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Results for “Rotator Cuff Injuries”

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PubMedDate not supplied

[An x-ray study in the diagnosis of rotator cuff injuries].

The author has studied 142 x-ray films and 132 arthrograms of patients with various lesions of the rotator cuff and has found that in none of the cases has a correct roentgenological diagnosis been made outside his own department. The main routine x-ray and arthrographic signs of such lesions are described. The conclusion is made that in spite of inability of each particular x-ray method to reveal precise dimensions of the gap of the rotator cuff a combined roentgenological examination permits one to determine indications to surgery and elaborate an adequate operative strategy.

Arthrography↗
PubMedDate not supplied

Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries.

In the examination and rehabilitation of patients with shoulder injuries it is necessary to isolate the individual rotator cuff muscles as much as possible. We subscribe to the belief that, independent of the deltoid, the rotator cuff muscles can become fatigued, injured, or atrophied individually, Accordingly, we feel that these muscles must be considered separately during examination and rehabilitation. This paper describes methods and positions to isolate the cuff and, thus, enable the examiner to be more precise in diagnosis and treatment. In addition, individual exercises for each component are described.

Athletic Injuries↗
PubMedDate not supplied

[Evaluation of a simple test for shoulder function in patients with surgically treated rotator cuff injuries].

INTRODUCTION: To assess overall shoulder function a simple examination of the range of motion and strength may not be sufficiently representative. because the shoulder in its daily use is often required for repetitive activities, fatigue at an early stage could be a sign of disturbed shoulder function. Therefore the shoulder function test (SFT) was created to incorporate the factor time into shoulder assessment. With this study the SFT was evaluated for its clinical use in the prospective follow-up of a series of patients operated on for rotator cuff tears. METHODS: Using forward flexion, the patient had to lift a 500-g weight onto a shelf placed at a height which he could reach with his extended arm. The achieved height (5 levels possible) and the time he needed for 5 repetitions were recorded. The SFT value was calculated by division of the time required by the level of the reached shelf. Thus, a lower SFT score represents a better shoulder function. This was tested on 45 patients prior to rotator cuff repair and at 3, 6 and 12 months postoperatively. As validation the SF-36 and the Constant score were evaluated in parallel. Construct, criterion, content and discriminative validity and responsiveness were calculated Results: At all assessments the SFT correlated with the Constant score (r = - 0.47 to r = - 0.62) and the SF-36 (r = - 0.26 to r = - 0.61) demonstrating construct validity. As criterion validity the SFT correlated with the reported pain (r = 0.34 to r = 0.61), patients' self-estimation (r = 0.38 to r = 0.59) and doctors' estimation of the patients shoulder function (r = 0.36 to r = 0.54). Known groups validity was positive as the SFT could differentiate between shoulders with and without rotator cuff tears. The SFT demonstrated a good responsiveness with significant improvement (p = 0.01) after rotator cuff repair. CONCLUSION: Repetitive forward flexion is an important function of the shoulder in daily activities. The SFT allows a reliable and valid quantitative measurement of this function. In order to improve functional assessment of the shoulder and scoring we would recommend using this patient- and function-orientated test in combination with the Constant score to document the current status of shoulder function.

Activities of Daily Living↗
PubMedDate not supplied

Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries.

Four cases of suprascapular neuropathy treated by nonoperative means have been presented. Complete recovery occurred in all four. The anatomy of the suprascapular nerve and probable mechanisms of injury secondary to traction have been discussed. The importance of electromyography in diagnosis has been stressed. Longer periods of nonoperative treatment are recommended here than by previous authors. Since the lesion is felt not to be an entrapment phenomenon but, rather, a traction injury, operative treatment should consist of release of the nerve at the notch to reduce the possibility of further traction injury, and a neurolysis should be done as well.

Adolescent↗
PubMed2003

The effect of cigarette smoking on musculoskeletal-related disability.

