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PubMed2004

Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology.

STUDY DESIGN: Prospective blinded comparison of clinical examination and surgical findings of consecutive patients seen at a tertiary shoulder center. OBJECTIVE: To investigate the validity of the supraspinatus test in diagnosing rotator cuff pathology using arthroscopy or open surgery as reference standards. A positive supraspinatus test was defined as pain for all types of rotator cuff pathology and weakness for full-thickness tears. BACKGROUND: Rotator cuff tenopathy is a very common condition. However, there have been relatively few studies documenting the validity of physical examination for this condition and further investigation of the measurement properties of these tests is warranted. METHODS AND MEASURES: One hundred two consecutive subjects were examined. Fifty subjects, ranging in age between 24 and 79 years (mean age, 50 years; SD, 14.4 years) and composed of 16 females and 34 males, underwent surgery. RESULTS: The sensitivity of the supraspinatus test was 62%, 41%, and 88% for "supraspinatus tendonitis or partial thickness tear," "full-thickness tear," and "large to massive tears," respectively. The specificity values were 54%, 70%, and 70% for the above conditions, respectively. The negative likelihood ratios varied from 0.17 to 0.84, and the positive likelihood ratios varied from 1.35 to 2.93, depending on the presence of pain or weakness. CONCLUSION: Application of the supraspinatus test in isolation is helpful in diagnosing large or massive rotator cuff tears. The change that this test makes in pretest probability of less extensive rotator cuff pathology is insignificant.

Adult↗
PubMed1990

[Evaluating histologic findings of the rotator cuff of the shoulder].

Tearing of the rotator cuff is normally due to degenerative changes of the supraspinator tendon. The vascular situation as well as histological findings in elderly patients--oedema, necrosis and hyalinosis--are reasons for the defect. A classical rupture caused by a real trauma is very rare; it is therefore better to call these typical findings "rotator cuff defect". Regular histological examination is necessary for the classification as traumatic rupture or degenerative defect.

Edema↗
PubMed2003

Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: An arthroscopic approach.

PURPOSE: The purpose of this study was to evaluate the surgical outcome of patients with combined subcoracoid and subacromial impingement with associated rotator cuff tears. TYPE OF STUDY: Case series. METHODS: Eight patients with a mean age of 63.6 (+/- 8.9) years were reviewed. All patients had combined subscapularis, supraspinatus, and infraspinatus tears of the rotator cuff with associated subacromial and subcoracoid impingement. All patients were treated with arthroscopic subacromial decompression, subcoracoid decompression, and rotator cuff repair. RESULTS: At a mean follow-up of 8.8 months (range, 6-12 months), all patients were satisfied with the procedure. The mean University of California Los Angeles (UCLA) score increased from 11.0 +/- 2.6 preoperatively to 30.9 +/- 2.9 postoperatively (P <.00001). Preoperatively, all patients were in the poor category by UCLA criteria. Postoperatively, 2 patients had excellent results, 5 patients had good results, and 1 patient had a fair result. All patients had significant reduction in pain postoperatively, with 4 patients showing complete elimination of pain during all activities. No patient complained of pain anteriorly over the coracoid or had positive impingement signs postoperatively. Active forward elevation increased from a mean of 103.1 degrees +/- 46.5 degrees preoperatively to a mean of 155 degrees +/- 18.5 degrees (P <.02). Preoperatively, 4 patients had no active overhead function with positive Napoleon tests. Postoperatively, all showed improvement of the Napoleon test and regained active overhead function. CONCLUSIONS: Arthroscopic treatment of combined subcoracoid and subacromial impingement can lead to good results in this patient population. A high index of suspicion for these combined lesions, along with adequate surgical decompression and rotator cuff repair, is essential in providing pain relief and improved function.

Aged↗
PubMedDate not supplied

Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging.

