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PubMed2000

[Tendinosis calcarea of the rotator cuff].

Calcifying tendinitis of the rotator cuff is a common disorder of the shoulder which affects mainly individuals between 30 and 50 years of age. The etiology is still a matter of speculation. The calcification is a reactive process actively mediated by cells in a viable environment. The deposit undergoes an evolution (precalcific stage--calcific stage with formative phase, resting period and resorption--postcalcific stage), which ultimately remodels normal tendon tissue. However, the evolutionary stages of the disease do not always follow the typical sequence. A symptomatic deposit may persist or postcalcific tendinitis develop. The treatment should be based on the knowledge of the natural history of the disease, which shows a strong tendency towards self-healing by spontaneous resorption of the deposit. The stage of evolution of the disease should be judged, combining pain history, morphology of the deposit on plain X-rays, and ultrasound findings. The therapeutic approach depends on the evolution of the disease. During the resorption phase we favor a conservative approach. For deposits which are not under resorption we propose a concept which consists of three steps: a conservative approach, extracorporal shock wave therapy (ESWT) or needling, and arthroscopic surgery. The efficacy of ESWT and needling has still to be proven. Patients with persisting pain after steps 1 and 2 are candidates for surgical removal of the deposit. We prefer the arthroscopic approach. In some cases an additional arthroscopic subacromial decompression (ASD) is indicated.

Adult↗
PubMed2005

Rotator cuff tears associated with os acromiale.

INTRODUCTION: Os acromiale is a rare anatomical condition; its incidence in cadaver studies has been found to be approximately 8%. In this retrospective study we investigated the incidence and types of os acromiale in patients with rotator cuff tears. METHODS: We assessed operation notes and axillary radiographs for the presence and the type of os acromiale in 1000 consecutive patients with open rotator cuff repairs. RESULTS: 62 patients (6.2%) showed an os acromiale in the axillary radiographs. In 6 of these the os acromiale was not described in the operation notes. 57 os meso-acromiale and 5 os pre-acromiale were found. The average number of tendons involved in the cuff tear was the same (1.4) in patients with and without os acromiale. The average age of patients with os acromiale was 55 years, and 56 years in patients without os acromiale. INTERPRETATION: Os acromiale is a co-condition in patients with rotator cuff tear. The prevalence of os acromiale in patients with rotator cuff tear is similar to that in a standard population with unknown integrity status of the rotator cuff. Thus, it seems debatable whether an os acromiale is a pathological condition leading to rotator cuff tears.

Acromion↗
PubMedDate not supplied

Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear?

PURPOSE: Our purpose was to determine the association between sonographically detected subacromial/subdeltoid (SA/SD) bursal and biceps tendon sheath effusions and arthrographically proven rotator cuff tears. METHODS: Shoulder sonography reports and sonograms of 105 shoulders in 102 patients who also underwent arthrography were retrospectively reviewed for the presence of fluid within the biceps tendon sheath and SA/SD bursa. Reports and sonograms for 151 asymptomatic shoulders were also reviewed. RESULTS: Biceps tendon sheath effusion and/or bursal fluid were detected in 50 (48%) of 105 shoulders. Fifty-one patients had rotator cuff tears; 28 of them had effusions at 1 or both sites. The sensitivity, specificity, and positive predictive value (PPV) of biceps tendon sheath effusions for diagnosing rotator cuff tear were 35%, 74%, and 56%, respectively. For SA/SD bursal effusions, the sensitivity, specificity, and PPV were 8%, 94%, and 57%, respectively. For combined biceps tendon sheath and bursal effusions, the sensitivity, specificity, and PPV were 12%, 91%, and 54%, respectively. There was no statistically significant association between rotator cuff tears and effusions in the biceps tendon sheath, SA/SD bursa, or both. Among the 151 asymptomatic shoulders, 12 (7.9%) had biceps tendon sheath fluid, 5 (3.3%) had SA/SD bursal effusion, and 2 (1.3%) had both biceps tendon sheath and bursal effusions. CONCLUSIONS: The sonographic detection of intraarticular fluid, SA/SD bursal fluid, or both has a low sensitivity and PPV in the diagnosis of rotator cuff tears. Isolated intra-articular and/or SA/SD bursal effusions are not reliable signs of rotator cuff tear.

