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PubMed1980

[Shoulder mechanism - study based on cineradiography and radiography with the arm elevated (author's transl)].

In order to better understand the shoulder mechanism and make a clinical assessment of the "zero-position", a study by means of cineradiography and radiography was performed on normal and disordered shoulders with arm elevated. The conception of the "scapular plane" has been widely accepted as the reference plane for the mechanism at the shoulder joint, but practically this plane is not easily defined. Thus, a cineradiographic study of 50 normal joints has been carried out in 7 planes between the frontal and the sagittal plane, during upward and downward movement of the arm. As a result, it was determined that the "scapular plane" should be inclined forward at an angle of 30 degrees to the frontal plane. In evaluating the anatomical relationship between the humeral head and the glenoid during upward and downward movement of the arm, 50 normal shoulders and 22 disordered shoulders composed of 12 loose shoulders and 10 rotator cuff injuries were analyzed in the "scapular plane" using devised method of measurement. Concerning the "zero-position", information was gained mostly from radiographies of 600 normal and 32 disordered shoulder joints. Especially o the disordered joints, a radiographic study of the shoulder with arm elevated was made pre- and postoperatively with the arm elevated. The results obtained are as follows, 1. In the "zero-position", the humerus must be elevated to 150 degrees in the "scapular plane", with individual variations. 2. Regularization of the glenohumeral rhythm of the normal shoulder joints was observed between the end of the "setting phase" and the "zero-position". 3. Glenohumeral mechanism of the normal and disordered shoulders was different between upward and downward movement of the arm, especially more remarkable at the disordered joints. 4. Lateral deviation of the humeral head toward the glenoid was found in the loose shoulder during upward and downward movement of the arm, especially during maximum elevation of the arm. 5. Glenoid osteotomy was determined to be the reasonable procedure for stabilizing loose shoulders, from the aspect of radiographic study with the arm elevated. 6. In rotator cuff injuries, the glenohumeral rhythm was disturbed, and in some patients instability at the glenohumeral joint was observed. From postoperative radiographic evaluation with the arm elevated, it has been observed that the anatomical situations at the glenohumeral joint have recovered to nearly norma conditions. 7. In conclusion the author emphasizes the mechanism of normal and disordered glenohumeral joints, using radiography of the shoulder with the arm elevated.

Adolescent↗

PubMed1998

Fractures of the greater tuberosity presenting as rotator cuff abnormality: magnetic resonance demonstration.

BACKGROUND: To show that magnetic resonance imaging (MRI) can be useful to diagnose radiographically invisible greater tuberosity fractures in patients with clinical presentations suspicious for rotator cuff injury. METHODS: Six patients with subtle greater tuberosity fractures who were sent for MRI because of possible rotator cuff tear are reviewed (age range, 27-51 years; mean, 40.5 +/- 8.4 years). Five of the patients recount direct trauma to their shoulders, whereas one noticed shoulder pain after a fall in which she fractured her ankle. RESULTS: MRI showed an area of edema confined to the greater tuberosity with linear low signal extending through the tuberosity consistent with a fracture in all cases. Although five patients had a complete set of shoulder radiographs before MRI, these were interpreted as normal in all cases. Full-thickness rotator cuff tears were not present in any of the cases. All of the patients were treated conservatively with good results. CONCLUSIONS: MRI can prevent unnecessary arthroscopy in patients clinically suspected of rotator cuff damage by showing subtle fractures of the greater tuberosity not visible on radiographs.

Accidental Falls↗

PubMed1983

Inferior glenohumeral dislocation.

Presented is the case of a 55-year-old alcoholic with an inferior glenohumeral dislocation of his right shoulder. The patient was unable to move his right arm, which was flexed at the elbow and locked in an overhead position. After roentgenographic confirmation of the dislocation, traction-counter-traction was employed for reduction. Reduction was indicated by an audible click. The shoulder was immobilized and the patient was discharged for follow up in two weeks. Luxatio erecta is the result of a severe hyperabduction mechanism frequently associated with significant rotator cuff injury. Immediate reduction followed by surgical repair of the rotator cuff at a later date is the standard treatment.

