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PubMedDate not supplied

Two 6-year follow-up studies of large and massive rotator cuff tears: comparison of outcome measures.

The purposes of this report are (1) to describe the development of a quality-of-life outcome measure for rotator cuff disease (RC-QOL) and a new simple test of rotator cuff function, the Functional Shoulder Elevation Test (FSET), and (2) to compare these with the SF-36 and the American Shoulder and Elbow Surgeons Assessment (ASESA) in a cohort of 86 patients with surgically treated large and massive rotator cuff tears. The RC-QOL is a 34-item self-administered questionnaire that has demonstrated excellent reliability, face validity, and ability to discriminate between large and massive cuff tears; it has also confirmed the construct of higher correlations with the other shoulder outcome measures than with the SF-36. The FSET is a simple test of rotator cuff function that uses 5% body weight and measurement of pain and discomfort on a 100-point visual analog scale. It was highly correlated with the RC-QOL and ASESA and discriminated between large and massive cuff tears. The study achieved an 82% follow-up at an average of 3.5 years. Large cuff tears had statistically significantly improved outcome scores in comparison with massive cuff tears on these 3 outcome measures. The SF-36, however, was not able to discriminate between tear sizes. The RC-QOL and the FSET are recommended outcome measures for rotator cuff disease.

Adult↗
PubMed1999

Incidence and symptoms of clinically manifest rotator cuff lesions.

A clinical study of 200 unselected elderly subjects with an average age of 78 years living in retirement homes was performed to determine the prevalence of clinically manifest rotator cuff tears and the relevance of the tear for daily life. A comprehensive questionnaire was performed and the examination included the UCLA- and Constant-shoulder assessment scales and a multitude of special tests. The criteria for clinical diagnosis of a rotator cuff tear were a positive Jobe-test, diminished external rotation, a positive zero-degree-abduction test, the drop arm sign, pseudoparalysis and atrophy. By these criteria we found 28 (7%) rotator cuff tears in 25 people. There were 15 women and 10 men and the mean age of symptom onset was 55 years. Eleven craftsmen, 7 office workers and 7 housewives met our criteria for rotator cuff tears. Pain was present in 22 shoulders. Moderate weakness was found in 2 people and severe weakness in 22. In 20 people the range of motion was severely reduced and in 8 moderately reduced. Activities of daily living were impaired in all affected subjects. Eight people reported onset of symptoms after trauma. Patients with clinically diagnosed rotator cuff tears scored an average of 13 points in the UCLA-shoulder assessment scales and 40 points in the Constant-shoulder assessment scales. In conclusion rotator cuff may be symptomatic only in some people. Probably more anatomic than symptomatic rotator cuff tears exist, and it can be supposed that physical activities may be one possible reason for clinically relevant tears.

Aged↗
PubMed2006

Clinical inquiries. What is the best way to diagnose a suspected rotator cuff tear?

The evaluation of a suspected rotator cuff tear should start with a history and a clinical exam of the shoulder (strength of recommendation [SOR]: B, based on a systematic review of cohort studies). Three clinical test results in particular--supraspinatus weakness, weakness of external rotation, and impingement--or 2 positive tests for a patient older than 60 years were highly predictive of rotator cuff tear (SOR: B, based on individual prospective study). Either magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear (SOR: B, based on a systematic review of cohort studies). If a patient has an implantable device prohibiting MRI imaging, conventional arthrography is an alternative (SOR: A, individual randomized controlled trial). Suspected partial-thickness tears are best verified with an ultrasound (SOR: B, based on a systematic review of cohort studies).

Humans↗
PubMed1985

Sonographic detection of rotator cuff tears.

Thirty-nine consecutive patients referred for shoulder arthrography underwent shoulder sonography to determine the ability of sonography to detect rotator cuff tears. Fifteen patients had arthrographically proven rotator cuff tears. Of these, 14 were detected by sonography, for a sensitivity of 93%. The three sonographic criteria indicative of rotator cuff tear were (1) discontinuity in the normal homogeneous echogenicity of the rotator cuff; (2) replacement of the normal homogeneous echogenicity by a central echogenic band; and (3) nonvisualization of the cuff. Twenty patients had normal sonographic examinations, 19 of which were normal by arthrography. Therefore, the predictive value of a negative sonogram was 95%. On the basis of these findings, sonography can provide a noninvasive means of screening patients with suspected rotator cuff tears.