We studied magnetic resonance images of rotator cuff tears to determine whether it was possible to establish preoperatively the feasibility or infeasibility of primary repair. The study comprised 27 shoulders in 26 patients who underwent magnetic resonance imaging before surgery because of complete tears of the rotator cuff and who were treated with primary repair or by the patch graft technique because primary repair was not feasible. The length and width of each tear, the thickness of the supraspinatus muscle at the superior margin of the glenoid, and the presence or absence of a high signal intensity in the infraspinatus muscle were statistically analyzed. Primary repair was often not feasible when both the length and width of the tear exceeded 40 mm on a preoperative magnetic resonance image, when the supraspinatus muscle was thin at the superior margin of the glenoid, and when a high signal intensity was observed in the infraspinatus muscle.

Adult↗
PubMed2004

Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep.

BACKGROUND: Ruptures of the tendons of the rotator cuff lead to profound and possibly irreversible changes in the structure and physiological properties of the rotator cuff muscles. Muscle atrophy and fatty infiltration are important prognostic factors that affect the natural history and outcome of treatment. The purpose of this study was to examine the amount of muscle atrophy and fatty infiltration in an animal model and to determine whether the repair of a long-standing tendon tear can reverse these changes. METHODS: The infraspinatus tendon in six sheep was released and encased in a silicone tube to prevent spontaneous healing. The musculotendinous unit was allowed to retract for forty weeks. Throughout this period, the muscular changes were studied with use of computed tomography, histological analysis, and electron microscopy. At forty weeks, the elasticity, intramuscular pressure, and perfusion were measured intraoperatively and a tendon repair was carried out. The structural changes of the muscle were studied for thirty-five weeks after the repair. The animals were then killed, and the musculotendinous units were examined macroscopically and by computed tomography, histological analysis, and electron microscopy. RESULTS: At the time of the tendon release, the infraspinatus showed no fatty changes. The force needed to cause a tendon excursion of 1 cm was a mean (and standard deviation) of 6.8 +/- 1 N. The application of tension on the tendon did not alter the perfusion and decreased the intramuscular pressure. After the tendon release, muscular atrophy developed and there was a significant increase (p < 0.001) in interfascicular and intrafascicular fat, representing fatty infiltration rather than fatty degeneration. Furthermore, there was an increase of interstitial connective tissue. At the time of the tendon repair, between forty and forty-two weeks after the release, there was a sevenfold poorer elasticity of the musculotendinous unit but preserved muscle perfusion. The structural changes increased six weeks after the repair and then recovered partially at twelve and thirty-five weeks thereafter but only to the amount demonstrated before the repair. CONCLUSIONS: Musculotendinous retraction induced by tendon release is associated with profound changes in the structure and function of the affected muscle. Vascularization, intramuscular pressure, and individual fiber composition are not markedly affected, and muscle fibers do not appear to degenerate. However, muscle atrophy, infiltration by fat cells, and an increase of interstitial connective tissue lead to impairment of the physiological properties of the muscle. These changes were irreversible under the conditions of this experiment with the repair technique used.

Adipose Tissue↗
PubMed1988

Rotator cuff injuries in baseball. Prevention and rehabilitation.

Rotator cuff and ligamentous capsule injuries are common in the young baseball player. In order to understand these injuries, it is important to first appreciate the delicate balance between shoulder mobility and stability as well as the biomechanics of throwing. This background information makes it easy to see how shoulder injuries are really part of a progressive continuum beginning with instability leading to subluxation, and later impingement which can result in a rotator cuff tear. A detailed and precise history and physical is crucial in determining where a patient might be on the continuum. An accurate evaluation will also help appropriately place a patient in one of the following 4 groups: pure impingement, anterior instability due to trauma with secondary impingement, anterior stability due to a hyperelasticity with secondary impingement, and pure anterior instability. A kinesiological repair is the initial treatment of choice. It is the best preventative or early treatment available, and consists of a specific strengthening programme. If this fails (as in only 5 to 10% of the cases), an anatomical repair is instituted. There are 4 basic guidelines when doing this surgery: (a) maintain muscle attachments and proprioceptive fibres; (b) do not shorten the capsule significantly; (c) build up the anterior labrum; and (d) regain full range of motion quickly through abduction splinting and rehabilitation. A postoperative rehabilitation programme is then diligently adhered to, as it is at least as important as the surgery itself.

Adolescent↗
PubMed1993

Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options.

