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PubMed2003

Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years' follow-up.

PURPOSE: The purpose of this study was to compare the outcomes of arthroscopic repair of medium and large rotator cuff tears with the outcomes for mini-open repair of similar tears in which arthroscopic repair was technically unsuccessful. TYPE OF STUDY: Retrospective case series. METHODS: We evaluated 76 patients who were treated for full-thickness rotator cuff tears either by all-arthroscopic (42 patients) or mini-open salvage of technically unsuccessful arthroscopic repair (34 patients). Patients who had acromioclavicular arthritis, subscapularis tear, or instability were excluded. There were 39 men and 37 women, with a mean age of 56 years (range, 42 to 75 years). At a mean follow-up of 39 months (range, 24 to 64 months), the results of both groups were compared using the University of California Los Angeles and American Shoulder and Elbow Surgeons shoulder rating scales. RESULTS: Shoulder scores improved in all ratings in both groups (P <.05). Overall, 66 patients showed excellent or good and 10 patients showed fair or poor scores by the University of California Los Angeles scale. Seventy-two patients satisfactorily returned to previous activity, and 4 showed unsatisfactory returns. The range of motion, strength, and patient satisfaction were improved postoperatively. No differences were seen in shoulder scores, pain, and activity return between the arthroscopic and mini-open salvage groups (P >.05). However, patients with larger tears showed lower shoulder scores and less predictable recovery of strength and function (P <.05). Postoperative pain was not different with respect to the size of the tear (P =.251). CONCLUSIONS: Arthroscopic repair of medium and large full-thickness rotator cuff tears had an equal outcome to technically unsuccessful arthroscopic repairs, which were salvaged by conversion to a mini-open repair technique. Surgical outcome depended on the size of the tear, rather than the method of repair.

Adult↗
PubMed1987

Examinations of the pathology of the rotator cuff.

We performed autopsies on 195 shoulder joints in order to check the differing opinions as to the pathogenesis and incidence of tendinopathia calcarea and rupture of the rotator cuff that have been expressed in literature. There was a rupture rate of 11%. Intratendinous calcific deposits could be observed by radiology in 22% of the cases. The simultaneous presence of intratendinous calcification and rotator cuff rupture could be proved in 13 of 22 cases with a rupture of the rotator cuff. On the basis of our results we conclude that tendinopathia calcarea and rupture of the rotator cuff have an identical pathogenesis.

Adolescent↗
PubMedDate not supplied

Primary anterior shoulder dislocation and rotator cuff tears.

In a prospective controlled study 167 patients with 167 primary traumatic anterior shoulder dislocations underwent early ultrasonograpic evaluation for rotator cuff tears. We found 53 (31.7%) full-thickness cuff tears in this group. Compared with a group of 93 healthy volunteers, we found with statistical significance more cuff tears in the patients aged < 60 years. Women ruptured the cuff more often than men. If the patient is not able to elevate the affected arm more than 90 degrees in the scapular plane 2 weeks after the dislocation, there should be a high suspicion of rotator cuff tear (76.7%). For early detection of relevant rotator cuff lesions, we recommend shoulder ultrasonographic examination and measurement of active elevation after each traumatic shoulder dislocation in the above mentioned age group.

Adolescent↗
PubMedDate not supplied

"Bursal reactions" in rotator cuff tearing, the impingement syndrome, and calcifying tendinitis.

Subacromial bursal specimens from 63 patients undergoing surgery for rotator cuff tearing (n = 43), the impingement syndrome (n = 14), and calcifying tendinitis n = 6) were studied to characterize the reactions that develop at the tendinopathy "lesional" sites. Intensity of the bursal reactions and production of type III collagen vary considerably, with the highest incidence of both seen in patients with rotator cuff tears. The intensity of bursal reactions correlated with the degree of formation of perivascular new collagen and type III collagen expression. In 22 of the 63 patients the bursal reaction distant to the tendon lesion was also studied. It was minimal and did not correlate to the lesional bursal findings. A strong correlation, however, existed between surgical appearance and histologic grading. The term "localized bursal reaction" as opposed to bursitis more correctly describes bursal involvement. Resection of bursal tissues should be limited to the lesional tissue that interferes with subacromial motion.