Adult↗
PubMed1994

The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology.

The relative prevalence of various acromial shapes, appearance of the coracoacromial ligament and enthesophytes along the inferior aspect of the acromioclavicular joint in patients with and without rotator cuff tears were evaluated. Of 76 patients with clinical instability and impingement, 31 had a normal rotator cuff and 45 demonstrated a partial or full tear of the supraspinatus tendon at surgery. Results were compared with those from magnetic resonance (MR) scans of 57 asymptomatic volunteers. Of the 45 patients with a supraspinatus tear, 38% (17) had a flat acromial undersurface (type I), 40% (18) had a concave acromial undersurface (type II), 18% (8) had an anteriorly hooked acromion (type III), and 4% (2) had an inferiorly convex acromion (type IV). Among the 31 patients with a normal rotator cuff at surgery and the 57 asymptomatic volunteers, the respective prevalences of the type I acromion were 39% (12) and 44% (25), of type II 48% (15) and 35% (20), type III 3% (1) and 12% (7), and type IV 10% (3) and 9% (5). Shoulders with surgically proven rotator cuff tears showed a tendential association with a type III acromion (8/45) and statistically significant associations with a thickened coracoacromial ligament (17/45) and acromioclavicular enthesophytes (18/45). For the association between inferiorly directed acromioclavicular joint enthesophytes and rotator cuff tears, age appears to be a confounding factor. The type IV acromion, newly classified by this study, does not have a recognizable association with rotator cuff tears.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMed2006

Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears.

PURPOSE: Clinical and ultrasound evaluation of patients who had undergone debridement of a partial rotator cuff tear in conjunction with an arthroscopic acromioplasty. TYPE OF STUDY: Retrospective follow-up study. METHODS: Thirty-three consecutive patients were included in the study; 26 of the 33 (79%) patients underwent ultrasound evaluation of both shoulders and were examined by independent observers after a follow-up period of 101 months (range, 60 to 128 months; minimum, 5 years). RESULTS: The median time between onset of symptoms and surgery was 24 months (range, 6 to 360 months). At follow-up, the Constant score was 65 points (range, 15-98). The Constant score on the contralateral side was 84 points (range, 15-96; P < .0001). The strength in abduction was 4.7 kg (range, 1.2 to 11.1 kg) on the operated side and 5.1 kg (range, 1.8 to 10.4 kg) on the contralateral side (not significant). Twelve of the 26 patients reported discomfort or pain in the contralateral shoulder and during the follow-up period, and 3 of 26 had undergone an arthroscopic acromioplasty of the contralateral shoulder. Two of 26 patients underwent further surgery of the index shoulder during the follow-up period. The visual analogue score for pain for the index shoulder was 20 mm (range, 0 to 85). The ultrasound evaluation revealed that 9 of 26 patients had a full-thickness rotator cuff tear in the index shoulder and, of these, 3 of 9 were bilateral. CONCLUSIONS: It appears that an arthroscopic acromioplasty and rotator cuff debridement in patients with partial tears does not protect the rotator cuff from undergoing further degeneration. LEVEL OF EVIDENCE: Level IV.

Acromion↗
PubMedDate not supplied

Augmented subscapularis muscle transposition for rotator cuff repair during shoulder arthroplasty in patients with rheumatoid arthritis.

The effectiveness of rotator cuff repair by augmented subscapularis transposition via the Leeds-Keio artificial ligament was evaluated in patients with rheumatoid arthritis undergoing total shoulder arthroplasty. The minimum follow-up period was 2 years. Final clinical scores (Hospital for Special Surgery scoring system) and the incidence of radiolucency and upward migration of shoulder components in 20 shoulders with rotator cuff repair by augmented subscapularis transposition were superior to those of 19 shoulders with cuff repair by subscapularis transposition alone and similar to those of 22 shoulders with intact rotator cuffs. In shoulders with augmented subscapularis transposition and intact cuffs, clinical scores continued to improve even after the first postoperative year. Our augmented subscapularis transposition did not increase postoperative complications. We conclude that cuff repair by augmented subscapularis transposition is an acceptable alternative for repairing a supraspinatus or supraspinatus and infraspinatus rotator cuff defect in rheumatoid arthritis patients undergoing total shoulder arthroplasty.