Accidents, Home↗

PubMed2025

The effects of N-acetylcysteine and adipose-derived stem cells on tendon healing in chronic rotator cuff tears: a rabbit model study.

BACKGROUND: Rotator cuff tears are associated with significant morbidity, and retear rates after surgical repair remain high, largely due to chronic degenerative changes such as muscle atrophy and fatty infiltration. This study aims to evaluate the effects of locally injected adipose tissue-derived stem cells and orally administered N-acetylcysteine, individually and in combination, on tendon healing in a rabbit model of chronic rotator cuff rupture. METHODS: Thirty-two male New Zealand white rabbits were used as models of chronic rotator cuff tear, surgically established by detaching the supraspinatus tendon and delaying repair to create a chronic defect. The rabbits were divided into four groups: Group A (control, saline-treated), Group B (N-acetylcysteine-treated), Group C (adipose tissue-derived stem cells-treated), and Group D (combined adipose tissue-derived stem cells and N-acetylcysteine-treated). Chronic rotator cuff tear repairs were conducted after six weeks. Histological, immunohistochemical, and biomechanical assessments were performed 12 weeks post-repair. Key outcomes included collagen organization, fatty infiltration, type I collagen expression, and tensile strength. RESULTS: Histopathological analysis revealed significantly improved collagen fiber alignment, reduced fatty infiltration, and decreased inflammation in Groups C and D compared to Groups A and B (p < 0.001). Immunohistochemical analysis revealed higher Type I collagen reactivity in Groups C and D, with Group D exhibiting the highest reactivity (p < 0.001). Biomechanical testing confirmed significantly increased load to failure in Groups C and D, with Group D achieving the highest values (p < 0.001). CONCLUSIONS: Adipose tissue-derived stem cells and N-acetylcysteine independently promote tendon healing, with adipose tissue-derived stem cells showing superior effects on collagen organization and fatty infiltration reduction. Combined treatment with adipose tissue-derived stem cells and N-acetylcysteine demonstrated synergistic effects, resulting in optimal tendon regeneration and strength. These findings support the potential of adipose tissue-derived stem cells and N-acetylcysteine as complementary therapies for chronic rotator cuff injuries. Further research is warranted to explore their mechanisms of action and clinical applications.

Animals↗

PubMed1991

Magnetic resonance imaging of shoulder impingement.

MRI is an accurate technique for diagnostic evaluation of a broad spectrum of shoulder pathology. In particular, rotator cuff injuries are a frequent cause of pain and disability. The mechanism of injury to the supraspinatus tendon usually begins with microscopic tears of fibers of the triple helix collagen molecule. This leads to increased motion of the bound water within the collagen molecule that lengthens the effective T2 of the tendon, allowing short TE imaging sequences to detect signal in abnormal tendons. Clinically significant disease probably does not occur without frank collagen rupture, and the associated collection of free water within the severely diseased tendon presents as high signal on long TE images. Thus, the clinical significance of tendon disease is best evaluated on long TR, long TE image acquisitions. Any process that accelerates microscopic tear formation or delays repair can increase a patient's risk of supraspinatus tendon tears. Impingement is the most important process accelerating microscopic tear formation. MRI's multiplanar, tomographic imaging ability markedly improves the ability to sensitively and specifically detect bony impingement. Hopefully, this will allow earlier arthroscopic decompression and improved patient prognosis with impingement.

Athletic Injuries↗

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↗

PubMed1996

[Ultrasound diagnosis of the shoulder].

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Adolescent↗

PubMed2003

Magnetic resonance imaging of the shoulder: rotator cuff.

Magnetic resonance imaging has proven to be useful in the assessment of rotator cuff injuries. Improvements in magnetic resonance techniques, including fast spin-echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff. Rotator cuff disease is multifactorial. Primary impingement within the coracoacromial arch, degeneration of the rotator cuff tendons, trauma, and glenohumeral instability may be contributing factors. Shoulder pain in athletes can be related to acute myotendinous and muscle injuries, which can be easily detected using magnetic resonance imaging.

