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PubMed1984

Rotator cuff rupture: management with suprascapular neuropathy.

In patients with shoulder pain, weakness, and limitation of motion from rupture of the rotator cuff, there may be concomitant suprascapular neuropathy. In five patients with partial tears and one postsurgical patient with a complete tear of the rotator cuff, confirmed by arthrography, shoulder pain and weakness persisted 6 to 10 weeks after trauma. Electrodiagnosis in all six patients demonstrated prolonged suprascapular distal nerve latencies to the involved infraspinatus muscles. During the first 5 months after trauma, clinical recovery was much more rapid than later. Eight months after injury, despite conservative therapy, some discomfort remained and electrodiagnostic values had not completely returned to normal. The combination of a torn rotator cuff and a suprascapular neuropathy can present a complex diagnostic and management challenge, suggesting the importance of alertness to the possibility of such a combination in patients with tears of the rotator cuff.

Adult↗
PubMedDate not supplied

Arthroscopic assessment of full-thickness rotator cuff tears.

SUMMARY: To evaluate the reliability of the arthroscopic assessment of full-thickness rotator cuff tears, 117 cases were prospectively investigated by imaging, arthroscopy, and open surgery. The confidence of the surgeon, his accuracy, and the surgeon-dependent character of arthroscopic assessment were evaluated in terms of the description of the main anatomic parameters. The surgeons were confident and accurate in diagnosing a full-thickness tear of the supraspinatus, but they underestimated its coronal and sagittal extent and its reducibility to the greater tuberosity. Conversely, the technique appeared very accurate in describing the rotator interval. Endoscopic assessment was particularly operator-dependent in the anteroposterior analysis of the tear. This study shows the limits of endoscopic assessment of full-thickness rotator cuff tears. It illustrates the need for an adequate arthroscopic technique with a thorough knowledge of normal and pathological anatomy of the rotator cuff.

Arthroscopy↗
PubMed2002

Magnetic resonance imaging of sports-related injuries to the shoulder: impingement and rotator cuff.

MR imaging provides clinically useful information in detecting and characterizing sports-related pathology of the rotator cuff and other shoulder disorders in a non-invasive 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.

Athletic Injuries↗
PubMed1988

Rotator cuff disruption: diagnosis with digital arthrography.

Shoulder arthrography is a reliable technique for use in the diagnosis of tears of the rotator cuff, although delineation of the precise site and size of tears requires meticulous double-contrast technique and considerable examiner expertise. The authors initiated a prospective evaluation of digital arthrography of the glenohumeral joint in 28 patients with clinical manifestations suggesting rotator cuff tear because they believed that examination with this technique would allow more accurate definition of the precise status of the cuff. Fifteen patients had normal studies. Ten complete and three partial rotator cuff tears were demonstrated with digital technique, and the precise site of the tear was demonstrated in all of these cases. The results indicate that digital arthrography of the glenohumeral joint may have some advantages over standard arthrography in the delineation of complete and partial tears of the rotator cuff, particularly in defining the exact site of tears.

Adult↗
PubMed2006

[Bipolar shoulder prosthesis for rheumatoid arthritis with irreparable rotator cuff tear: results after 5 years' follow-up].

PURPOSE OF THE STUDY: The goal of this study was to assess the clinical and radiological outcome of bipolar shoulder prosthesis in twelve shoulders with rheumatoid arthritis (RA) and irreparable rotator cuff tears. MATERIAL AND METHODS: The follow-up was more than five years (range 2-9 years). In addition, in order to investigate the effect of rheumatoid arthritis on outcome, results were compared with ten bipolar shoulder prostheses implanted for osteoarthritis with massive rotator cuff tears. RESULTS: The mean preoperative Constant score was 16.9 points with 2.6 points for pain, 4.2 points for activity, 9.5 points for motion and 0.6 points for force. The preoperative active motion was 63.8 degrees for forward flexion, 45 degrees for abduction and 12 degrees for active external rotation. At last follow-up, the average Constant score was 39.4 points with 10.7 points for pain, 10.8 points for activity, 13.8 points for motion and 4.1 points for force. Regarding the active motion, mean forward flexion was 83.7 degrees, 70.4 degrees for abduction and 29.1 degrees for external rotation. The complication rate was low, mainly superior migration due to infraspinatus tear and glenoid wear. Satisfactory deltoid arm level was achieved in all patients and no loosening was observed. Preoperative and postoperative scores of the rheumatoid group were not significantly different from the arthritis group (p<0.001). DISCUSSION: Our findings suggest that bipolar shoulder prosthesis provides a viable replacement alternative in RA combined with massive rotator cuff tear with a low rate of complication. Bipolar shoulder prosthesis demonstrates no clear superiority over conventional hemiarthroplasty regarding improved motion and glenoid wear. In addition, no significant difference with arthritis was observed (p<0.05), assuming that outcome depends principally on the preoperative condition of the rotator cuff. CONCLUSION: Some massive tears involving the subscapularis tendon can lead to anterior recurrence after bipolar shoulder prosthesis. They might be a limit to the procedure and require a reversed shoulder prosthesis or a glenohumeral arthrodesis.

