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PubMed2003

Arthroscopic rotator cuff tear repair.

Rotator cuff injuries or disease can be particularly troubling to patients by causing them pain, weakness, and dysfunction of the shoulder. Surgery of the shoulder and, in particular, of the rotator cuff, has evolved over the years from open surgery to include arthroscopic treatment for many conditions. Although technically demanding, arthroscopic repair of full- and partial-thickness rotator cuff tears has been shown to produce satisfactory results. Along with the advantages of the arthroscopic technique, smaller skin incisions, access to the glenohumeral joint for inspection and treatment of intra-articular lesions, no detachment of the deltoid, and less soft-tissue dissection, patients' results are comparable with those obtained with the open method of repair. The three phases of shoulder rehabilitation for patients who have undergone surgical treatment of rotator cuff disease are described: Phase 1, the immediate postoperative, or protective, phase; phase 2, the progressive strengthening phase; and phase 3, the advanced conditioning and return-to-sport phase. The postoperative rehabilitation programs for the arthroscopic and mini-open rotator cuff repair are essentially the same.

Arthroscopy↗
PubMedDate not supplied

Comparison of open and arthroscopically assisted rotator cuff repairs.

Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Recently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with regard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were evaluated in 36 patients with a minimum followup of 2 years. The open repair group comprised 20 shoulders with an average followup of 3.3 years; the arthroscopically assisted repair group comprised 17 shoulders with an average followup of 3.2 years. Overall, the open repair group had 80% good-to-excellent results and 88% patient satisfaction, and the arthroscopically assisted repair group had 85% good-to-excellent results and 92% patient satisfaction. Shoulder flexion and abduction strength, the size of the tear repaired, and the functional outcome did not differ significantly between the two groups. In general, however, small and moderate-sized tears (< 3 cm) had better functional outcome with arthroscopically assisted repair. The arthroscopically assisted repair group was hospitalized 1.2 days less and returned to previous activity an average of 1 month earlier. In the surgical treatment of symptomatic complete rotator cuff tears, arthroscopically assisted rotator cuff repair is as effective as open repair.

Adult↗
PubMedDate not supplied

Intra-articular migration of a sutureless arthroscopic rotator cuff fixation device.

Rotator cuff tears are a common orthopaedic condition. Recent new advances in arthroscopic equipment and devices has allowed many rotator cuff tears to be repaired arthroscopically. Some of these newer devices allow sutureless repair of rotator cuff tears. We report a case of failure in intra-articular migration of such a fixation device. Displacement of the device was noted 4 months after surgery on magnetic resonance arthography. The device was removed arthroscopically with no long-term sequelae. Nevertheless, it is important to recognize that these devices have the potential for intra-articular migration. Due diligence is required in placing these devices. As with all arthroscopic procedures, there appears to be a learning curve associated with the use of sutureless rotator cuff repair fixation devices.

Aged↗
PubMed1991

[Correlation and validation of different methods of evaluation of results after surgery of the rotator cuff. Plea for a standardized method].

Several charts elaborated for the assessment of the results of surgical treatment of cuff rotators tears were critically analysed. Twenty-one patients were reviewed and results assessed with three different charts, the Patte, Kenesi and Constant ones. The correlation of the parameters was studied and was found to be satisfactory.

Evaluation Studies as Topic↗
PubMed2006

Arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair is being performed by an increasing number of orthopaedic surgeons. The principles, techniques, and instrumentation have evolved to the extent that all patterns and sizes of rotator cuff tear, including massive tears, can now be repaired arthroscopically. Achieving a biomechanically stable construct is critical to biologic healing. The ideal repair construct must optimize suture-to-bone fixation, suture-to-tendon fixation, abrasion resistance of suture, suture strength, knot security, loop security, and restoration of the anatomic rotator cuff footprint (the surface area of bone to which the cuff tendons attach). By achieving optimized repair constructs, experienced arthroscopic surgeons are reporting results equal to those of open rotator cuff repair. As surgeons' arthroscopic skill levels increase through attendance at surgical skills courses and greater experience gained in the operating room, there will be an increasing trend toward arthroscopic repair of most rotator cuff pathology.

