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Results for “Rotator Cuff Injuries”

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PubMed1998

[Tensile strength of the tendon of the supraspinatus muscle in the human. A biomechanical study].

The traumatic tear of the rotator cuff has been discussed very intensively for a long time despite the fact that there do not exist representative objective data about the native tensile strength of these tendons. The aim of this study was to evaluate the age related native strength of the supraspinatus tendon. 25 fresh frozen cadaver specimen (age: 23-94, 24 h post mortem, 18 male, 7 female) were tested using so called cryojaws for soft tissue fixation. The results showed the major part of the tensile forces to be transmitted through the anterior thicker part of the tendon (e.g. 14 bony avulsions in this area). We found significant correlations between age and maximum strength (p < 0.001), age and stiffness of the tendon (p < 0.005) and stiffness and maximum strength (p < 0.001). These results show that tensile strength and stiffness of the supraspinatus tendon decrease with age. However, a 65 year old specimen still demonstrates a weight bearing structure (about 900 N maximum tensile strength) and is not necessarily ruptured or degeneratively altered.

Adult↗
PubMed2000

[Recommendations for diagnosis and expert assessment of traumatic rotator cuff lesions].

Traumatic rotator cuff lesions are a very rare condition. However, this article represents a comprehensive survey according to current knowledge on anatomy, biomechanics, and pathogenesis of rotator cuff pathology. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the causality of an acute traumatic rotator cuff tear. Therefore, a catalogue of potential adequate and inadequate trauma mechanisms is proposed. Emphasis is also placed on posttraumatic diagnostic steps following persistent rotator cuff deficient shoulder function (e.g., ultrasound, MRI). From a legal aspect (e.g., private accident insurance, workers compensation claim), different minor and major criteria are defined, which could help experts to judge the causality of posttraumatic rotator cuff deficiency. These criteria mainly refer to distinct details concerning patients' history, trauma mechanism, primary clinical appearance, and diagnostic findings.

Diagnosis, Differential↗
PubMed2000

[The macroscopic aspect of rotator cuff tears in traumatic and nontraumatic rupture cases].

The decision whether a rotator cuff tear has a traumatic or degenerative origin still causes some controversy. Especially in medical expert appraisals the etiology of the rotator cuff tear plays an important role referring to insurance services for the patient. The purpose of this paper is to compare the intraoperative pathomorphologic shape of the cuff tear in traumatic and degenerative cases. This study reports of 56 patients with rotator cuff tears which were divided in primarily acute, subacute traumatic and degenerative study groups referring to their history of present illness. We considered the location of the tear, the shape and the size. Furthermore the grade of retraction of the supraspinatus tendon, its quality and the shape of the long head of biceps were examined. The results showed that in general the shape of the tear gives only in some cases significant information whether the etiology is traumatic or not. The isolated rupture of the subscapularis muscle and the hematoma at the edge of the tendon is significant for the trauma. In comparison with the degenerative study group the tenosynovitis and the dislocation of the long head of biceps is in our study significant for traumatic tears.

Diagnosis, Differential↗
PubMed2000

[Prevalence of rotator cuff defects in dislocated fractures of the humerus head in elderly patients].

Humeral head fractures are commonly found in elderly patients. A high rate of spontaneous rotator cuff tears in this patient group may endanger good results following surgical treatment. 70 patients > 65 years with dislocated humeral head fractures were prospectively studied and treated surgically following a standardised treatment protocol. In all cases the rotator cuff was examined intraoperatively. A tear of the rotator cuff was documented in 4 cases (5%). The prevalence of rotator cuff tears in elderly patients with dislocated humeral head fractures is significantly smaller than expected referring to magnetic resonance-, sonographic and cadaveric studies of same-age patients without fracture. Therefore the rotator cuff may serve as retention anchor for the surgical treatment of dislocated humeral head fractures in elderly patients.

Aged↗
PubMed2001

[Comparison of 2 surgical techniques in isolated supraspinatus rupture. A matched-pair study].

The comparison of results after open surgery methods in the repair of rotator cuff ruptures needs homogen patient groups. We compared 34 patients in 2 groups who were treated with open surgery for isolated ruptures of the supraspinatus muscles (lesion type III). Patients in group I were treated with transosseous suture refixation of the supraspinatus, in group II suture anchors (type: Corkscrew) were used. Both groups were age and gender paired. Preoperatively, all patients had the same clinical status. For the evaluation of the clinical results at follow-up we used the Constant-Score. In addition, strength and pain measurement and oblique X-rays of the shoulder were performed. The follow-up time was 18 months. In all patients, the mean Constant-Score improved significantly with increase in muscle strength and marked pain reduction. Significant differences between both groups could not be observed. The mean time of surgery in group II (suture anchor) was significantly lower than in group I. In conclusion, with the anchor techniques the same good results can be achieved as with bone refixation. The shortening of the surgery time should, however, be seen in relation to the higher costs with this technique.

Adult↗
PubMed2001

[Outcome analysis after open reconstruction of rotator cuff ruptures. A comparative assessment of recent evaluation procedures].