Adult↗
PubMed2006

"Transosseous-equivalent" rotator cuff repair technique.

In order to optimize healing biology at a repaired rotator cuff footprint, we have developed a "transosseous-equivalent" rotator cuff repair that can be performed arthroscopically. What the arthroscopically repaired tendon experiences is "equivalent" to what is experienced with a traditional open suture-bridge technique. This repair maximizes the utility of a single-row repair technique by preserving the suture limbs of the medial single-row and bridging these sutures over the footprint insertion with distal-lateral interference screw suture fixation; the medial row uses a mattress suture configuration. The geometry of the construct compresses the tendon, optimizing tendon-to-tuberosity contact dimensions, while providing strength sufficient to withstand immediate postoperative rehabilitation.

Arthroscopy↗
PubMed2004

Rotator cuff repair in patients fifty years of age and younger.

BACKGROUND: Currently, there is no information on the long-term results of rotator cuff repair in young patients. The purpose of the present study was to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure of this procedure in patients fifty years of age and younger. METHODS: Thirty-two patients (thirty-six shoulders) who were fifty years of age or younger underwent repair of a full-thickness rotator cuff tear between 1976 and 1987. Seven patients (seven shoulders) died after less than thirteen years of follow-up. The remaining twenty-nine shoulders, which had been followed for a minimum of thirteen years or until revision surgery, were included in the analysis. The most recent follow-up was performed in the clinic for five shoulders and by means of a questionnaire for twenty-four shoulders. RESULTS: There were three small, fifteen medium, six large, and five massive tears. Rotator cuff repair was associated with significant long-term pain relief (p = 0.0001). However, there was no significant long-term improvement in active abduction or external rotation. Postoperative pain, active abduction, and external rotation did not vary significantly according to gender, tear size, repair type, or whether a distal clavicular excision had been performed. There were eleven excellent, five satisfactory, and thirteen unsatisfactory results. Seven shoulders had additional surgery for the treatment of a recurrent tear (five), instability (one), or osteoarthritis (one). Three of the five repairs that were done for the treatment of a recurrent tear were performed ten years or more after the time of the index procedure. CONCLUSIONS: Rotator cuff repair in young patients is associated with long-term pain relief. However, this procedure is not associated with significant long-term improvement in motion, and a large proportion of patients have an unsatisfactory long-term result. The results of rotator cuff repair in young patients appear to be less favorable than those in a mixed-age population.

Adult↗
PubMed1996

Captured shoulder: a complication of rotator cuff surgery.

Thirteen patients who developed restrictive subdeltoid adhesions after rotator cuff repair were identified. These patients underwent second-look arthroscopy and takedown of adhesions at an average of 37 weeks after their index surgery. Clinical findings include pain and restricted motion that does not yield to manipulation under anesthesia. Arthroscopic findings are subdeltoid adhesions and a chondral lesion (companion lesion) of the humeral head articular surface. Patients were reevaluated at 26 weeks after their release of adhesions. Prerelease and postrelease University of California, Los Angeles (UCLA) scores average 14.8 and 30.1, respectively. Prerelease and postrelease UCLA pain scores averaged 2.6 and 7.7, respectively. Prerelease and postrelease range of motion was as follows: Flexion, 141/158; abduction, 123/141; internal rotation, 47/69; and external rotation, 53/74. The authors have proposed a theory to explain the clinical and arthroscopic findings in this subgroup of patients who are dissatisfied after rotator cuff repair. A technique for and the results of release of the subdeltoid adhesions also are reported.

Arthroscopy↗
PubMedDate not supplied

[Rotator cuff tear--an occupational disease? An epidemiological analysis].

