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PubMed2005

Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients.

INTRODUCTION: In older patients we documented the incidence of additional injuries in shoulder dislocations in a non-randomised, prospective study and compared the results of conservative and of operative therapy of rotator cuff tears. MATERIAL AND METHODS: Between 1993 and 1999 a total of 87 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy patients were free to decide between surgical and conservative treatment. Patients were monitored for function, subjective stability, and satisfaction over a minimum follow-up period of 1 year. RESULTS: In 54% of the patients enrolled a cuff tear was documented; the frequency increased with advancing age to 100% in patients over the age of 70. Surgical treatment of the cuff tears resulted in better function and satisfaction. There were three recurrences in the conservative treatment group, while no recurrences were documented in surgically treated patients. The significant benefit of cuff repair was confirmed by regression analysis. CONCLUSION: In this selected patient group, we believe surgical repair of the symptomatic rotator cuff tear should be discussed with the patient.

Adult↗
PubMedDate not supplied

Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up.

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (< 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O-PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1-PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

Adult↗
PubMed1991

Partial thickness rotator cuff tears: results of arthroscopic treatment.

Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.

Adult↗
PubMedDate not supplied

[Evaluation of a simple test for shoulder function in patients with surgically treated rotator cuff injuries].

INTRODUCTION: To assess overall shoulder function a simple examination of the range of motion and strength may not be sufficiently representative. because the shoulder in its daily use is often required for repetitive activities, fatigue at an early stage could be a sign of disturbed shoulder function. Therefore the shoulder function test (SFT) was created to incorporate the factor time into shoulder assessment. With this study the SFT was evaluated for its clinical use in the prospective follow-up of a series of patients operated on for rotator cuff tears. METHODS: Using forward flexion, the patient had to lift a 500-g weight onto a shelf placed at a height which he could reach with his extended arm. The achieved height (5 levels possible) and the time he needed for 5 repetitions were recorded. The SFT value was calculated by division of the time required by the level of the reached shelf. Thus, a lower SFT score represents a better shoulder function. This was tested on 45 patients prior to rotator cuff repair and at 3, 6 and 12 months postoperatively. As validation the SF-36 and the Constant score were evaluated in parallel. Construct, criterion, content and discriminative validity and responsiveness were calculated Results: At all assessments the SFT correlated with the Constant score (r = - 0.47 to r = - 0.62) and the SF-36 (r = - 0.26 to r = - 0.61) demonstrating construct validity. As criterion validity the SFT correlated with the reported pain (r = 0.34 to r = 0.61), patients' self-estimation (r = 0.38 to r = 0.59) and doctors' estimation of the patients shoulder function (r = 0.36 to r = 0.54). Known groups validity was positive as the SFT could differentiate between shoulders with and without rotator cuff tears. The SFT demonstrated a good responsiveness with significant improvement (p = 0.01) after rotator cuff repair. CONCLUSION: Repetitive forward flexion is an important function of the shoulder in daily activities. The SFT allows a reliable and valid quantitative measurement of this function. In order to improve functional assessment of the shoulder and scoring we would recommend using this patient- and function-orientated test in combination with the Constant score to document the current status of shoulder function.

Activities of Daily Living↗
PubMed2003

Functional and electromyographic results after open rotator cuff repair.

Fifty-one patients treated for full-thickness rotator cuff tears were followed up an average of 4 years after surgery (range, 2-6.4 years). The shoulder function was assessed according to the Constant classification, each patient did strength measurements, and had electromyographic evaluation of the supraspinatus and infraspinatus muscles. The mean value of the Constant score for the surgically treated shoulder was 2.7 points. Forty-five patients (88.2%) had satisfactory scores and six patients (11.8%) had unsatisfactory scores. The result of treatment was significantly correlated to the size of the tear and the time elapsed from injury to surgery. However, no correlation was found between the result of the treatment and the type of surgery, mode of postoperative rehabilitation, and age. The strength measurement of abduction and of external rotation indicated significantly reduced power in surgically treated shoulders compared with contralateral shoulders. There was a significant difference of the infraspinatus motor unit potential interference pattern reduction between surgically treated and the contralateral shoulder. There was a positive correlation between electromyographic findings and the results of rotator cuff reconstruction.

Adult↗
PubMedDate not supplied

Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear.