Aged↗
PubMedDate not supplied

Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases.

The purpose of this study is to evaluate the objective, subjective, and radiographic results of arthroscopic biceps tenotomy in selected patients with rotator cuff tears. Three hundred seven arthroscopic biceps tenotomies were performed in patients with full- thickness rotator cuff tears. Patients were selected for arthroscopic tenotomy if the tear was thought to be irreparable or if the patient was older and not willing to participate in the rehabilitation required after rotator cuff repair. Patients were evaluated clinically and radiographically at a mean of 57 months' follow-up (range, 24-168 months). The mean Constant score increased from 48.4 points preoperatively to 67.6 points postoperatively ( P < .0001). Eighty-seven percent of patients were satisfied or very satisfied with the result. The acromiohumeral interval decreased by a mean of 1.3 mm during the follow-up period and was associated with a longer duration of follow-up ( P < .0001). Preoperatively, 38% of patients had glenohumeral arthritis; postoperatively, 67% of patients had glenohumeral arthritis. Concomitant acromioplasty was statistically associated with better subjective and objective results only in patients with an acromiohumeral distance greater than 6 mm. Fatty infiltration of the rotator cuff musculature had a negative influence on both the functional and radiographic results ( P < .0001). Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long-standing rotator cuff tears.

Acromion↗
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↗
PubMed2006

Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair.

BACKGROUND: In a previous study, we found that medical comorbidities have a negative effect on preoperative pain, function, and general health status in patients with a chronic rotator cuff tear. In this study, we evaluated the relationship between medical comorbidities and the postoperative outcome of rotator cuff repair. METHODS: One hundred and twenty-five patients were evaluated on the basis of a history (including medical comorbidities) and use of outcome tools preoperatively and at one year after rotator cuff repair. Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, the Simple Shoulder Test (SST), visual analog scales (pain, function, and quality of life), and the Short Form-36 (SF-36). RESULTS: The mean number of medical comorbidities was 1.91 (range, zero to six). At one year after rotator cuff repair, there were no significant correlations between comorbidities and pain, shoulder function, or quality of life as determined with the SST, DASH, and visual analog scales (p > 0.05). A greater number of comorbidities was associated with a worse postoperative general health status (SF-36 role emotional [p = 0.045], SF-36 bodily pain [p = 0.032], SF-36 general health [p = 0.001], and SF-36 vitality [p = 0.033]). Nevertheless, a greater number of comorbidities was associated with greater improvement, compared with the preoperative status, in the pain score on the visual analog scale (p = 0.009), function as assessed with the visual analog scale (p = 0.022) and the DASH (p = 0.044), and quality of life as assessed with the visual analog scale (p = 0.041). CONCLUSIONS: Patients with more medical comorbidities have a worse general health status after rotator cuff repair. Interestingly, it also appears that these patients have greater improvement in overall shoulder pain, function, and quality-of-life scores compared with preoperative scores. Therefore, despite a negative effect of comorbidities on outcomes, patients with more comorbidities have greater improvement after the repair, to the point where postoperative shoulder function and pain are not significantly influenced by medical comorbidities. Consequently, a higher number of medical comorbidities should not be considered a negative factor in determining whether a patient should undergo rotator cuff repair.

Adult↗
PubMedDate not supplied

[Diagnosis of rotator cuff rupture: correlation of clinical findings and magnetic resonance tomography with intraoperative findings].

The diagnosis of rotator cuff tears may be based on clinical examination and MRI. The aim of this study was to define the relative value of these methods. Clinical and MRI diagnoses of 88 shoulders were compared with the intraoperative findings. The correct diagnosis of a posterosuperior rotator cuff rupture was made in 79% of the cases by clinical examination and in 91% of the cases by MRI. For the subscapularis tendon clinical examination corresponded to the intraoperative findings in 73% of the cases versus 59% for MRI. MRI was superior to clinical examination in diagnosing a posterosuperior rotator cuff rupture. For the evaluation of ruptures of the subscapularis tendon, clinical examination was more reliable than MRI. Diagnosis of rotator cuff rupture can most often be obtained by a simple physical examination.