Athletic Injuries↗

PubMedDate not supplied

Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings.

Our purpose was to compare the accuracy of ultrasonography (US) and magnetic resonance (MR) in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings. Using US and MR, we studied all painful shoulders seen during 1998 in our orthopaedic unit. Diagnosis was confirmed in 61 cases. The diagnosis of full thickness rotator cuff tear was highly specific on both imaging techniques (100% for US and 97.1% for MR) but was not as sensitive on US (57.7%) as on MR (80.8%). The diagnosis of partial tear was acceptably specific (67.9% for US and 75.5% for MR) but was not sensitive (overall, 12.5% for US vs 50% for MR). The specificity of a US diagnosis of a tear allows us to recommend surgery, thus making it a good imaging technique for the initial study of painful shoulders. The low sensitivity makes it necessary to undertake an additional MR study. If the MR also discovers no pathology, the sensitivity based on the US and MR images (92.7%) can be sufficient to avoid a false-negative diagnosis.

Arthroscopy↗

PubMed2000

Luxatio erecta: a rarely seen, but often missed shoulder dislocation.

Luxatio erecta is an uncommon disorder and presents in a unique, unusual manner. Luxatio erecta is often misdiagnosed as an anterior dislocation. The presentation is unmistakable and classic: the arm hyperabducted and locked above the head. Neurovascular injuries consist of neuropraxia of brachial plexus, radial and ulnar nerve. Vascular injuries are complicated by intimal tears, transections, and/or thrombosis of the axillary artery or vein. Reduction is done with the traction and countertraction maneuver. Once it is reduced the arm is then placed and maintained with a sling in adduction to the chest. Orthopedic referral is required because of the high incidence of rotator cuff injury.

Accidental Falls↗

PubMedDate not supplied

Standard sonography and arthrosonography in the study of rotator cuff tears.

PURPOSE: The aim of this study was to evaluate the sensitivity of ultrasonography, integrating standard ultrasound and arthrosonography after injecting a saline solution into the glenohumeral cavity in cases of suspected rotator cuff tears. MATERIALS AND METHODS: We prospectively examined 40 patients awaiting shoulder arthroscopy for suspected or diagnosed tears of the rotator cuff. A radiologist, unaware of the pre-operative diagnosis, performed an ultrasound scan on all the patients before and after the injection of saline solution into the glenohumeral cavity. The parameters considered were presence or absence of a rotator cuff injury; type of injury according to Snyder and its extent along the longitudinal and transverse planes; presence or absence of effusion into the articular cavity; subacromial/subdeltoid bursal distension. All the patients underwent arthroscopy either the same day or the day after the ultrasound examination. RESULTS: Standard sonography showed 26 complete rotator cuff tears (type C according to Snyder), 2 partial tears (type B according to Snyder) and 12 intact rotator cuffs. Arthrosonography detected 31 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs.Arthroscopy identified 32 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs. Analysis of the results shows that, taking arthroscopy as the gold standard, the sensitivity of normal sonography is 81.2%, whereas that of arthrosonography is 96.8% (p < 0.05). CONCLUSIONS: On the basis of the data obtained in this study, standard sonography, integrated with the injection of a saline solution into the glenohumeral cavity, considerably increases the diagnostic sensitivity for rotator cuff tears. The authors suggest that arthrosonography can be used in the event of suspected rotator cuff tears, when MRI is contraindicated.

Adult↗

PubMedDate not supplied

SLAP lesions: a retrospective multicenter study.