BACKGROUND: In literature there are only few data which describe the influence of occupation on the development of rotator cuff disease. METHODS: In a retrospective study, 760 open rotator cuff repairs were analysed and related to the profession and occupational load. Exclusion criteria were traumatic tears and sports injuries. All male persons were statistically analysed and the data compared with occupational patterns of the region, obtained from the Federal Statistical State Office. RESULTS: Rotator cuff repairs were performed in 472 males who had no evidence for a traumatic origin. After statistical analysis (p < 0.001) we found significantly more patients working in agriculture and forestry (6.38% versus 1.07% in Bavaria) and in the building industry (35.11% versus 13.40% in Bavaria). CONCLUSIONS: Our data suggest that working exposure increases the risk or leads to the clinical manifestation of rotator cuff tears. Although a detailed analysis of individual physical exposure is not available yet, the statistical results indicate that rotator cuff tears must be taken into consideration as a result of ergonomic exposure.

Adult↗
PubMedDate not supplied

Lag signs in the diagnosis of rotator cuff rupture.

We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign (IRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions.

Adolescent↗
PubMed1986

Reconstruction of chronic massive rotator cuff tears with synthetic materials.

Synthetic materials for repairing experimental massive rotator cuff tears were investigated in 60 rats. The same materials were investigated for massive rotator cuff ruptures in 25 patients. The materials were well tolerated when used for repair of torn segments of the musculotendinous cuff. Of 25 patients with massive rotator cuff tears, 23 had satisfactory functional results. The muscle strength tests on tendons repaired with Teflon felt (which was thicker than the other materials) were superior to results of repairs with other materials; 3-5 mm proved to be the optimum thickness of Teflon felt used for repair of the musculotendinous cuff.

Aged↗
PubMed1999

Magnetic resonance imaging evaluation of muscle usage associated with three exercises for rotator cuff rehabilitation.

PURPOSE: Methods of determining muscle usage for exercises involving rotator cuff muscles are limited. Therefore, this investigation used magnetic resonance imaging (MRI) to evaluate the effect of three different exercises used for rehabilitation of the rotator cuff. METHODS: Five normal volunteer subjects (3 men, 2 women, mean age 31.4 yr) were studied. The exercises were scaption with internal rotation (SIR), military press (MP), and side-lying 45 degrees abduction (SLA). MR imaging was performed immediately before and after exercise using a "fast" spin echo STIR sequence and oblique coronal plane imaging. Changes in signal intensity pre- and post-exercise were measured at comparable section locations for the MR images of the supraspinatus, infraspinatus, teres minor, subscapularis, deltoid, and trapezius. RESULTS: The SLA showed the greatest increase in signal intensity in all the muscles (percent change, P < 0.01) except for the trapezius, which was used more by the MP and SIR. None of the exercises activated the teres minor (percent change, P = not significant). CONCLUSION: These findings have important implications in efficacy of physical rehabilitation of the rotator cuff and avoidance of subacromial impingement exercise motions.

Adult↗
PubMed2000

Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases.