Aged↗
PubMedDate not supplied

Articular surface partial-thickness rotator cuff tears.

Between 1987 and 1992, one hundred eleven articular surface partial-thickness rotator cuff tears were diagnosed in 106 patients; 90 were men, and 16 were women. The average age was 42.5 years. Average follow-up was 32.3 months, ranging from 26 to 84 months. Patients were separated into three groups. Group 1 consisted of 85 shoulders in which impingement was believed to be the primary cause; these shoulders were treated with debridement of the tear and arthroscopic subacromial decompression. Group 2 consisted of 14 shoulders with instability treated with debridement of the partial tear and anterior reconstruction (n = 10) or debridement and rehabilitation (n = 4). Group 3 contained 12 shoulders with tearing caused by trauma that were managed with debridement and open repair, if necessary. In 98 of 111 cases (88%), the patients had a satisfactory result. Five patients required open rotator cuff repair at a later date because of continued symptoms. Complications included significant postoperative stiffness in four shoulders, which required open release.

Acromion↗
PubMedDate not supplied

Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears.

The purpose of this study was to assess the diagnostic accuracy of transdeltoid palpation (the rent test) for the diagnosis of full thickness rotator cuff tear. Clinical and arthroscopic findings were documented prospectively for 109 consecutive patients undergoing shoulder arthroscopy by the senior author. A retrospective analysis was then performed on these data to assess the accuracy of transdeltoid palpation in the diagnosis of full thickness rotator cuff tear. Transdeltoid palpation was found to have a sensitivity of 95.7% and specificity of 96.8% for the diagnosis of full thickness rotator cuff tear. The positive and negative predictive values for transdeltoid palpation were 95.7% and 96.8%, respectively. Overall, the diagnostic accuracy of transdeltoid palpation was 96.3%. We conclude that transdeltoid palpation is highly accurate for the clinical diagnosis of full thickness rotator cuff tear.

Adult↗
PubMed1994

Functional and anatomical results after rotator cuff repair.

The anatomic condition of the rotator cuff and the functional results obtained were studied in a homogeneous series of 100 full thickness cuff tears in 98 patients with an average followup of 4 years. Constant's functional score, used by the European Society for Shoulder and Elbow Surgery, was done preoperatively and postoperatively in each patient, in addition to ultrasonography at followup. There was a close correlation between the anatomic condition of the cuff and Constant's functional score before surgery (p = 0.0063) and after repair, irrespective of the type of tear repaired (p = 0.0012) or the sonographic appearance of the cuff at followup (p = 0.0001). Ultrasonography showed 65% intact cuffs, 11% intact but thinned cuffs, and 24% recurrent defects. Three predisposing factors for recurrence were noted: size of tear to be repaired (p = 0.0001) accounted for 57%, age (p = 0.063) for 25%, and degree of occupational use for 18%. The functional results obtained were more related to the anatomic condition of the repaired cuff at followup than to the tear size at surgery. Predictive clinical factors for recurrence included overall Constant's functional score, reduced ability to perform daily activities, reduced active flexion, abduction and external rotation, and loss of muscular strength. Constant's functional score reflected the functional results with accuracy, reliability, and reproducibility. Additional ultrasonography appears necessary to specify the exact size of the recurrent defect and to distinguish between certain anatomic types, such as thinned cuffs, which can give rise to difficult problems in manual workers after defect repair.

Activities of Daily Living↗
PubMed1998

Sonography for the office screening of suspected rotator cuff tears: early experience of the orthopedic surgeon.

This study examined the feasibility of orthopedic surgeons performing sonography of the shoulder at the initial office evaluation of the rotator cuff and assessed the sensitivity, specificity, and predictive value of sonography for the detection of tears in the rotator cuff. Initial results in 24 patients suggest that sonography by the orthopedic surgeon is feasible and that it detects tears in the rotator cuff with sufficient accuracy for clinical decision making.

Adult↗
PubMed1993

Degenerative change and rotator cuff tears. An anatomical study in 160 shoulders of 80 cadavers.

