuff tears (FTRCTs). MATERIALS AND METHODS: Thirty-four shoulders with FTRCT and 49 control shoulders without FTRCT were selected for this study. Direct measurement of the subacromial space (SAS) and MRI grading of SAS and subacromioclavicular space (SACS) were correlated with FTRCT. In addition, the MRI impingement score (sum of SAS grade and SACS grade) was correlated with age and FTRCT. RESULTS: Direct measurement of the SAS showed poor correlation with FTRCT. The SAS grade showed significant correlation with FTRCT; however, SACS grade showed poor correlation. Shoulders with higher MRI impingement scores were associated with FTRCT in patients over 40 years of age. CONCLUSION: The MRI sign of rotator cuff impingement is fairly reliable and helpful in discriminating patients with FTRCT, especially older patients.

Acromioclavicular Joint↗
PubMed2001

Diagnosis of rotator cuff tears.

Rotator cuff tears account for almost 50% of major shoulder injuries but are sometimes difficult to diagnose. To aid diagnosis, we did a prospective study, comparing results of 23 clinical tests from 400 patients with and without rotator cuff tears. Three simple tests were predictive for rotator cuff tear: supraspinatus weakness, weakness in external rotation, and impingement. When all three were positive, or if two tests were positive and the patient was aged 60 or older, the individual had a 98% chance of having a rotator cuff tear; combined absence of these features excluded this diagnosis.

Adult↗
PubMed1998

Management of shoulder impingement syndrome and rotator cuff tears.

Rotator cuff impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. Symptoms include pain, weakness and loss of motion. Causes of impingement include acromioclavicular joint arthritis, calcified coracoacromial ligament, structural abnormalities of the acromion and weakness of the rotator cuff muscles. Conservative treatment (rest, ice packs, nonsteroidal anti-inflammatory drugs and physical therapy) is usually sufficient. Some patients benefit from steroid injection, and a few require surgery.

Diagnosis, Differential↗
PubMedDate not supplied

Association of osteopenia of the humeral head with full-thickness rotator cuff tears.

Rotator cuff tendon repair may fail for various reasons. Although the role of repair techniques and of the musculotendinous unit has been studied, there is little information on the quality of the bone to which the tendon is to be repaired. Therefore, 14 cadaveric humeral heads, 7 specimens without and 7 with a full-thickness rotator cuff tendon tear, were quantitatively assessed by use of high-resolution micro-computed tomography. Bone density is higher below the articular surface than in the greater tuberosity (40% vs 10%-20%), and tendon tears are associated with a reduction in cancellous bone density of greater than 50%, leading to a virtually hollow greater tuberosity, with intact cortical bone. The results found suggest that in long-standing rotator cuff tears, creating a deep trough should be avoided to achieve reliable tendon-to-bone contact. For optimal suture fixation to bone, sutures or anchors should be positioned subcortically or medially under the articular surface.

Aged↗
PubMed1992

[The deltoid flap-plasty. Therapy of choice in large rotator cuff ruptures?].

Rotator cuff tear is an extremely common and important disease. An extensive rotator cuff tear is an incapacitating event and remains a major problem which forces to respect to the management. The late outcome of majors ruptures of such tears are often a defect-arthropathy with a complete destroy of the shoulder and a loss of flexibility caused by pain. The deltoid muscle plasty, as the logical reconstruction method and relatively easy to perform, lead to better results in compare to all the variety of surgical treatments of restoring the anatomical continuity. This article reviews the clinical manifestations, operative technique and the results associated with the treatment by deltoid muscle plasty. Based on the results. Based on the results of flexibility, and postoperative pain in shoulder we conclude that the early results in our group of the first 20 patients are excellent. 84% of the patients were subjectively very satisfied and free of pain.

Aged↗
PubMedDate not supplied

[Latissimus dorsi transfer in case of irreparable rotator cuff tear--a comparative analysis of primary and failed rotator cuff surgery, in dependence of deficiency grade and additional lesions].