Arthroscopy↗
PubMedDate not supplied

Activation of the rotator cuff in generating isometric shoulder rotation torque.

This study compared and quantified electromyographic muscle activation of the rotator cuff with the isometric torque generated by performing shoulder rotation in various positions. Twenty healthy volunteers were tested in 29 shoulder positions. Using a Cybex II dynamometer synchronously with electromyography, surface electrodes were placed over the pectoralis major muscle and three parts of the deltoid muscle. Intramuscular wire electrodes were inserted into the four rotator cuff muscles. We found that the greatest external rotation isometric force is generated in the frontal and scapular planes in the neutral or full internal rotation positions. The sagittal, dependent, and the scapular plane with 45 degrees of elevation in rotational positions of either full or half external rotation generated the greatest torques for internal rotation isometric force. The rotator cuff muscles generated greatest electromyographic activity in neutral to midrotational positions. The scapular plane with 90 degrees of shoulder elevation in neutral rotation best isolated the subscapularis muscle. The infraspinatus-teres minor muscles were isolated in the sagittal plane with 90 degrees of shoulder elevation in a half externally rotated position. We were unable to isolate the supraspinatus muscle in any of these tested positions. These positions are recommended for manual muscle testing and for strengthening these muscles.

Adult↗
PubMed2001

[The fibrous frame of the rotator cuff. Contributions of an in vivo three dimensional study of the tendons of the rotator cuff].

The presence of a fibrous frame within the rotator cuff has been recently emphasized. This frame may be of interest in understanding of shoulder physiology and in attempts to improve shoulders disorders treatments. We report an original method to study the fibrous frame. MRI were done in healthy volunteers. 3D reconstruction were obtained and provided a 3D image of the fibrous frame. This technic should allow to calculate, for instance, the angles between the cuff muscles and the upper end of the humerus.

Humans↗
PubMed1995

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 1: Preoperative functional and anatomical evaluation of ruptures of the rotator cuff].

PURPOSE OF THE STUDY: In a consecutive series of 98 patients presenting 100 full thickness cuff tears and managed by the same medico-surgical team, the authors studied the correlation between preoperative shoulder function values and the anatomic lesions found at surgery. Predictive factors of tear size were evaluated and any elements that were likely to improve preoperative function were determined so that patients could be best prepared for surgery. The validity of preoperative radiographic assessment of lesions was examined. MATERIAL AND METHODS: Prior to surgery, each patient was given the same rehabilitation program, the same arthrotomographic assessment of lesions and each was rated functionally using Constant's scoring method. Preoperative radiographic assessment of lesions showed supra-spinatus tears in 69 per cent, combined supraspinatus and infraspinatus tears in 22 per cent, and tears involving the supraspinatus, infraspinatus and subscapularis in 9 per cent. RESULTS: The preoperative Constant score averaged 46/100 points. The score was higher when patients had been prepared by preoperative rehabilitation to overcome stiffness. The optimum duration of rehabilitation was found to be 3 months (p < 0.05). Active range of motion was 90 per cent of normal in 84 per cent of cases. The patients in this series therefore underwent surgery more for continuing severe pain (25 per cent) and muscle weakness (86 per cent) than for reduced active motion. DISCUSSION: Examination of the correlations existing between an anatomic lesion and the preoperative rating of shoulder function shows that the Constant preoperative score provides a good prediction of the size of the tear to be repaired (p = 0.0063). The greater the tear size, the lower the preoperative Constant sore is. Active range of motion (especially in abduction and external rotation) and muscular strength are factors with the most predictive value contrary to pain and discomfort which are influenced by tear size. CONCLUSION: Preparing patients suffering full thickness cuff defects through preoperative rehabilitation to overcome stiffness provides the best conditions for surgery. Constant's functional scoring method gives a reproducible and reliable reflection of the anatomic rotator cuff lesion to be repaired. Its use for preoperative rating is useful for determining a reference value for function prior to surgery.