OBJECTIVE: The management of patients with signs and symptoms referable to the rotator cuff depends on the presence of cuff injury and the size of the tear. Treatment options include conservative nonsurgical management for patients with an intact or partially torn cuff, arthroscopic decompression of the coracoacromial space for those not responding to nonsurgical management, and a range of surgical techniques to repair full-thickness tears. This study was designed to determine whether sonographic evaluation with classification of the extent of cuff injury is accurate for purposes of treatment planning. SUBJECTS AND METHODS: Preoperative sonography of the rotator cuff was performed on 225 patients, and findings were classified into intact, partial tear, small full-thickness tear, large full-thickness tear, and massive tear groups. Surgical correlation with the predicted sonographic classification was provided by arthroscopic inspection or open surgery. RESULTS: The sonographic findings were surgically confirmed for 206 (92%) of the 225 patients. More extensive cuff injury was encountered during surgery than had been predicted sonographically in 11 patients (5%); less extensive injury than predicted was found during surgery in eight patients (4%). CONCLUSION: Our results show a high correlation between the sonographic classification of rotator cuff injury and the surgical findings. The selection of appropriate treatment programs can be reliably based on the sonographic classification.

Adult↗
PubMed2002

Interleukin-1-induced glenohumeral synovitis and shoulder pain in rotator cuff diseases.

Synovitis of the subacromial bursa has been identified as a main source of shoulder pain in rotator cuff diseases. Little interest, however, has been paid into the synovitis of glenohumeral joint. The mRNA expression levels of interleukin-1beta (IL-1beta) and interleukin-1 receptor antagonists produced in the synovitis reflect the magnitude of inflammation. The present study was undertaken to determine the relationship between mRNA expression levels of IL-1beta and its receptor antagonists (secreted interleukin-1 receptor antagonist (IL-1ra) and intracellular IL-1ra) in the synovium of the glenohumeral joint and shoulder pain in rotator cuff diseases, analyzing the synovial specimens by reverse transcriptase polymerase chain reaction. Thirty-five patients with rotator cuff diseases were candidates. Based on the presence of cuff perforation, they were divided into two categories: 16 with non-perforating tears and 19 with perforating tears. The degree of shoulder pain was evaluated by use of a visual analogue scale. The pain degree of non-perforating tears was significantly greater than that of perforating tears (P < 0.01). In contrast, the expression levels of the cytokine-mRNAs were constitutively greater in perforating tears than in non-perforating tears (P < 0.01, respectively). The expression levels of the cytokine-mRNAs were inversely correlated with the degree of pain (IL-1beta: r = 0.930; secreted IL-1ra: r = 0.861; intracellular IL-1ra: r = 0.932, P < 0.001 respectively). These results suggest that the expression levels of the cytokine-mRNAs in the synovium of the glenohumeral joint contribute less to the generation of shoulder pain in rotator cuff diseases.

Adult↗
PubMed1996

[Results of a series of deltoid flaps for the treatment of massive rotator cuff tears with an average follow-up of 3.5 years].

PURPOSE OF THE STUDY: We report a series of 14 patients with a massive rotator cuff tear operated on with a deltoid flap according to Augereau's technique. The aim of this study was to evaluate the benefits of this technique using Constant's scoring system. The follow up is 40 months. MATERIAL AND METHOD: 14 patients, mean age 59 years, with a total rotator cuff tear type III according to Gerber's classification were included. There was 13 total ruptures of the supra and infra spinatus tendon and one infraspinatus and subscapularis lesion. All the patients had shoulder pain, and the preoperative, Constant's score was 24.1/100. The diagnosis of the rotator cuff rupture was confirmed by X-rays, arthrography and ultra-sonography. 8 patients had a Magnetic Resonance Imaging (MRI) evaluation. The surgical procedure was the technique described by Augereau, and three patients had a resection of the distal clavicle. One patient had a small piece of dacron to reinforce the suture of a very thin deltoid flap. All the patients had a immobilization in abduction and the rehabilitation programm began immediately. RESULTS: Results on pain were good: +11.4 points according to Constant's score, but improvement strength (+0.7 point) or motion (+1 point) was not significative. Postoperative Constant's score was 46.9, ponderated score increased from 29.5 per cent to 57.5 per cent. Ten patients were very satisfied, 2 were satisfied and two were disappointed. One of them neaded shoulder arthrodesis; the other needed a new surgery to remove the piece of dacron, and was allayed with NSAI drugs. External rotation was slightly increased: +2 point. DISCUSSION: These results are similar to others series on pain relief, but the results are poor on strength restauration and on shoulder motion. This technique is a heavy surgical procedure and results are not better than arthroscopic sub acromial decompression for massive rotator cuff tear.