AIM: Latissimus dorsi transfer is a difficult operation with a long rehabilitation. We investigated if it is worth the effort. METHOD: We used this technique in 22 patients with an inoperable rotator cuff tear (15 patients had a primary surgery, 7 patients were operated after failed prior rotator cuff repair). Additional lesions were also considered in the analysis. The average follow up was 9 months. The results were divided in 4 groups: severe indication, primary reconstruction, 3-tendon rupture, secondary reconstruction. RESULTS: The best results were achieved by the group "severe indication" (raising in the Constant score from 38 to 79 points). The group with primary surgery (increasing from 43 to 67 points) had better results than the group with failed prior reconstruction (increasing from 33 to 62 points). In case of additional rupture of the subscapularis tendon (45 to 58 points) or insufficiency of the deltoid muscle (33 to 45 points) the results are not satisfactory. The postoperative pain relief was felt as the predominant improvement. CONCLUSION: The latissimus dorsi transfer is a valuable and safely reproducible procedure. Depending on the preoperative grade of deficiency it is possible to achieve a shoulder function of 60-90 % in comparison to the healthy shoulder. Despite the difficult operation technique and the long rehabilitation phase, the LDP is worth the effort on patients with irreparable rotator cuff tears. It is not the right procedure in cases of defect arthropathy--in these cases inverted shoulder prosthesis should be used.

Aged↗
PubMed2000

Nonoperative treatment of rotator cuff tears.

Rotator cuff tears and subacromial impingement are second only to acromioclavicular joint disorders as the most common causes of shoulder pain. Although most orthopedic surgeons are willing to initially treat shoulder impingement syndrome conservatively, they are reluctant to manage rotator cuff tears-especially full-thickness tears-nonoperatively. The purpose of this article is to explain the biomechanical rationale of nonoperative treatment, review the literature pertaining to nonoperative treatment of full-thickness rotator cuff tears, and describe a nonoperative treatment program.

Biomechanical Phenomena↗
PubMed2004

Rotator cuff disease.

Rotator cuff disease is a complex condition. It includes a variety of pathologies, ranging from tendinosis to complete tear. The cause seems to be multifactorial and is most likely a combination of major trauma, microtrauma from daily wear and tear, and age related degeneration. When establishing a program for the patient with rotator cuff dysfunction, the rehabilitation specialist should consider biomechanical factors, the patient's functional goals, and issues beyond the shoulder that may affect the course of the disease.

Biomechanical Phenomena↗
PubMed2000

Perforation of rotator cuff increases interleukin 1beta production in the synovium of glenohumeral joint in rotator cuff diseases.

OBJECTIVE: To study the hypothesis that perforation of the rotator cuff increases the degree of inflammation in the synovium of the glenohumeral joint in rotator cuff diseases. METHODS: Thirty-five synovial specimens in the glenohumeral joint of patients with rotator cuff diseases were examined. They were obtained during surgery and divided into 2 groups on the basis of the presence or absence of rotator cuff perforation, i.e., perforating and nonperforating tears. The expression levels of inflammatory cytokine mRNA of interleukin 1beta (IL-1beta) and 2 forms (secreted type and intracellular type) of IL-1 receptor antagonist (IL-1ra) were measured by reverse transcriptase polymerase chain reaction (RT-PCR). The protein level of IL-1beta was determined by Western blot analysis. IL-1beta producing cells were also identified by in situ RT-PCR and immunohistochemistry. RESULTS: In perforating tears cytokine mRNA in the glenohumeral synovium was more significantly expressed than in nonperforating tears. Also, higher levels of IL-1beta protein were detected in perforating tears. CONCLUSION: Perforation of the rotator cuff increases IL-1beta production in the glenohumeral joint, enhancing inflammatory intensity at the site. These findings suggest the possibility that glenohumeral synovitis in rotator cuff diseases may be a factor for the development of glenohumeral arthropathy.

Adult↗
PubMed2007

Biomechanical fixation in arthroscopic rotator cuff repair.

Rotator cuff repair remains a challenging and rapidly evolving field. Several recent studies have shown that arthroscopic repair yields functional results similar to those of mini-open and open procedures, with all of the benefits of minimally invasive surgery. However, the "best" repair construct remains relatively unknown, with wide variations in surgeon preference and conflicting evidence in the literature. The most recent developments in basic science, suture and suture anchor technology, and innovative prospects for arthroscopic rotator cuff repair are reviewed.

Arthroscopy↗