Adult↗
PubMed2007

[Biomechanical evaluation of glenohumeral stability through muscle force vector analysis. Effect of a decreased glenoid inclination in shoulders with global rotator cuff tears].

OBJECTIVES: The aim of the study was to quantify the decrease in glenohumeral stability following a global rotator cuff tear and to evaluate the effect of a decreased glenoid inclination angle through analysis of muscle force vectors in a computer model. MATERIAL AND METHODS: The lines of action of eight shoulder muscles were integrated into a standard geometric model. Muscle force magnitudes were estimated based on physiological cross-sectional area and normalized electromyographic activity. The magnitude and elevation angle of the resultant force vector was calculated at 0, 30, 60, and 90 degrees of abduction. A rotator cuff tear was simulated by reduction of the corresponding muscle force vectors. RESULTS: At 0 and 30 degrees of glenohumeral abduction a global rotator cuff tear showed a resultant force vector pointing outside the glenoid. In the computer model, decreasing the inclination angle of the glenoid by 30 degrees increased the stability in rotator cuff-deficient shoulders. CONCLUSIONS: The results of this study provide a biomechanical rationale for clinical complications of global rotator cuff tear such as superior humeral head translation. The decreased glenoid inclination simulated in the computer model may represent a biomechanical basis for the development of new operative techniques to treat global rotator cuff tears.

Biomechanical Phenomena↗
PubMed1997

MR imaging of the rotator cuff.

MR imaging provides clinically useful information in detecting and characterizing pathology of the rotator cuff and other shoulder disorders in a noninvasive fashion. Complete and partial tears of the rotator cuff as well as factors contributing to impingement can be detected and characterized with MR imaging. The size and location of complete tears of the rotator cuff can be accurately determined with MR imaging.

Adult↗
PubMed1999

[Arthroplasty with a mobile cup for shoulder arthrosis with irreparable rotator cuff rupture: preliminary results and cineradiographic study].

PURPOSE OF THE STUDY: Management of patients with massive irreparable rotator cuff tears associated with severe glenohumeral joint degeneration presents a difficult clinical challenge. The present study reports on 24 patients with disabling shoulder pain due to rotator cuff arthropathy treated using a bipolar arthroplasty. MATERIAL AND METHODS: Between 1995 and 1997, a bipolar shoulder arthroplasty (Biomet, Warsaw, In) was used in 24 patients (25 shoulders) with rotator cuff arthropathy. Patients were monitored for an average of 14.5 months (range 12 to 24 months). The coracoacromial ligament was maintained in all patients to provide anterosuperior stability. The rotator cuff was irreparable and no attempt was made to cover the superior defect. Postoperative results were reviewed with the Constant score and the Swanson score. In order to verify the head-shell motion and to analyze the dynamic comportement of bipolar arthroplasties, we recorded anterior active elevation and active rotations with video-fluoroscopy. RESULTS: At final the follow-up, 21 shoulders had no or slight pain. Average active flexion improved to 84.8 degrees after operation from 62.4 degrees beforehand. 13 patients achieved more than 90 degrees of active flexion after operation. Active external rotation improved from a mean 3 to 28.8 degrees. Before surgery the average Constant score was 17.62. Postoperatively, the average Constant score was 46.97 and the average Swanson score was 23.13. Complications requiring reoperation occurred in 2 cases: 1 component dislocation (Head-shell), 1 subluxation of the long head of the biceps. Radiographic evaluation at follow up demonstrated no humeral stem loosening or component migration and no bony erosion of the coracoacromial arch. Rupture of the infraspinatus tendon (absolute Constant score: p = 0.04, adjusted Constant score: p = 0.02, Swanson score: p = 0.03, Functional score: p = 0.04), preoperative anterior subluxation of the humeral head (absolute Constant score: p = 0.03, adjusted Constant score: p = 0.05, anterior elevation: p = 0.01, functional score: p = 0.04), preoperative narrowing of the acromio-humeral interval (adjusted Constant score: p = 0.02, overall mobility: p = 0.02, anterior elevation: p = 0.03) may jeopardize the subsequent success of bipolar shoulder arthroplasty. The results of this study suggest that the radius curvature of the shell must match that of the bony surface of the glenoid and the coracoacromial arch (absolute Constant score: p = 0.003, adjusted Constant score: p = 0.005, overall mobility: p = 0.002, anterior elevation: p = 0.0008, functional score: p = 0.002). Recording of anterior active elevation with video-fluoroscopy allowed to identify 3 different types of movements after bipolar shoulder arthroplasty. Recording of internal and external rotation allowed to distinguish 2 differents types of movements. Motion appeared to occur between the bipolar shell and the head. The amount of motion was variable and depended on the biomechanics. DISCUSSION AND CONCLUSION: Bipolar shoulder arthroplasty is an effective surgical option for patients with massive irreparable tears of the rotator cuff with concomitant glenohumeral arthritis. Satisfactory pain relief and modest gains in motion result in significant functional improvement in this "low functional demand" population. Predictive factors have been identified and should be discussed before surgery.