A randomized study of two types of conservative treatment of 78 shoulders in 78 patients with rotator cuff tears was performed. Twenty-five milligrams of sodium hyaluronate (SH) was injected into shoulders in one group (SH group) and 2 mg of dexamethasone was injected in the other group (steroid group). Injection of each drug was planned for once per week for 5 consecutive weeks. In the SH group, University of California at Los Angeles score before treatment was 13.6 +/- 2.6 points in 16 patients who did not require surgery (satisfied patients) and 12.8 +/- 3.5 points in 22 patients who required surgery (unsatisfied patients) (not statistically significant). In the steroid group, University of California at Los Angeles score before treatment was 11.9 +/- 3.6 points for 15 satisfied patients and 12.6 +/- 3.9 points for 25 unsatisfied patients (again, not statistically significant). In the SH group, the score at 4 weeks after treatment for satisfied patients increased to 27.6 +/- 3.1 points, whereas that for unsatisfied patients was 14.9 +/- 1.2 points (P <.0001). Similarly, in the steroid group, the score at 4 weeks after the treatment for satisfied patients increased to 26.5 +/- 2.0 points, whereas that for unsatisfied patients was 15.0 +/- 4.0 points (P <.0001). At 24 weeks after treatment, the score for satisfied patients was 26.2 +/- 3.1 points in the SH group and 25.3 +/- 2.5 points in the steroid group. The effective rate of the SH group was 39.5% and that of the steroid group was 35%. Therapeutic efficacy in the SH group was equivalent to that in the steroid group. In both groups, the rate of patients who engaged in manual labor was significantly higher in the group of unsatisfied patients than in that of satisfied patients. No adverse reaction to either treatment was observed. These results suggest that SH is an effective conservative treatment for patients with rotator cuff tears.

Activities of Daily Living↗
PubMed2003

Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability.

PURPOSE: The purpose of this study was to evaluate the outcome of patients who underwent arthroscopic repair of anterosuperior rotator cuff tears. The null hypothesis, that there was no difference between preoperative scores and postoperative scores, was tested statistically. TYPE OF STUDY: A cohort study. METHODS: The preoperative and postoperative status of patients with anterosuperior rotator cuff tears was analyzed using the Constant score, American Shoulder and Elbow Society Index (ASES Index), a visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction, "would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today." There were also 2 groups compared: 1 that had a "tac" used for repair of the subscapularis tendon, and the other that used a "tie" technique for subscapularis repair. All supraspinatus tendon tears were complete and were repaired using a soft-tissue fixation device. RESULTS: There was a statistically significant difference for all outcome measures except for the objective Constant score of the tie group, P =.58. Follow-up was 2 to 4 years. There were no differences based on sex or type of fixation device used for repair of the subscapularis tendon. There were no reruptures, clinically. CONCLUSIONS: The arthroscopic repair of anterosuperior rotator cuff tears provides reliable expectation for improvement in function, decreases in pain, decreases in clinical findings of biceps subluxation and inflammation, improvement in shoulder scores, and the improvement of clinical findings of subscapularis insufficiency.

Aged↗
PubMed1995

Nonoperative treatment of rotator cuff tears.

In this study, 33 patients with full-thickness tears of the rotator cuff were given a supervised nonoperative program of rotator strengthening exercises and then were seen at followup an average of 3.8 years later. Of the 14 patients who were dissatisfied with nonoperative care, 12 eventually had opted for surgery and 2 were dissatisfied with their status at followup. In attempting to identify patients who would benefit from nonoperative care, the authors were unable to show that individual parameters such as rotator strength, symptom duration, or functional impairment were useful to predict outcome. However, it was found that those who have an insurance claim or who experience significant sleep loss due to shoulder pain are unlikely to be satisfied with nonoperative treatment. Patient satisfaction with nonoperative treatment is best correlated with improved pain relief, the ability to carry a 10- to 15-pound suitcase at one's side, the ability to use the arm at shoulder level, and the ability to eat using a utensil. Objective variables such as rotator strength and active motion are not correlated with ultimate patient satisfaction.

Activities of Daily Living↗
PubMed2004

[Value of sonography after rotator cuff repair: a comparison with MRI and clinical results].