Adult↗
PubMed2003

Role of community diagnostic ultrasound examination in the diagnosis of full-thickness rotator cuff tears.

BACKGROUND: Diagnostic ultrasound examination has become the most commonly used investigation in Australia for diagnosing rotator cuff tears. The authors felt that the results of such investigations were often inaccurate in their clinical practices. METHODS: The diagnostic ultrasound findings in 336 cases were compared to arthrography, and in 225 cases findings at surgery. RESULTS: A very poor accuracy rate of 0.38 was found for diagnostic ultrasound examination. The sensitivity was 0.24 and specificity was 0.61. CONCLUSIONS: Extreme caution is recommended in the use of diagnostic ultrasound, as currently practised in a general community setting, in diagnosing full-thickness rotator cuff tears.

Adolescent↗
PubMed1999

The static rotator cuff does not affect inferior translation of the humerus at the glenohumeral joint.

BACKGROUND: The static contribution of the rotator cuff to the inferior stability of the shoulder is poorly understood. The purpose of this study was to determine the effect of static rotator cuff muscles on the inferior stability of the glenohumeral joint. METHODS: The humeral head positions relative to the glenoid were obtained in 12 shoulder specimens under the following conditions: with and without a 1.5-kg load; with the humerus adducted and abducted 90 degrees; and in three stages of dissection: (1) before release of any of the rotator cuff muscles, (2) after release of the supraspinatus or the cuff muscles other than the supraspinatus, and (3) after release of all of the cuff muscles. The order of release was changed in two ways: release of the supraspinatus followed by the release of other muscles in one group, and the opposite order in the other group. RESULTS: In both adduction and abduction, there were no significant differences in the positions of the humeral head either among the three stages of release or between the two different orders of release. CONCLUSION: The static contribution of the cuff muscles to the inferior stability of the shoulder is insignificant.

Biomechanical Phenomena↗
PubMedDate not supplied

Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction.

The aim of this study was to investigate tendon integrity after surgical repair of single-tendon rotator cuff lesions. In 31 patients, 31 single-tendon repairs were evaluated. Thirty-one patients were available for clinical assessment and magnetic resonance imaging (MRI) at follow-up. A standard series of MR images was obtained for each. The results of functional assessment were scored according to the system of Constant. According to MRI evaluation, 21 (68%) patients had an intact or thinned rotator cuff and 10 (32%) had recurrence of a full-thickness cuff defect at follow-up. Patients with an intact or thinned rotator cuff had a median Constant score of 75.5 points; patients with a full-thickness cuff defect had a median score of 62 points. There was no correlation between tendon integrity on postoperative MR images and functional outcome. Patients with intact or thinned cuffs did not have significantly better functional results than patients with retorn cuffs. Because of the presence of metal artifacts and the difficulty in distinguishing postoperative scar tissue from partial tears or thinning, MRI is of minor diagnostic value in assessing the shoulder after cuff repair. However, full-thickness tears are readily diagnosed after operation with MRI.

Adult↗
PubMed1995

[Magnetic resonance tomography in disorders of the rotator cuff].

Magnetic resonance imaging (MRI) has become a powerful diagnostic tool for the evaluation of the painful shoulder in general and of the diseased rotator cuff in particular. MRI evaluates cuff disease in terms of tendon morphology and pathologic signal alterations within diseased cuff tendons. Additionally, MRI displays important pathoanatomic changes of the coracoacromial arch which are predisposing factors for the development of shoulder impingement syndrome and cuff disease. The accuracy of MRI in diagnosing small rotator cuff tears and in assessing the integrity of the labral-ligamentous complex is improved by the intraarticular injection of a suitable contrast agent. In the preoperative assessment of patients with cuff disease, MR arthrography enhances the staging of the disease and allows a more confident exclusion of concomitant lesions of the shoulder joint.

Contrast Media↗
PubMed2002

[Ultrasound diagnosis of the rotator cuff].