A retrospective analysis of 530 glenohumeral arthroscopies performed by three independent Belgian arthroscopists revealed the presence of 32 SLAP lesions, which represents an incidence of 6%. Since this is exactly the same percentage as found by Snyder et al., we report our data in this article. We classified 23 of the SLAP lesions using Snyder's classification, 7 needed the additional classification of Maffet et al., and 2 lesions were considered to be anatomic variations; 53% of the lesions were of type II. Concerning the mechanism of injury, we found comparable percentages of traction (22%) and compression (28%) injury as reported by Snyder, but also a high number (25%) of overhead sports activities as described by Andrews et al. Associated lesions were in close accordance with Snyder's data, but a relatively low incidence of rotator cuff injuries (10%) was present. Comparison of treatment regimens showed that the same percentage of lesions (34%) was fixed arthroscopically in both series. Only SLAP II, IV, and V lesions must be considered as unstable and in need of fixation. We confirm that patients' complaints and clinical symptoms are vague and inconsistent. Imaging, using computed tomographic arthrography or magnetic resonance, was performed in a minority of cases. Advantages and pitfalls of both techniques are discussed. Anatomic variations causing an extra-large sublabral hole are shown, and we warn about potential diagnostic and therapeutic errors in these cases.

Adolescent↗

PubMed1996

[Lesions to the axillary nerve].

PURPOSE OF THE STUDY: The authors have reviewed 67 axillary nerve lesions from 1987 to 1993. 35 times the lesion was isolated; 20 times it was associated to other nerve lesions (9 times supra scapular nerve, 3 times musculocutaneous nerve, 8 times posterior cord) and 12 times lesions were associated to rotator cuff injury. MATERIAL AND METHODS RESULTS DISCUSSION: Injury corresponded 9 times to stretching mechanism in upper limb traction and came 58 times with osteoarticular lesions (30 anterior dislocations and 28 shoulder fractures). In 11 cases, shoulder active abduction was normal, inspite of deltoïd's complete palsy and this accounted for diagnosis delay. Concerning axillary nerve isolated lesions (35 cases), 7 recovered spontaneously and 28 have been operated. Surgical operation was undertaken 9 months after injury using a combined anterior and posterior approach. Rupture was located in the quadrilateral space and 23 nerve grafts, 4 neurolysis and 1 direct suture were performed. Results were good (muscle measured to M4) and excellent (muscle measured to M5) in 57 per cent of cases. Concerning axillary nerve lesions associated to suprascapular nerve lesions (9 cases) and musculocutaneous nerve (3 cases), all axillary nerve lesions were grafted with 50 per cent of good and very good results. The scapular nerve was neurolysed 6 times with 4 good and excellent results and evaluated irreparable in 3 cases. Musculocutaneous nerve was grafted in all cases with 2 good results out of 3. Posterior cord lesions (8 cases) required an osteotomy of the clavicle. Five grafts and 3 neurolysis were performed with aleatory results. At last, when associated lesions of the rotator cuff muscle were found (12 cases), 6 cases recovered spontaneously and 3 times cuff rupture was small enough to be reinserted with 2 good results. The 6 other cases corresponded to an axillary nerve rupture which were all grafted with 2 good results. On the cuff, result was in relation with lesion's type. Twice a supraspinatus tendon rupture was reinserted with 1 good result and 1 fair result. In 3 older patients, there was a small size rupture which has been reinserted with 1 good result, 1 fair result and 1 failure. At last, one surgical repair of a large rupture couldn't be justified. CONCLUSION: These encouraging results suggest to propose repair of axillary nerve when deltoid muscle palsy does not recover until 3 to 6 months. Rupture diagnosis is then suspected and the best surgical technique is a nerve graft.

Accidents, Traffic↗

PubMed2000

The painful shoulder: part II. Acute and chronic disorders.

Fractures of the humerus, scapula and clavicle usually result from a direct blow or a fall onto an outstretched hand. Most can be treated by immobilization. Dislocation of the humerus, strain or sprain of the acromioclavicular and sternoclavicular joints, and rotator cuff injury often can be managed conservatively. Recurrence is a problem with humerus dislocation, and surgical management may be indicated if conservative treatment fails. Rotator cuff tears are often hard to diagnose because of muscle atrophy that impairs the patient's ability to perform diagnostic maneuvers. Chronic shoulder problems usually fall into one of several categories, which include impingement syndrome, frozen shoulder and biceps tendonitis. Other causes of chronic shoulder pain are labral injury, osteoarthritis of the glenohumeral or acromioclavicular joint and, rarely, osteolysis of the distal clavicle.