BACKGROUND: This study describes cigarette smoking's effect on development of physical disability following initial musculoskeletal-related hospitalization. METHODS: We followed 15,140 US Army personnel hospitalized for common musculoskeletal disorders between 1989-1996 for up to 8 years (1997) to assess risk for long-term physical disability. RESULTS: Trends between increased smoking level and long-term disability were identified for persons with knee injuries, rotator cuff injuries, and intervertebral disc displacement. In proportional hazards models, disability was significantly associated with heavy smoking among all subjects (relative hazard (RH) = 1.21). Both heavy smokers (RH = 1.49) and light to moderate smokers (RH = 1.44) were at greater risk for disability following meniscal injuries. Excess fraction due to smoking among subjects with meniscal injuries who currently smoke was 38%. CONCLUSIONS: Findings suggest an association between smoking and development of disability following meniscal injury. Given the high excess fraction of disability associated with smoking, other studies are needed to confirm this association.

Adult↗
PubMed2003

MR imaging of sports injuries to the rotator cuff.

Impingement pain and rotator cuff injury are common in athletes, particularly in overhead throwers. The cuff can be injured in these patients in the typical location in the anterior supraspinatus tendon and near the junction of the supraspinatus and infraspinatus tendons. The cuff tears in athletes are usually small, articular surface partial-thickness tears. The posterior cuff tears in overhead throwers are seen best at MR arthrography with the arm in abduction and external rotation. Other abnormalities, such as instability lesions or labral fraying, can be associated with rotator cuff tears in athletes.

Athletic Injuries↗
PubMed1990

[Injury of the rotator cuff. II. Diagnostic and therapeutic problems].

Authors examined the clinical problems of the rotator cuff injuries. The possibilities of the early diagnosis are reviewed and the significance of the detailed physical examination and of the shoulder arthrography stressed. The indication of the conservative and operative treatment is defined and also the optimal time of the reconstructive operation. In massive tears, in young age, the early diagnosis and the necessity of the urgent operations is stressed whereas in degenerative alterations, before the operative therapy of the cuff defects, in every case complex physiotherapeutic treatment is suggested. It is underlined that the operative results are improved by the good exposure, the possibly simple and reliable closure of the defect with a synchronous widening of the space under the shoulder vault. Because of the great variety of the injuries an individually chosen functional aftertreatment of many months is thought necessary.

Acromioclavicular Joint↗
PubMed2006

Characteristics of the rat supraspinatus tendon during tendon-to-bone healing after acute injury.

Rotator cuff repair is known to have a high failure rate. Little is known about the natural healing process of the rotator cuff repair site, hence little can be done to improve the tendon's ability to heal. The purpose of this study was to investigate the collagen formation at the early repair site and to localize TGFbeta-1 and 3 during early healing and compare their levels to cell proliferation and histological changes. Bilateral supraspinatus tendons were transected and repaired in 60 rats. Specimens were harvested and evaluated at 0, 1, 3, 7, 10, 28, and 56 days. Histological sections were evaluated for cell morphology. Immunohistochemistry and in situ hybridization was performed to localize protein and mRNA for collagen types I and III and TGFbeta-1 and 3. Proliferating cell nuclear antigen (PCNA) assay was performed to measure cell proliferation, and cells were counted to determine cell density. Biomechanical properties were evaluated. Repair tissue demonstrated an initial inflammatory response with multinucleated cells present at 1 and 3 days, and lymphocytes and plasma cells presents at 7 and 10 days. Capillary proliferation began at 3 days and peaked at 10 days. Ultimate force increased significantly over the time period studied. Collagen I protein and mRNA significantly increased at 10 days, and reached a plateau by 28 and 56 days. Collagen III showed a similar trend, with an early increase, and remained high until 56 days. TGFbeta-1 was localized to the forming scar tissue and showed a distinct peak at 10 days. TGFbeta-3 was not seen at the healing insertion site. Cell proliferation and density followed the same trend as TGFbeta-1. A wound healing response does occur at the healing rotator cuff insertion site, however, the characteristics of the tendon after healing differ significantly from the uninjured tendon insertion site at the longest time-point studied. A distinctive collagen remodeling process occurred with an initial increase in the formation of collagen types I and III followed by a decrease toward baseline levels seen at time 0. Growth factor TGFbeta-1 was localized to repair tissue and coincided with a peak in cell proliferation and cellularity. Repair sites remained unorganized histologically and biomechanically inferior in comparison to previously described uninjured insertion sites.