Shoulder sonography is a well-established and standardized method to evaluate the status of the rotator cuff, the long head of the biceps, and the subacromial and subdeltoid bursae. Using high-frequency linear probes, the sensitivity in detecting total tears sized 0.5 cm and greater is > 90% and in detecting partial thickness tears of at least one-third of the cuff substance > 75% when using the dual-criteria standard. Ultrasound achieves comparable or better results than native magnetic resonance tomography at far less cost. False results can be excluded in the majority of cases by strict adherence to a dual-criteria model. The ability to display the joint's soft tissue structures in real time is unique up to now. The limits of sonography are (1) in the estimation of tear size in global tears as retraction of tendon stumps under the acromion cannot be visualized and (2) in the evaluation of status of rotator cuff muscles since volumetric information about atrophy can be gained by ultrasonography, but a differentiation between simple atrophy and fatty degeneration is not possible.

Cost-Benefit Analysis↗
PubMed1999

[Treatment of fresh humeral diaphysis fractures by Seidel intramedullary locked nailing. A study of 23 initial cases after 2.5 years with rotator cuff evaluation].

PURPOSE OF THE STUDY: The Seidel intramedullary locking nail is one of the alternative methods for operative treatment of humeral shaft fractures. Short follow-up demonstrated persistent pain and stiffness at the shoulder joint. The aims of this retrospective study were first to evaluate results with attention to operative technique, consolidation rate and postoperative complications. Second we studied rotator cuff healing in our first patients. MATERIAL AND METHODS: Twenty-five acute diaphyseal fractures were treated between May 91 and Dec 94. We reviewed personally 23 patients with a mean follow-up of 33 months (range 22-66). The dominant fracture type according to AO was type A. Clinical shoulder assessment was carried out using the Constant score. Isometric strength was recorded in both shoulders with a hand-held dynamometer in abduction, external and internal rotation. Sonographic evaluation of the rotator cuff was performed using a 7.5 MHz linear array transducer in all 23 patients. RESULTS: All but one fracture healed at an average of two months. Impingement was observed in three patients but pain relief and normal shoulder motion have been reached after nail removal. Infection occurred in one patient but final result was good. Constant score averaged 78.7 (range 51-94.2) classifying the result in all but two patients as excellent or good. Compared with the external and internal rotations, strength was significantly reduced in abduction but reached 83.5 per cent of the opposite shoulder. No statistical differences were found in relation with age, gender and side. Compared with the contralateral shoulder, rotator cuff evaluation with sonography was considered as normal in 18 patients. Calcium deposits of the cuff were noticed in the infected patient. In three cases sonography detected hyperechoic line considered as scar in the supraspinatus tendon without any partial or full-thickness tear. DISCUSSION AND CONCLUSION: A median starting point avoids the avascular area and gives a straight access to the medullary canal. This study demonstrates that using this entry portal and a reliable technique antegrade nailing of the humerus does not compromise rotator cuff healing and shoulder function. Technical errors lead to poor or fair results but despite this learning curve, Seidel nail when operative treatment is indicated, is a good choice. Attention must be paid to patients with clinical history of impingement or rotator cuff tendinopathy.

Adult↗
PubMed2005

Are pain location and physical examinations useful in locating a tear site of the rotator cuff?

BACKGROUND: Pain is the most common symptom of patients with rotator cuff tendinopathy, but little is known about the relationship between the site of pain and the site of cuff pathologic lesions. Also, accuracies of physical examinations used to locate a tear by assessing the muscle strength seem to be affected by the threshold for muscle weakness, but no studies have been reported regarding the efficacies of physical examinations in reference to their threshold. HYPOTHESIS: Pain location is useful in locating a tear site. Efficacies of physical examinations to evaluate the function of the cuff muscles depend on the threshold for muscle weakness. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors retrospectively reviewed the clinical charts of 160 shoulders of 149 patients (mean age, 53 years) with either rotator cuff tears (140 shoulders) or cuff tendinitis (20 shoulders). The location of pain was recorded on a standardized form with 6 different areas. The diagnostic accuracies of the following tests were assessed with various thresholds for muscle weakness: supraspinatus test, the external rotation strength test, and the lift-off test. RESULTS: Lateral and anterior portions of the shoulder were the most common sites of pain regardless of existence of tear or tear location. The supraspinatus test was most accurate when it was assessed to have positive results with the muscle strength less than manual muscle testing grade 5, whereas the lift-off test was most accurate with a threshold less than grade 3. The external rotation strength test was most accurate with a threshold of less than grade 4+. CONCLUSION: The authors conclude that pain location is not useful in locating the site of a tear, whereas the physical examinations aiming to locate the tear site are clinically useful when assessed to have positive results with appropriate threshold for muscle weakness.