Outcome evaluation is becoming increasingly important for reconstructive surgery in musculoskeletal diseases. In addition to established shoulder-scores, new outcome-scores are being developed to cover all effects caused by a disease or intervention. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients suffering from rotator cuff deficiency. These were correlated to the Constant-Murley Shoulder Score and to a visual analogue scale for satisfaction. 7 women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 +/- 10.5, r/l: 14/9, FU 57.8 +/- 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons Shoulder Index (ASES), the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). In addition, a visual analogue scale for satisfaction was employed. All four scores as well as the visual analogue scale revealed improvement at a statistically significant level (paired, two-tailed t-test, P < 0.01) after surgery. All questionnaires had a significant correlation with the Constant-Murley Shoulder Score (Pearson's correlation coefficient: ASES: r = 0.871, P < 0.01; DASH: r = -0.758, P = < 0.01; SST: r = 0.494, P < 0.05). All were easy to apply and provided a reliable, postoperative evaluation of shoulder function. The SST was easy to apply, however compound outcome analysis was only possible with the ASES Shoulder Index and the DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination which is advantageous but must be carried out in the clinic. For postoperative assessment, without the patient having to return to the clinic, the ASES Shoulder Index is preferred as it correlates well with the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762).

Adult↗
PubMed2004

[Biceps tendon disorders: ultrasound, MR imaging and MR arthrography].

Ultrasound and MR imaging are competitive imaging modalities for the diagnosis of pathologic conditions of the biceps tendon. MR imaging has substantial advantages over ultrasound because biceps tendon lesions are most commonly located in the proximal part where lesions are hidden under the acromion for ultrasound assessment. The value of MR arthrography is substantiated by the capability to assess associated diagnoses which are otherwise difficult to assess. Associated diagnoses include full- and partial thickness tears of supraspinatus and subscapularis tendons, pulley lesions, and adhesive capsulitis (frozen shoulder). Moreover, MR arthrography is the method of choice for the assessment of superior labral anterior posterior (SLAP) lesions.

Arthrography↗
PubMed2004

[Postoperative imaging of the shoulder].

Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primary impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications.

Arthrography↗
PubMed2004

[Impingement syndrome of the shoulder].

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention.

Acromion↗
PubMed2004

[New developments for the surgical treatment of shoulder problems].

Tremendous advancement has been made in the surgical treatment of the shoulder within the last years. Arthroscopic techniques for treatment of rotator cuff lesions, instability problems and biceps tendon lesions are today established because of significant improvement of instruments, suture materials and anchor techniques. The 4th generation of shoulder prosthesis systems guarantee today anatomical and biomechanical advantages with significant functional improvement for the patient.

Arthroplasty, Replacement↗
PubMed2004

[Conservative treatment and rehabilitation of shoulder problems].

The shoulder joint has an important influence on arm- and hand function. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy.

Biomechanical Phenomena↗
PubMed2004

[Shoulder instability].

Shoulder instability is a common clinical feature leading to recurrent pain and limited range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging.

Arthrography↗
PubMed1996

[Diagnosis of shoulder impingement syndrome].

This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Shoulder impingement is caused by compression of the supraspinatus tendon underneath the coracoacromial arch, mainly in forward flexion of the arm. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs may overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff.

Diagnosis, Differential↗
PubMed1996

[Indirect MR arthrography of the shoulder. An alternative to direct MR arthrography?].

INTRODUCTION: The purpose of this study was to evaluate the diagnostic power of indirect MR arthrography (I-MRA) particularly in rotator cuff tears. MATERIAL AND METHODS: Sonography, conventional MRI and I-MRA were compared with arthroscopy in 25 patients. Additionally literature about experience with the method in other shoulder disease was searched. RESULTS: Sensitivity and specificity in the detection of rotator cuff tears were 0.6 and 0.7 respectively using sonography, 0.66 and 1 with conventional MRI and 1 and 0.86 for I-MRA. I-MRA was especially useful in diagnosing partial tears. In other studies I-MRA showed good results in the evaluation of glenoid labral tears, with a sensitivity of 91% and a specificity of 92%. CONCLUSION: I-MRA can be successfully used to diagnose rotator cuff and labral tears.

Adult↗
PubMed1996

[MR arthrography of the shoulder joint in a postoperative patient sample].

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff.

Adult↗
PubMed2002

[Ultrasound diagnosis of the rotator cuff].

Shoulder sonography is a well-established and standardized method to evaluate the status of the rotator cuff, the long head of the biceps, and the subacromial and subdeltoid bursae. Using high-frequency linear probes, the sensitivity in detecting total tears sized 0.5 cm and greater is > 90% and in detecting partial thickness tears of at least one-third of the cuff substance > 75% when using the dual-criteria standard. Ultrasound achieves comparable or better results than native magnetic resonance tomography at far less cost. False results can be excluded in the majority of cases by strict adherence to a dual-criteria model. The ability to display the joint's soft tissue structures in real time is unique up to now. The limits of sonography are (1) in the estimation of tear size in global tears as retraction of tendon stumps under the acromion cannot be visualized and (2) in the evaluation of status of rotator cuff muscles since volumetric information about atrophy can be gained by ultrasonography, but a differentiation between simple atrophy and fatty degeneration is not possible.

Cost-Benefit Analysis↗