BACKGROUND: There has been limited acceptance of shoulder ultrasonography by orthopaedic surgeons in the United States. The purpose of this retrospective study was to determine the diagnostic performance of high-resolution ultrasonography compared with arthroscopic examination for the detection and characterization of rotator cuff tears. METHODS: One hundred consecutive shoulders in ninety-eight patients with shoulder pain who had undergone preoperative ultrasonography and subsequent arthroscopy were identified. The arthroscopic diagnosis was a full-thickness rotator cuff tear in sixty-five shoulders, a partial-thickness tear in fifteen, rotator cuff tendinitis in twelve, frozen shoulder in four, arthrosis of the acromioclavicular joint in two, and a superior labral tear and calcific bursitis in one shoulder each. All ultrasonographic reports were reviewed for the presence or absence of a rotator cuff tear and a biceps tendon rupture or dislocation. All arthroscopic examinations were performed according to a standardized operative procedure. The size and extent of the tear and the status of the biceps tendon were recorded for all shoulders. The findings on ultrasonography and arthroscopy then were compared for each parameter. RESULTS: Ultrasonography correctly identified all sixty-five full-thickness rotator cuff tears (a sensitivity of 100 percent). There were seventeen true-negative and three false-positive ultrasonograms (a specificity of 85 percent). The overall accuracy was 96 percent. The size of the tear on transverse measurement was correctly predicted in 86 percent of the shoulders with a full-thickness tear. Ultrasonography detected a tear in ten of fifteen shoulders with a partial-thickness tear that was diagnosed on arthroscopy. Five of six dislocations and seven of eleven ruptures of the biceps tendon were identified correctly. CONCLUSIONS: Ultrasonography was highly accurate for detecting full-thickness rotator cuff tears, characterizing their extent, and visualizing dislocations of the biceps tendon. It was less sensitive for detecting partial-thickness rotator cuff tears and ruptures of the biceps tendon.

Arthroscopy↗
PubMed1994

Magnetic resonance imaging of rotator cuff lesions.

The purpose of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) in rotator cuff diseases. Forty consecutive patients studied by MRI from September 1990 to September 1992 were included in the study. MRI was performed on a 1.5 tesla MR scanner. Each MRI study was reviewed by two radiologists experienced in rotator cuff tendons. The MRI finding was compared with the surgical result. MRI sensitivity for all tears (partial and complete) was 1.0 (22/22), specificity 0.89 (16/18), accuracy rate 0.95 (38/40), and the predictive value 0.92 (22/24). Signal changes of the rotator cuff tendon (primary signs) were the most reliable criteria in diagnosis of the tear. Changes of subacromial and subdeltoid fat planes and bursa (secondary signs) were complimentary when primary signs were indeterminant. The direction of the long axis of abnormal signal intensity in the rotator cuff tendon may be a good indicator when differentiating tears from tendinitis. We conclude that MRI shows excellent performance in the determination of the presence or absence of a rotator cuff tear.

Adolescent↗
PubMed2002

Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up.

PURPOSE: This study was performed to evaluate 2 arthroscopic techniques for rotator cuff repair used by 1 surgeon for more than 12 years. The main objective of this study was to test the reliability of these arthroscopic repair techniques not only using clinical assessment during the follow-up, but through observation of the healing process of the tendons during the arthroscopic removal of the staples in our first group of patients. TYPE OF STUDY: This study was a before/after trial. METHODS: We present the results of arthroscopic repair of full-thickness rotator cuff tears in 100 patients. In group I, 35 patients had staple fixation, and in group II, 65 patients had side-to-side suture and anchor repair. Follow-up ranged from 2 to 14 years. All shoulders were evaluated using the UCLA rating scale. Shoulders repaired with staples (group I) were evaluated arthroscopically at staple removal. Arthroscopic subacromial decompression was performed in 26 of the 35 patients in group I and in 65 of the 65 patients in group II; 58 patients in group II had concomitant resection of distal clavicle. RESULTS: In group I, 22 patients (63%) had excellent results (UCLA scores, 34-35), 7 (20%) had good results (UCLA scores, 28-33), 4 (11%) had fair results (UCLA scores, 21-27), and 2 (6%) of the patients had poor results (UCLA scores, 0-20). In group II, 47 patients (72%) had excellent results (UCLA scores, 34-35), 12 (19%) had good results (UCLA scores, 28-33), 2 (3%) had fair results (UCLA scores, 21-27), and 4 (6%) of the patients had poor results (UCLA scores, 0-20). CONCLUSIONS: Patients with well-healed rotator cuff tendons had satisfactory postoperative results and better overall functional results. The arthroscopic techniques for rotator cuff repair achieve results comparable to the results of traditional open repair. However, these technically demanding arthroscopic procedures require advanced arthroscopic skills and have a steep learning curve.