Activities of Daily Living↗
PubMed1997

Acromion-splitting approach through an os acromiale for repair of a massive rotator cuff tear.

Os acromiale, failure of fusion of the secondary centers of ossification of the acromion process, has been noted as a contributing factor in shoulder impingement syndrome and rotator cuff tears. Treatments for symptomatic os acromiale with or without rotator cuff tears have been reported in the literature and range from excision of small fragments to fusion of larger, fragments with internal fixation and bone grafting. Generally, rotator cuff repairs have been performed when possible. We report an acromion splitting approach through an existing os acromiale to gain exposure for the repair of a massive rotator cuff tear. Subsequent to this repair, the acromion was repaired with internal fixation. Good functional use of the patient's upper extremity was obtained and the patient expressed satisfaction with the surgical outcome. The acromion splitting approach is a viable approach in patients with an os acromiale and a coexistent rotator cuff tear.

Acromion↗
PubMed2004

Effectiveness of tendon transfers for massive rotator cuff tears: a simulation study.

UNLABELLED: OBJECTIVE To determine what the most effective tendon transfer is in the case of a dysfunctional rotator cuff. DESIGN: A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity. BACKGROUND: Massive rotator cuff tears are not easily repaired. To compensate for this loss of rotator cuff function other techniques like muscle transfers are developed. METHODS: Three range of motion tasks and six activities of daily living of 24 subjects were measured. Kinematics from these tasks were used as input to the Delft Shoulder and Elbow Model. The muscle parameters of the Delft Shoulder and Elbow Model were modified to simulate a rotator cuff tear and the ability to perform the measured tasks with and without simulated transfer procedures was checked. RESULTS: The highest improvements (28-30%, P = 0.00 ) in the ability to perform tasks were observed after a simulated tendon transfer of either both muscles or teres major alone attached to the supraspinatus or infraspinatus insertion. Although all transfer procedures produce significant improvements (P = 0.00 ), there is a significant difference between the procedures (Chi square=58.8, P = 0.00 ) dependent on attachment site. CONCLUSIONS: According to the simulation procedure used in the current study, a tendon transfer of teres major and latissimus dorsi or teres major alone to the supraspinatus insertion appears to be the most effective procedure in the case of a dysfunctional rotator cuff. Practical factors, like subacromial space, volume of the muscles and tendons, tensile properties and the ability to split the muscles, will finally determine which is the preferred transfer option.

Analysis of Variance↗
PubMed1993

A double-blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis.

Thirty-five patients with rotator cuff tendinitis were randomly allocated to active (CB Medico Master III 830 nm Ga As AL diode) laser or dummy laser treatment twice weekly for 8 weeks. Movement range, painful arc score, resisted movement score and responses to visual analogue scales for night pain, rest pain, movement pain and functional limitation were measured second weekly. All responses improved from baseline but there was no difference between the two groups. These results fail to demonstrate the effectiveness of laser therapy in rotator cuff tendinitis.

Adolescent↗
PubMed2004

Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique.

In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.

Arthroscopy↗