Adult↗
PubMed1989

Rotator cuff disorders.

Rotator cuff problems present with shoulder pain on repetitive overhead activity. Chronic irritation may develop into impingement tendonitis, with weakness of abduction and external rotation and night pain. Conservative management with rest, anti-inflammatory medicine and physiotherapy resolves the majority of symptoms. If these persist, surgical decompression affords good relief of pain.

Combined Modality Therapy↗
PubMed2005

Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain.

STUDY DESIGN: Fine-wire EMG rotator cuff onset time analysis in 2 matched groups of throwers with and without pain. OBJECTIVE: To identify if there is a difference in the activation patterns of the rotator cuff muscles during a rapid shoulder external rotation task between throwers with and without pain. BACKGROUND: The coordinated action of the rotator cuff is recognized as essential for glenohumeral joint control in the throwing athlete. Identification of abnormalities occurring in muscle activation patterns for injured athletes is relevant when prescribing rehabilitative exercises. METHODS AND MEASURES: Twelve throwers with shoulder pain were compared to a matched group of 11 asymptomatic throwers. Participants were matched for age, height, body mass, and habitual activity. Fine-wire EMG electrodes were inserted into the subscapularis, supraspinatus, and infraspinatus. EMG activity was measured during a reaction time task of rapid shoulder external rotation in a seated position. The timing of onset of EMG activity was analyzed in relation to visualization of a light (reaction time) and to the onset of infraspinatus activity (relative latency). RESULTS: In the group with shoulder pain, the onset of subscapularis activity was found to be significantly delayed (reaction time, P = .0018; relative latency, P = .0005) from the onset of infraspinatus activity when compared to the control group. CONCLUSIONS: The presence of shoulder pain in these athletes was associated with a difference in the onset of subscapularis EMG activity during a rapid shoulder external rotation movement. This was an initial step in the understanding of the joint protection mechanisms of the glenohumeral joint and the problems that occur in throwers. This information may assist in providing future guidelines for more effective rehabilitation and prevention strategies for this condition.

Adult↗
PubMed1989

Limited sensitivity of ultrasound for the detection of rotator cuff tears.

Bilateral rotator cuff sonography was performed on 56 patients referred for shoulder arthrography to detect rotator cuff tears. Since one patient had bilateral arthrography there were 57 arthrograms. Twenty-seven shoulders had rotator cuff tears shown on arthrography, 15 of which were detected by sonography. Eleven were false negative by sonography, and one was indeterminate. Of the 30 shoulders with negative arthrograms, 28 had normal sonograms and two were false positive. Sensitivity was 58%, specificity was 93% and overall accuracy was 77%. The positive and negative predictive values were 88% and 72%. These results suggest that sonography has limited value in screening patients for rotator cuff tears and that a positive sonographic reading is more reliable than a negative one. Theories relating to the variable anatomic configuration of a tear are postulated to explain these results, which differ from those previously reported.

Adult↗
PubMed2006

MR imaging of the rotator cuff interval.

The rotator cuff interval is defined as the space between the anterior aspect of the supraspinatus tendon and the superior aspect of the subscapularis tendon. Knowledge of the anatomy, an understanding of the commonly encountered pathology, and an approach for the systematic inspection of the rotator cuff interval is crucial for the accurate characterization and diagnosis of pathology of this region. This article reviews the basic normal anatomy of the rotator cuff interval, imaging considerations unique to this area, and commonly encountered pathology.

Humans↗
PubMed2002

The use of the long head of triceps interposition muscle flap for treatment of massive rotator cuff tears.

Massive rotator cuff tears present a difficult problem for orthopedic surgeons. To address this problem, a long head of triceps muscle interposition flap was proposed. Ten patients underwent repair of massive rotator cuff tears using the triceps muscle flap. The patients' strength and range of motion were tested preoperatively, and a University of California, Los Angeles, shoulder score was assigned. Similar testing was performed 1 year later. Postoperatively, the patients showed significant improvement in the overall shoulder score and in the pain and function components of the score. There was no significant improvement in shoulder range of motion, except for shoulder flexion. An important finding was that there was no loss of strength in elbow extension following the loss of the long head of triceps muscle. It was concluded that the long head of triceps interposition flap is useful in the reconstruction of the massive rotator cuff tear.