Arthroscopy↗
PubMed1990

A comparative study of ultrasonography and arthrography in evaluation of the rotator cuff.

Fifty patients with signs and symptoms of chronic impingement syndrome and/or rotator cuff tear were evaluated with shoulder arthrograms and ultrasonography. Ninety asymptomatic shoulders of a comparable age had ultrasonography to serve as a control group. All controls had normal ultrasonograms with no hypoechoic or sonolucent areas. The 50 symptomatic shoulder patients had the following: 28 had a normal arthrogram with either normal ultrasonograms or buckling of the supraspinatus tendon; eight had normal arthrograms, but ultrasonography indicated a thin (less than 4 mm) irregular supraspinatus tendon; 11 had complete rotator cuff tears visualized on both arthrography and ultrasonography (nine of these 11 patients had surgery confirming complete tears in all); two had a false-positive sonogram, and one had a false-negative sonogram. Thus, the ultrasonography's overall positive predictive value to detect a full-thickness rotator cuff tear was 85%, its negative predictive value was 97%, its sensitivity was 92%, and its specificity was 95%. Real-time ultrasonography is a diagnostically sensitive and specific noninvasive method to evaluate patients with shoulder impingement syndrome, leading to the recommendation that it be used as a primary imaging technique to obviate or supplement arthrography in evaluating rotator cuff disease. However, static ultrasonographic pictures, without real-time ultrasonography as a supplement, were not helpful.

Adult↗
PubMed2003

A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.

BACKGROUND: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. METHODS: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function. RESULTS: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function. CONCLUSIONS: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.

Age Factors↗
PubMed1993

Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters.

Clinical results of arthroscopic rotator cuff debridement and decompression in 25 patients are presented. Additionally, a fluoroscopic study of 14 patients with known massive rotator cuff tears reveals four kinematic patterns in patients with major cuff deficiencies. Biomechanical models are used to support further the clinical impression that certain rotator cuff tears are amenable to arthroscopic debridement and decompression without repair. Specific indications for arthroscopic debridement and decompression are developed and presented.

Aged↗
PubMed1975

Surgical treatment of rupture of the rotator cuff tendon.

A total of 55 tears of the rotator cuff tendon were surgically treated at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, during the period 1960-1970. The rate of operative treatment was about 12 per cent. When more than half a year had elapsed since the accident, excision of the acromion was almost the only operative procedure carried out (10/12 patients). Excision of the acromion was performed as the only procedure in 16 cases and in connection with surgical repair of the rotator cuff tendon in 20 cases. This operation brings relief of nocturnal pain, but it is harmful in the treatment of large tears when used alone and sometimes also in connection with surgical repair of the rotator cuff tendon. Surgical repair of the lesion seems to give the best results, provided it is performed within 1 month of the injury.

Adult↗
PubMed1988

Value of ultrasonography in preoperative diagnosis of rotator cuff tears and postoperative follow-up.

Four hundred and six patients presenting with shoulder pain underwent bilateral shoulder ultrasonography. Rotator cuff lesions were diagnosed in 197 patients. In 155 of the 308 patients who had additional arthrographic examinations, the arthrogram documented rotator cuff tears. Sixty-eight patients underwent surgery. There was good correlation between the ultrasonographic and arthrographic findings as well as the surgical results, with a sensitivity of 91% for each examination technique. Thirty-six postoperative patients were studied ultrasonographically; a minor to marked increase in rotator cuff echogenicity was demonstrated in them all. Its high predictive value makes ultrasonography the method of choice in diagnosing rotator cuff tears. Based on the evaluation of particular criteria, rotator cuff tears (greater than 1 cm) are commonly documented by ultrasonography. Only in patients with indeterminate or negative ultrasonograms in whom there is a high index of clinical suspicion, should arthrography be performed as a complementary imaging test. In postoperative follow-up the degree of scar formation at the reinsertion of the tendon is adequately documented by ultrasonography.

Adult↗