Aged↗
PubMed2005

The German Short Musculoskeletal Function Assessment questionnaire: reliability, validity, responsiveness, and comparison with the Short Form 36 and Constant score--a prospective evaluation of patients undergoing repair for rotator cuff tear.

In a prospective clinical trial, first the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D) was tested for reliability, validity, and responsiveness in 23 patients with rotator cuff tears, and secondly the Short Form (SF)-36, and the Constant score were evaluated comparatively in 45 patients with rotator cuff tear undergoing open repair. Retest reliability was excellent for the functional index of the SMFA-D and satisfactory for the bother index. The SMFA-D showed good validity and responsiveness. All three instruments demonstrated significantly the positive effect of rotator cuff repair at 12-month follow-up. Using comparable scales, effect sizes were bigger with the SMFA-D than with the SF-36 and as big as the Constant score. Significant correlations of the SMFA-D indices with the SF-36 scales and the Constant score could be shown preoperatively. At 12-month follow-up, all correlations between SMFA-D indices, SF-36 scales, and Constant score function scales were still significant. We recommend use of the SMFA-D to assess changes in functional status concerning patients with rotator cuff tear undergoing open repair.

Adult↗
PubMed1996

Sonographic signs of complete rotator cuff tears.

BACKGROUND: To evaluate the usefulness of high resolution ultrasound (HRUS) in the examination of complete rotator cuff tear (RCT). METHODS: A prospective study of 157 patients with sonographic examination of shoulder was performed. All of them complained of chronic shoulder pain and were referred by clinician for suspicion of RCT. Their age ranged from 30 to 76 years. The ultrasonic scanners we used were Acuson 128 XP 10 with 7MHz linear transducer, or Diasonics VST master series using 10MHz linear transducer. Examination positions included external rotation of shoulder for scanning biceps tendon and subscapularis tendon, and internal rotation for supraspinatus tendon and lateral scan of infraspinatus tendon and teres minor tendon. Sonographic criteria of complete RCT included 1. complete absence of rotator cuff (RC); 2. focal thinning of RC; 3. focal hypoechoic cleft of RC; 4. focal depression of RC; and 5. heterogeneous hypoechoic RC with subdeltoid bursa fluid. Arthrography was performed after sonography examination on the same day. RESULTS: Among 49 complete RCTs diagnosed by sonography, 46 were proved to be complete RCT by arthrography; only 3 were false positive. In 108 patients with normal rotator cuff diagnosed by sonography, 104 had compatible results with arthrography; only 4 patients turned out to be complete RCT. The sensitivity, specificity, positive predictive values, negative predictive values and accuracy were 92%, 97.2%, 93.9%, 96.3% and 95.5%, respectively. CONCLUSIONS: HRUS can directly demonstrate the morphological changes of RC. It has a high sensitivity and specificity in the diagnosis of complete RCT, and can be used as a firstline screening modality for complete RCT in patients with chronic shoulder pain.

Adolescent↗
PubMed2003

Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up.

PURPOSE: The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. TYPE OF STUDY: Prospective cohort study. METHODS: Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow Society (ASES) index, visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction (Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today?). The null hypothesis that was tested was that there was no difference between the preoperative and postoperative outcomes. The 37 patients were divided, by cohort design, into 2 groups; massive anterosuperior (AS; subscapularis, supraspinatus, and infraspinatus with or without the teres minor) and massive posterosuperior (PS; supraspinatus and infraspinatus, with or without the teres minor) tears. Additionally, the null hypothesis that there was no difference between outcomes for massive AS and massive PS subgroups was tested. RESULTS: There was no statistically significant difference between either subset of massive rotator cuff tears with respect to preoperative and postoperative outcomes. The null hypothesis was supported for between groups. All but 2 patients said that they would undergo surgery again to achieve the postoperative state. CONCLUSIONS: The arthroscopic repair of massive rotator cuff tears is effective for decreasing pain and improving the functional status of the shoulder for most patients. Complete coverage was achieved in 78% of the patients at the time of surgery. A subset of patients who did not have complete coverage or coverage at a second setting showed similar outcomes as those with full coverage. The patient satisfaction rate was 95%.