Adolescent↗
PubMed2003

All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison.

PURPOSE: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. TYPE OF STUDY: Retrospective outcome study. METHODS: Sixty-four shoulders (58 patients) were identified; 35 in the all-arthroscopic group and 29 in the mini-open group. Average follow-up for all patients was 44.6 months, with a minimum of 24 months. The all-arthroscopic group included 3 small tears (< 1 cm), 24 medium-size tears (1 to 3 cm), and 9 large tears (3 to 5 cm). The mini-open group included 2 small tears, 9 medium tears, and 18 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. None underwent formal acromioclavicular joint resection. Four of the all-arthroscopic and 11 of the mini-open patients underwent coplaning of the acromioclavicular joint. Anchors were the primary method of arthroscopic fixation, with an average of 1.5 anchors per case. RESULTS: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 91.7 and for the mini-open group was 90.0. No patients in the arthroscopic group developed fibrous ankylosis, whereas 4 patients in the mini-open group developed the condition (14%). No anchor-related complications were noted. Shoulders in the all-arthroscopic group showed greater motion at 6 and 12 weeks postoperatively and slightly better motion at final review. However, final motion difference was not statistically significant. Overall, 4 patients (6.3%) demonstrated some tenderness in the acromioclavicular joint on palpation, but none had clinical symptoms requiring treatment. CONCLUSIONS: All-arthroscopic cuff repair provides comparable outcomes and complication rates to arthroscopic decompression with mini-open repair. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. A trend for better early motion was also noted in the all-arthroscopic group. Analysis of variance shows no measurable outcome difference between tear sizes.

Aged↗
PubMed2004

Arthroscopically assisted rotator cuff repair.

PURPOSE: The purpose of this study is to analyze the technique and value of arthroscopically assisted rotator cuff repair based on follow-up results after 3 years. TYPE OF STUDY: Case series. METHODS: Since the beginning of 1997, 216 patients included in a clinical case series at the Department of Trauma Surgery of the Hospital of the Barmherzigen Brüder Eisenstadt have undergone arthroscopically assisted rotator cuff repair. Radiographic, clinical, and intraoperative parameters were carefully documented. All patients were treated with an arthroscopically assisted transosseous technique, in which bone tunnels are drilled with a target drill unit through the humeral head lateral to the biceps tendon from a third ventrocaudal incision on the humerus. The nonresorbable sutures placed into the cuff with a suture punch are passed transosseously and tied in the incision directly on the humeral head using a knot pusher. In December 2000, 84 patients (average age, 54.8 years; range, 28 to 74 years) underwent a clinical follow-up evaluation after a mean follow-up time of 35 months (28 to 44 months). RESULTS: The average Constant score improved from a preoperative rating of 44.9 to a postoperative rating of 87.2. University of California, Los Angeles score was improved from 11.3 to 31.1 ( P <.001). Time of preoperative history, tear size, and condition of the long biceps tendon were found to have significant influence on results (P <.05). Thus, 20 patients with chronic, untreated tears of the long biceps tendon showed significantly worse results with a score of 81.8. Patients with curved or hooked acromion types (Bigliani II and III) showed significantly better results (P <.05) and patients with extensive tears had significantly worse results because of a residual strength deficit. The essential determinant was achievement of a stable tear closure with arthroscopic verification and documentation. Thus, 8 patients with a documented small gap between repaired cuff and bone showed a significantly worse rating in the Constant score, with 80.5 (P <.05). The complications encountered included development of seroma in one case and one case with frozen shoulder symptoms. CONCLUSIONS: Arthroscopically assisted repair of the rotator cuff was shown to be an effective procedure, guaranteeing good clinical results for medium- and large-sized tears with adequate mobility. Advantages include a primary stability comparable to that seen with open repair. Minimized trauma to soft tissue is associated with a lesser degree of postoperative pain and scarring and reduced hospitalization. LEVEL OF EVIDENCE: Level IV, case series.