In order to determine the effects of friction and rubbing in the development of rotator cuff tear, we studied 160 shoulders of 80 cadavers (age at death 43-93 years, mean 69.3 years). Seventy-two cadavers were fixed with formalin and eight were fresh cadavers. The surface of the cuff and the undersurface of the acromion were observed macroscopically. Eight shoulders of fresh cadavers were examined by scanning electron microscopy. Ninety-eight specimens (61%) showed degenerative changes of the supraspinatus tendon. The number of tendons with degeneration and tear increased from the fifth to sixth decade of life, and the size of the tear increased with age. However, there was no sustained increase in the incidence with aging from the age of 60 to 90 years, and the percentage with degenerative changes of the cuff remained at approximately 60% in each decade. Ninety-six specimens (60%) showed degeneration of the subacromial surface. The percentage with degeneration of the undersurface of the acromion remained at approximately 60% from the sixth to ninth decade. There was a significant correlation between the severity of the changes in the rotator cuff and the subacromial surface. Scanning electron microscopy showed changes suggesting effects of friction and rubbing on the rotator cuff, such as regularly arranged wool-like spherical structures on the surface of the tendon and rounded ruptured ends of the tendon fibers. These results indicate that degenerative change of the rotator cuff is aggravated by a friction and rubbing mechanism with the undersurface of the acromion and leads to development of a complete tear.

Acromion↗
PubMed1997

MR imaging of impingement and rotator cuff disorders. A surgical perspective.

The role of MR imaging in the diagnosis of impingement and rotator cuff disorders is expanding greatly. This article discusses the clinically pertinent history, physical examination, and surgical treatment of rotator cuff problems. A rationale for consideration of open, "mini-open," and arthroscopic surgical intervention is proposed. The utilization of MR imaging by the orthopedic surgeon for nonoperative, preoperative, and postoperative decision-making are presented. A close working relationship between the radiologist and the orthopedist is emphasized.

Diagnostic Imaging↗
PubMedDate not supplied

Rotator cuff ultrasonography: diagnostic capabilities.

Dynamic shoulder ultrasonography is a noninvasive, accurate method used to assess the rotator cuff tendons. It can be incorporated into the in-office physical examination of patients at risk for rotator cuff problems. The low cost, convenience, and lack of risk make dynamic ultrasonography an excellent imaging tool for evaluating the biceps, subscapularis, infraspinatus, teres minor, and supraspinatus tendons. In-office ultrasound also provides an opportunity for patient education and explanation of management options.

Diagnosis, Differential↗
PubMed1995

Costs analysis of successful rotator cuff repair surgery: an outcome study. Comparison of gatekeeper system in surgical patients.

In an effort to determine the cost effectiveness of rotator cuff repair surgery in workers' compensation patients, a financial analysis of 50 consecutive patients with a "successful" result was performed. Treatment costs were analyzed from the date of initial injury through all evaluations, diagnostic studies, surgical reconstruction, physical therapy and work hardening. Additionally, all workers' compensation payments and the cost of settlement was analyzed. The average cost of medical care was $50,302.25 per patient. The average time to return to unrestricted duty from the date of injury was 11 months. However, patients referred to a specialist immediately following the diagnosis of a rotator cuff tear had total costs that averaged $25,870.64 and returned to work an average of 7 months postoperatively. Patients managed via a "gatekeeper" system averaged $100,280.10 in total costs and the average return to work was 18 months. These differences in cost and return to work were both statistically significant, P < .05. In conclusion, immediate referral of rotator cuff tears for specialized care results in decreased cost and earlier return to work.

Absenteeism↗
PubMedDate not supplied

Rotator cuff repair as an outpatient procedure.

The purpose of this study was to evaluate outpatient rotator cuff repair on the basis of patient satisfaction, pain control, early postoperative complications, and cost control. Patients were considered good candidates for an outpatient repair if they were in good health and had adequate support at home. Seventy-five rotator cuff repairs were performed on an outpatient basis. The average age of the patients was 58 years. Patients with tears smaller than 2 cm in diameter were excluded. Postoperative pain was managed effectively in 74 of 75 outpatients. There were no cases of deltoid origin compromise, deep infection, or early failure of repair, and no outpatient required readmission to the hospital. This study demonstrates that outpatient rotator cuff repair is possible in the appropriately selected patient and can be performed safely and effectively with a 43% reduction in overall cost.

Adult↗
PubMed1996

MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population.

OBJECTIVE: MR imaging of the shoulder was performed in an asymptomatic population to determine the prevalence of MR-evident peritendinous and bone abnormalities. Findings were correlated with subject age and rotator cuff abnormalities. SUBJECTS AND METHODS: Dual-echo T2-weighted oblique coronal MR images of the shoulder were evaluated for 100 asymptomatic volunteers who were 19-88 years old. Twenty symptomatic patients with arthroscopic correlation were included as controls. Images were assessed independently by two reviewers with no knowledge of subject history or symptomatology. Bursal, peribursal, and bone findings were correlated with subject age and the appearance of the rotator cuff tendon. RESULTS: Changes characteristic of acromioclavicular joint osteoarthrosis were present in three fourths of the shoulders. One third had subacromial spurs. Changes in the peribursal fat plane and the presence of fluid in the subacromial-subdeltoid bursa paralleled the degree of MR-evident rotator cuff abnormalities. Joint fluid was observed in nearly all subjects. CONCLUSION: Our findings reveal a high prevalence of MR-evident bone and peritendinous shoulder abnormalities among asymptomatic individuals. The prevalence of subacromial spurs and humeral head cysts correlated closely with the severity of MR-evident rotator cuff abnormalities, as did changes in the bursa and peribursal fat. Acromioclavicular joint osteoarthrosis is seen in many shoulders independently of rotator cuff disease; therefore, its presence alone does not appear to be a reliable indicator of pain or tendon disease.