Aged↗
PubMed1991

Arthroscopic subacromial decompression in the treatment of full-thickness rotator cuff tears.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full-thickness rotator cuff tears is controversial. We observed 25 patients with full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and cuff debridement alone with a minimum of 1 year follow-up observation. Based on the University of California at Los Angeles shoulder rating, 84% of the cases were rated as excellent or good. There was significant improvement in pain, function, motion, and strength. Eighty-eight percent of the patients were satisfied with the procedure. Although all tear sizes improved significantly, smaller tears fared better than larger tears. The preliminary results of arthroscopic subacromial decompression with cuff debridement compare favorably to open techniques of rotator cuff repair with or without acromioplasty and should be considered in selected patients with full-thickness rotator cuff tears.

Acromion↗
PubMed2004

Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases.

BACKGROUND: Although many investigators have evaluated the accuracy of ultrasonography and magnetic resonance imaging for the detection of full and partial-thickness rotator cuff tears, few have directly compared the two tests. The purpose of our study was to compare the accuracy of the two tests for detection and measurement of the size of rotator cuff tears, with arthroscopic findings used as the standard. METHODS: One hundred and twenty-four consecutive patients with shoulder pain were prospectively studied with ultrasonography and magnetic resonance imaging. Seventy-one had subsequent arthroscopy, and they formed the study group. The arthroscopic diagnosis was a full-thickness tear in forty-six patients, a partial-thickness tear in nineteen, and no tear in six. The presence or absence of a full or partial-thickness tear and the tear size as demonstrated by each imaging test and at the time of arthroscopy were recorded. The findings of the imaging tests and arthroscopy were then compared for each parameter. RESULTS: Ultrasonography correctly identified forty-five of the forty-six full-thickness tears and magnetic resonance imaging, all forty-six. Ultrasonography correctly identified thirteen of the nineteen partial-thickness rotator cuff tears and magnetic resonance imaging, twelve of the nineteen. The overall accuracy for both imaging tests was 87%. Ultrasonography correctly predicted the degree of retraction of 73% of the full-thickness tears and the length of 85% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the retraction and length of 63% and 75%, respectively. Ultrasonography correctly predicted the width of 87% of the full-thickness tears and 54% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the width of 80% and 75%, respectively. No significant differences between ultrasonography and magnetic resonance imaging were demonstrated (p > 0.05). CONCLUSIONS: Ultrasonography and magnetic resonance imaging had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. When an investigator has comparable experience with both imaging tests, the decision regarding which test to perform for rotator cuff assessment does not need to be based on accuracy concerns. The choice can be based on other factors, such as the importance of ancillary clinical information (regarding lesions of the glenoid labrum, joint capsule, or surrounding muscle or bone), the presence of an implanted device, patient tolerance, and cost.

Adult↗
PubMedDate not supplied

Rotator cuff repair in a district hospital setting: outcomes and analysis of prognostic factors.

In a prospective study of 58 complete rotator cuff tears, 54 patients underwent surgery by a single surgeon for chronic, symptomatic, full-thickness rotator cuff defects. An independent observer performed the evaluation. Fifty-two of 58 patients reported marked relief of pain and rated themselves as having mild or no deficit in their ability to perform daily activities. The study evaluated preoperative and intraoperative factors that influenced postoperative outcome. Eighty-three percent of patients had good or excellent results according to the modified Constant scoring system and 76% with the UCLA system. There was no pain or minimal pain in 90%, and 92% reported overall improvement after the surgery. It is concluded that in a patient with a full-thickness rotator cuff tear, pain and shoulder function can be improved by acromioplasty and cuff repair, but a slight decrease in the range of motion and muscle strength will probably remain.