Acute Disease↗
PubMed2006

The rotator cuff functional index.

BACKGROUND: Despite improvements in the clinical assessment of rotator cuff injuries, shortcomings exist in diagnosing rotator cuff tears. PURPOSE: To formulate a clinical rotator cuff functional index for predicting rotator cuff tears based on handheld dynamometer measurements for shoulder strength testing and to assess its ability to diagnose a rotator cuff tear. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Preoperative handheld dynamometer measurements, including supraspinatus, external rotation, internal rotation, adduction, and lift-off force, were compared in 100 patients with full-thickness rotator cuff tears (> 1.0 cm) and 100 patients with no rotator cuff injury (confirmed by arthroscopy). Using multiple logistic regression analysis, the rotator cuff functional index and index for rotator cuff tear size were formulated in which 100 represented excellent rotator cuff function and less than 0 indicated a full-thickness supraspinatus tear. Each patient's index was calculated to determine its clinical value in predicting a rotator cuff tear; the Pearson correlation coefficient was established for the rotator cuff functional index for rotator cuff size. RESULTS: Two handheld dynamometer measurements predicted a rotator cuff tear (P < .001, r = 0.53), with rotator cuff functional index = 1.27 * supraspinatus (N) - 0.72 * adduction (N) - 11.6, but not tear size (r = 0.38). In predicting a rotator cuff tear (rotator cuff functional index < 0 = rotator cuff tear; rotator cuff functional index > 0 = no tear), the rotator cuff functional index had 83% sensitivity, 79% specificity, 80% positive predictive value, 82% negative predictive value, likelihood ratio of 4.0 for a positive test result and 0.2 for a negative test result and an accuracy of 81%. CONCLUSION: The 2 most useful tests for determining a rotator cuff tear with a handheld dynamometer were supraspinatus force and adduction force (as negative control). A functional index based on these measurements was able to rule out a rotator cuff tear and predict the presence but not the size of the tear.

Adult↗
PubMedDate not supplied

Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.

The purpose of this study is to define the prevalence of peripheral nerve injury associated with full-thickness tears of the rotator cuff presenting with shoulder muscle atrophy. Twenty-five patients with the diagnosis of full-thickness rotator cuff tear were included. Electrodiagnostic testing, including nerve conduction studies and needle examination, was performed on all patients. There were 7 abnormal electromyographic examinations. The most common diagnosis was upper trunk brachial plexopathy severely affecting the axillary nerve (4/7), followed by suprascapular neuropathy (2/7) and cervical radiculopathy (1/7). The prevalence of associated peripheral neuropathy was found to be 28%. Greater degrees of atrophy were significantly associated with the presence of neuropathy in these patients. Careful neurologic screening in all patients and electromyographic examination in clinically suspicious groups are recommended in patients with full-thickness cuff tears before surgical repair.

Adult↗
PubMed1995

Posterior superior glenoid impingement: expanded spectrum.

Posterior superior glenoid impingement is a recently recognized mechanism of injury producing rotator cuff injury in athletes. Usually the mechanism is repetitive overhand activity such as throwing. A survey of the author's practice was undertaken to show a wider spectrum of this mechanism both in the activity that caused it and the number of structures at risk of injury from this mechanism. The survey revealed 11 patients who had a clear recollection of their mechanism of injury and an objective documentation of the injury by arthroscopy or imaging studies. The majority of shoulders had damage to more than one of the five structures at risk from this mechanism of injury. Six cases were not sports related. Glenoid impingement may injure one or more of the following: (1) superior labrum, (2) rotator cuff tendon, (3) greater tuberosity, (4) inferior glenohumeral ligament or labrum, and (5) superior glenoid bone. Injury to more than one structure may be the rule and injury to one structure may indicate investigation of the other four.

Adult↗