Aged↗
PubMed2006

The accessory posteromedial portal revisited: utility for arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair is a technically challenging procedure. Accessory arthroscopic portals have been described that allow for optimal suture anchor placement, suture management, and knot tying. We describe here the usefulness of an accessory posteromedial portal that facilitates direct suture retrieval through the posterior aspect of a rotator cuff tear. This portal is created approximately 4 to 5 cm medial to the posterolateral corner of the acromion and 2 cm inferior to the scapular spine. The accessory posteromedial portal is especially useful when a retracted tear of the infraspinatus or teres minor is encountered. Because these tendons retract in a posterior and medial direction, the accessory posteromedial portal places the tendon-penetrating device in an ideal position for suture passage through the posterior portion of the rotator cuff tear. This portal also allows placement of margin convergence sutures for large U-shaped or L-shaped tears by permitting a direct "hand-off" of the suture to or from a second penetrating device that is placed through a standard anterior portal. If multiple suture anchors are required (as in the case of large or massive cuff tears, or when double-row fixation is employed), sutures can be pulled out through the accessory posteromedial portal to facilitate suture management.

Arthroscopy↗
PubMed2001

Prospective longitudinal analysis of postoperative shoulder function : a ten-year follow-up study of full-thickness rotator cuff tears.

BACKGROUND: Rotator cuff repair is associated with good short or mid-term results, but to date there have been no long-term functional outcome studies demonstrating durability of results over time. In most long-term studies, the results have been compared with those of historical controls or with those of other, short-term follow-up studies. The purpose of the present prospective study was to evaluate short and long-term shoulder function after surgical repair in a single population of patients in order to follow changes over time. METHODS: Thirty-three patients underwent surgery, performed by one surgeon, for the treatment of a chronic, symptomatic, full-thickness rotator cuff defect. Data were obtained from questionnaires and physical examinations preoperatively, at two years, and at ten years. Identical standardized pain and function questionnaires were used and clinical evaluation was performed in a consistent fashion at all time-periods. The activity level, Constant score, level of disability, shoulder function score, and patient's subjective rating of the outcome were determined at the time of the final follow-up and compared with the same parameters at the two-year follow-up examination in order to determine if early results change with time. RESULTS: At the ten-year follow-up examination, there was no change in the raw Constant score determined at the two-year examination. When the Constant score was normalized for expected age-related changes, the percentage of patients who had a satisfactory result at ten years was even greater than the percentage at two years. Activity level decreased significantly over the time-period (p = 0.005). At the final follow-up examination, twelve patients worked at the same occupation as they had when the two-year examination was performed, two worked at a less strenuous occupation, and the remaining patients were retired. Only two patients retired because of problems related to the shoulder. The level of disability decreased over the study period, and there was a small improvement in the patients' self-assessment shoulder function score. The patients' subjective assessment of the outcome remained unchanged. CONCLUSIONS: The results of open rotator cuff repair for chronic tears do not deteriorate with time (ten years). The level of disability decreases, presumably because of a concurrent decrease in the activity level and in the demand on the shoulder as the patient ages. It is important to consider age-related changes when assessing the final outcome.

Adult↗
PubMed1984

Ultrasonography of the rotator cuff: surgical correlation.

Rotator cuff tears are a common orthopedic problem. The portions of the cuff most commonly torn are accessible to sonographic examination with appropriate positioning of the shoulder. This study was undertaken to correlate the sonographic appearance of the pathologic rotator cuff with findings at the time of surgical repair. Rotator cuff tears are readily seen with high-resolution real-time sonography. Sonography can demonstrate tears not demonstrated arthrographically. In the appropriate clinical setting arthrography may not be necessary if the sonogram demonstrates characteristic findings.

Adult↗