Adult↗
PubMedDate not supplied

Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears.

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rotator cuff tears. One hundred twenty patients with preoperative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were analyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthroscopy confirmed a sensitivity of 95% for the full-thickness tears and 41% for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91%. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thickness tears.

Arthroscopy↗
PubMedDate not supplied

A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles.

SUMMARY: The author has previously elucidated and advocated various biomechanical principles for application in rotator cuff repair. This article is an attempt to link all these concepts together into a unified stepwise approach to arthroscopic rotator cuff repair that will maximize the strength of the repair for all tear configurations.

Arthroscopy↗
PubMed2005

Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation.

OBJECTIVE: To evaluate the sonographic findings of the rotator interval in patients with clinical evidence of adhesive capsulitis immediately prior to arthroscopy. DESIGN AND PATIENTS: We prospectively compared 30 patients with clinically diagnosed adhesive capsulitis (20 females, 10 males, mean age 50 years) with a control population of 10 normal volunteers and 100 patients with a clinical suspicion of rotator cuff tears. Grey-scale and colour Doppler sonography of the rotator interval were used. RESULTS: Twenty-six patients (87%) demonstrated hypoechoic echotexture and increased vascularity within the rotator interval, all of whom had had symptoms for less than 1 year. Three patients had hypoechoic echotexture but no increase in vascularity, and one patient had a normal sonographic appearance. All patients were shown to have fibrovascular inflammatory soft-tissue changes in the rotator interval at arthroscopy commensurate with adhesive capsulitis. None of the volunteers or the patients with a clinical diagnosis of rotator cuff tear showed such changes. CONCLUSIONS: Sonography can provide an early accurate diagnosis of adhesive capsulitis by assessing the rotator interval for hypoechoic vascular soft tissue.

Adult↗
PubMed2001

Treatment of rotator cuff arthropathy with a reversed Delta shoulder prosthesis.

The treatment of rotator cuff arthropathy is still a matter of debate. Up to now a hemiarthroplasty was usually used. We report the results obtained with a reversed shoulder prosthesis (Delta prosthesis, De Puy) in seven patients with severe rotator cuff arthropathy. The mean Constant score increased from 17.9/100 preoperatively to 56.7/100 postoperatively. The mean follow-up was 16 months. Loosening was not observed on follow-up x-rays.

Aged↗
PubMed2005

The role of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis: a case series.

OBJECTIVE: To study the efficacy of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis. DESIGN: Consecutive case series. SETTING: Musculoskeletal rehabilitation clinic. PARTICIPANTS: Twenty-eight tennis players (16 women, 12 men; mean age, 44.3y) with calcific rotator cuff tendinosis, who failed conservative measures. INTERVENTION: Subjects underwent fluoroscopically guided subacromial shoulder irrigation (50-75 mL of normal saline in 10 mL aliquots) followed by a corticosteroid injection (5 mL solution of 1 mL triamcinolone [40 mg/mL] and 4 mL of 0.5% bupivacaine). After the procedure, all patients completed the same exercise regimen. MAIN OUTCOME MEASURES: LInsalata Shoulder Rating Questionnaire (LSRQ) score, visual numeric pain score, and patient satisfaction. RESULTS: At 1-year follow-up, 85.7% reported a successful outcome with significant improvements in the LSQR and numeric pain scores. CONCLUSIONS: Our minimally invasive approach was safe, well tolerated, and effective, which should make it useful in providing relief for patients with rotator cuff tendinosis.

Acromion↗