Acromioclavicular Joint↗
PubMed1985

The pathology of the rotator cuff of the shoulder.

The pathology of the rotator cuff of the shoulder, which is often regarded as synonymous with the condition known as peri-arthritis of the shoulder, comprises: calcified tendinopathy, tendinosis, the acromio-humeral friction syndrome and rupture of the rotator cuff tendons. The authors analyse the various aspects of these pathological conditions in the light of recent physiopathological and clinical findings.

Adult↗
PubMed2003

Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff disease.

Vascular endothelial growth factor (VEGF) is a glycoprotein that plays an important role in neovascularization and increases vascular permeability. We reported that VEGF is involved in motion pain of patients with rotator cuff disease by causing synovial proliferation in the subacromial bursa (SAB). The present study investigates whether VEGF is also involved in the development of shoulder contracture in diabetics with rotator cuff disease. We examined 67 patients with rotator cuff disease, including 36 with complete cuff tears, 20 with incomplete tears, and 11 without apparent tears (subacromial bursitis). The patients were into groups according to the presence or absence of diabetes (14 type II diabetics and 53 non-diabetics). Specimens of the synovium of the SAB were obtained from all patients during surgery. Expression of the VEGF gene in the synovium of the subacromial bursa was evaluated by using the reverse transcriptase polymerase chain reaction. The VEGF protein was localized by immunohistochemistry, and the number of vessels was evaluated based on CD34 immunoreactivity. The results showed that VEGF mRNA was expressed in significantly more diabetics (100%, 14/14) than in non-diabetics (70%, 37/53) (P=0.0159, Fisher's test). Investigation of VEGF isoform expression revealed VEGF121 in all 14 diabetics and in 37 of the 53 non-diabetics, VEGF165 in 12 of the 14 diabetics and in 21 of the 53 non-diabetics, and VEGF189 in 1 of the 14 diabetics and in 2 of the 53 non-diabetics. No VEGF206 was expressed in either group. VEGF protein was localized in both vascular endothelial cells and synovial lining cells. The mean number of VEGF-positive vessels and the vessel area were also significantly greater in the diabetics (p<0.015, Mann-Whitney U test). Synovial proliferation and shoulder joint contracture were more common in the diabetics (P=0.0329 and P=0.073, respectively; Fisher's test). The mean preoperative range of shoulder motion significantly differed in terms of elevation between two groups: 103.8 degrees in diabetics and 124.9 degrees in no diabetics (p=0.0039 Mann-Whitney U test). In contrast, external rotation did not significantly differ: 44 degrees in diabetics and 49 degrees in non-diabetics (p=0.4957, Mann-Whitney U test). These results suggest that VEGF121 and VEGF165 expression in the SAB is responsible for the development of shoulder joint contracture, especially in elevation, among type II diabetic patients with rotator cuff disease.

Acromioclavicular Joint↗
PubMed1995

Rotator cuff disorders: interobserver and intraobserver variation in diagnosis with MR imaging.

PURPOSE: To determine interobserver and intraobserver variation in the interpretation of magnetic resonance (MR) images in rotator cuff disorders. MATERIALS AND METHODS: MR images of the shoulder in 97 patients were retrospectively reviewed twice, with a 3-week interval. Surgical findings indicated a full-thickness tear in 29 patients, grade 1 impingement in 19 (tendinitis), and grade 2 impingement (partial tear) in 26. The control population comprised 23 asymptomatic volunteers or patients. RESULTS: All observers were accurate in the diagnosis of a full-thickness tear (89%-98%), with good intraobserver (kappa = 0.67-0.84) and interobserver agreement (kappa = 0.74-0.92). In diagnoses of tendinitis, partial tear, and normal cuff, there were wide ranges of sensitivity (13%-74%) and specificity (72%-93%), as well as poor interobserver (kappa = 0.12-0.60) and intraobserver agreement (kappa = 0.35-0.78). CONCLUSION: Full-thickness tears of the rotator cuff can be accurately identified at MR imaging with little observer variation. Consistent differentiation of normal rotator cuff, tendinitis, and partial thickness tears is more difficult.

Female↗