Acute Disease↗

PubMedDate not supplied

Rotator cuff: evaluation with US and MR imaging.

Magnetic resonance (MR) and ultrasound (US) imaging are currently touted for assessment of rotator cuff disease. Optimum clinical imaging techniques include use of (a) a 1.5-T MR imaging unit with small planar coils, proton-density-weighted and T2-weighted fast spin-echo sequences, and 10-12-cm fields of view (yielding 400-470 x 500-625-microm in-plane spatial resolution) and (b) a state-of-the-art commercial US unit with insonation frequencies of 9-13 MHz (yielding 200-400-microm axial and lateral resolution). Proper diagnosis requires familiarity with normal anatomic characteristics and imaging pitfalls. Care must be taken to avoid sonographic tendon anisotropy and MR imaging magic angle effects, which can be misinterpreted as rotator cuff tear. At MR imaging, a complete cuff tear typically appears as either a hyperintense defect or a tendinous avulsion that extends from the bursal to the articular side of the cuff; a partial cuff tear typically appears as a focal hyperintense region that contacts only one surface of the cuff. Complete and partial tears manifest with a wide spectrum of findings at US. MR imaging and US are effective for evaluating rotator cuff injuries, with high reported accuracies for detection of complete tears but more disparate results for detection of partial tears.

Artifacts↗

PubMedDate not supplied

Possibility of clinical application of tremor in the upper limb.

A procedure to evaluate the function of the glenohumeral joint (i.e., shoulder joint) for persons with shoulder disorders was proposed by analyzing tremor. In order to compare subjects with shoulder disorders to healthy subjects without disorders, characteristics of tremor for the healthy persons under various angles of glenohumeral joint and under the dominant and no-dominant sides of the upper limb were obtained by peak frequency and power spectrum as basic data. As for the persons with rotator cuff injury, the ratio of total powers for the affected side and the healthy side was obtained as the affective side ratio. The ratio showed the characteristic of the persons with the disorder, and discriminated the total power spectra of persons who were healthy and those with disorders.

Adult↗

PubMed1981

[Injuries of the rotator cuff of the shoulder - experiences in diagnosis and treatment (author's transl)].

Arthrography is an established method to verify injuries of the rotator cuff of the shoulder. In this paper referring about 32 patients with 34 cuff injuries the results after operation (16 patients) and conservative treatment (18 patients) are compared. The following statements based on our experiences are possible: If conservative treatment is without result, operation should be done within 8 weeks after the accident. - Because of the danger of exostoses at the point of the osteotomy of the acromion which includes the restriction of movement, the transacromial approach is not advisable. - If there is only a small space between the acromion and the humeral head resection of the coracoacromial ligament is an advisable method for better admittance to the shoulder joint. - A sufficient treatment in the postoperative phase is of great importance for a good functional result.

Diagnosis, Differential↗

PubMedDate not supplied

Outcome of glenoid neck fractures.

The aim of this study was to analyze the outcome of extraarticular glenoid neck fractures with respect to glenoid neck malunion and rotator cuff injury. These fractures are often considered to have a favorable outcome if treated conservatively. More recent studies reveal that the outcome is not uniformly good, but the cause of poor outcomes has not been investigated. Our study identified 9 patients who had sustained a glenoid neck fracture of the scapula within the last 10 years and who were treated conservatively with immobilization and then early active motion. Their functional and anatomic outcomes were analyzed by clinical examination and validated scoring systems, including the Oxford questionnaire and Constant score. Plain radiography and magnetic resonance imaging were correlated to outcome. None of the 9 patients were pain-free, and some had poor Oxford and Constant scores. Pain was associated with glenoid neck malunion and evidence of subacromial bursitis or rotator cuff tendinopathy (or both).

Adult↗