Activities of Daily Living↗
PubMed2005

Accuracy of CT arthrography in the assessment of tears of the rotator cuff.

CT arthrography and arthroscopy were used to assess tears of the rotator cuff in 259 shoulders. Tear size was determined in the frontal and sagittal planes according to the classification of the French Arthroscopy Society. CT arthrography had a sensitivity of 99% and a specificity of 100% for the diagnosis of tears of supraspinatus. For infraspinatus these figures were 97.44% and 99.52%, respectively and, for subscapularis, 64.71% and 98.17%. For lesions of the long head of the biceps, the sensitivity was 45.76% and the specificity was 99.57%. Our study showed an excellent correlation between CT arthrography and arthroscopy when assessing the extent of a rotator cuff tear. CT arthrography should, therefore, be an indispensable part of pre-operative assessment. It allows determination of whether a tear is reparable (retraction of the tendon and fatty degeneration of the corresponding muscle) and whether this is possible by arthroscopy (degree of tendon retraction and extension to subscapularis).

Adult↗
PubMedDate not supplied

Portal-extension approach for the repair of small and medium rotator cuff tears.

One hundred ten consecutive cases (110 patients) of arthroscopically assisted rotator cuff repair through a limited, portal-extension approach were retrospectively reviewed. The average age of our patients was 58 years (range, 30 to 79). There were 35 women and 75 men. The dominant shoulder was affected in 67 patients (61%). All patients underwent a standard arthroscopic decompression. Acromioclavicular resections were performed in 15% of patients. The anterolateral portal was extended in the direction of Langer's lines to a total length of no more than 3 cm. The torn tendon was accessed through a small deltoid muscle split and repaired with nonabsorbable sutures. At an average follow-up of 35 months (range, 24 to 86), 106 patients (96%) had achieved excellent or satisfactory results. The average American Shoulder and Elbow Surgeons pain score improved from 7 preoperatively to 2 postoperatively. All but four patients were satisfied with the clinical result and reported significant improvement in active elevation and strength and a significant lessening of pain. Late acromioclavicular joint pain contributed to failure in three of the four patients with unsatisfactory results in this series. The results of this study suggest that, in selected patients with small to medium rotator cuff tears, arthroscopically assisted repair through an anterolateral portal-extension approach can produce excellent results.

Adult↗
PubMed1993

Bulk effect of rotator cuff on inferior glenohumeral stability as function of scapular inclination angle: a cadaver study.

Eleven fresh cadaver shoulders were studied to determine the static contribution (bulk effect) of the rotator cuff on inferior glenohumeral stability provided by scapular inclination. All musculature, including the rotator cuff, was removed. The position of the humerus relative to the scapula was recorded using an electromagnetic tracking device under conditions of no force and 1.5 kg of inferior translation force applied to the humerus, with the arm in the hanging position (sulcus test) and then in 90 degrees abduction (Abduction-Inferior Stability test = ABIS test), with the scapula inclined referable to the vertical line at -15 degrees, 0 degrees, 15 degrees and 30 degrees in the sulcus test and at 15 degrees, 30 degrees, 45 degrees and 60 degrees in the ABIS test. In the sulcus test without load, all shoulders dislocated at scapular inclination angles of -15 degrees and 0 degrees, whereas no shoulders dislocated at 30 degrees. The angle of scapular inclination had a significant effect on humeral head positions (p < 0.0001), with the head position at -15 degrees and 0 degree being lower than at 15 degrees, which was lower than at 30 degrees. In the ABIS test, none of the shoulders dislocated, although the effect of the angle of scapular inclination was significant (p < 0.0001), with the position of the humeral head being higher at 15 degrees than at other angles of inclination. Comparison of these data and previously reported data with the cuff intact showed no significant effect of rotator cuff removal on humeral head position and displacement in both tests. Therefore, we conclude that the static condition of the rotator cuff has no significant effect on the stabilizing function of scapular inclination. The stabilizing mechanism of scapular inclination seems to be associated with the bony configuration and/or anatomy and biomechanical properties of the superior capsuloligamentous structures.

Adult↗