AIM: How well do ultrasound- and MRI-results after rotator cuff reconstruction correlate with postoperative clinical findings? METHODS: Ultrasound- and MR-imaging of the afflicted shoulder on 40 patients who were surgically managed for isolated tear of the tendon of supraspinatus was performed at least 24 months after intervention. Patients were also clinically assessed. Based on the clinical result, sensitivity and specificity for the two imaging procedures was determined. RESULTS: Only 11 (27.5%) patients had a completely inconspicuous ultrasonography. By ignoring the sonographic parameter "echogenicity" this number was raised to 29 (72.5%) patients. Without the above mentioned parameter ultrasonography demonstrated a good specificity (90.3%) yet a poor sensitivity (33.3%). Incorporation of "echogenicity" markedly weakened both values. MR-imaging showed an intact cuff in 32 (80%) patients, 5 (12.5%) had signs for a partial tear and in 3 (7.5%) a recurrent tear was diagnosed. Based on the clinical result, MR-imaging showed sufficient specificity (87.1%), yet also a poor sensitivity (44.4%). CONCLUSION: After rotator cuff repair MRI- and ultrasound-findings frequently stand in distinct discrepancy to clinical results. Based on clinical findings, postoperative MR-imaging shows a slightly higher sensitivity than ultrasonography. Despite this, both radiographic methods do not allow deductions concerning the clinical outcome. The postoperative shoulder-scan and MRI should therefore be interpreted with utmost care. Symptoms and functional results are of high clinical relevance in the assessment of the postoperative shoulder.

Follow-Up Studies↗
PubMed1989

[Complete rotator cuff lesions in athletes].

The causal etiologies of complete rotator cuff lesions are described. Handball, volleyball, rugby, throwing and putting disciplins, but also tennis, swimming, golf and artistic gymnastics are regarded as sports especially straining the periarticular structures of the shoulder joints. In the period from November 1980 to April 1986, 72 shoulder joints with complete rotator cuff lesions were treated surgically (bilaterally in three cases). The 69 patients comprised 16 recreational and 11 competitive sportsmen. An average of 2.4 years after the operation, 66 shoulder joints (91.6%) could followed up clinically and sonographically with simultaneous use of a 100-point-score. Good and very good results were shown in 70% of the cases.

Adult↗
PubMed2002

Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear.

Results of shoulder arthroplasty in patients with a deficient rotator cuff often are suboptimal with significant limitations in postoperative active mobility. Short-term results using a reverse design prosthesis in the treatment of the cuff-deficient arthritic shoulder are encouraging. This prosthesis compares favorably, particularly with regard to postoperative active anterior elevation, to other treatment options in this challenging patient population.

Aged↗
PubMed2001

Arthroscopic rotator cuff repair.

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages of glenohumeral joint inspection, treatment of intraarticular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in open and arthroscopic shoulder operations.

Arthroscopy↗
PubMed2005

Arthroscopic repair of rotator cuff tears associated with large bone cysts of the proximal humerus: compaction bone grafting technique.

Large bone cysts associated with symptomatic rotator cuff tears may pose significant treatment problems. Bone loss associated with these cysts or with implant removal in cases of revision rotator cuff surgery may be so large that secure suture anchor fixation cannot be achieved with traditional techniques. This report describes how to arthroscopically bone graft these defects with a compaction technique that creates a densely packed bone bed into which suture anchors can be securely placed.

Arthroscopy↗
PubMedDate not supplied

Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders.

We determined on histologic examination the degree of degeneration at the insertion of 3 rotator cuff tendons in 76 cadaveric shoulders, 17 of which had a partial tear of the supraspinatus. Fiber thinning, the presence of granulation tissue, and incomplete tearing of fibers, all evidence of degeneration, were quantified separately for each tendon. Among the shoulders that were intact on macroscopy, no significant difference in degeneration score could be found. In all 3 tendons degeneration was more prominent on the articular sides compared with the bursal sides (P < .0001). The degeneration score of partially torn supraspinatus was significantly higher than that of the intact tendons (P < .0001). The extent of granulation tissue, 1 criterion of degeneration, seemed to contribute mostly to this difference. Intrinsic degeneration occurred foremost in the articular side of the rotator cuff and might constitute the primary cause of rotator cuff tearing.

Adult↗
PubMedDate not supplied

The Leclercq test in diagnosis of tear in the rotator cuff.

The authors report their experience in using the Leclercq test to diagnose tear in the rotator cuff of the shoulder. When positive, this test consists in a radiographic demonstration of reduction in the subacromial space in opposing abduction of the shoulder. Twenty-five patients affected with chronic painful shoulder and suspected lesion of the rotator cuff were submitted to the Leclercq test and subsequently to arthrography in order to evaluate the conditions of the cuff. In all of the cases where the cuff was whole, and arthrography normal, the Leclercq test was negative. When lesion of the cuff was revealed by arthrography, the test was positive in 75% of the cases considered globally, and in 92% of the cases with complete tear in the rotator cuff.

Adult↗
PubMedDate not supplied

A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.

We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was 26.6 months (range, 12 to 93 months). The preoperative CS was 38.2 points; 41% were supraspinatus tears, 40.2% were supra and infraspinatus tears, 10.5% were three-tendon tears, and 8.1% were supraspinatus and subscapularis tears. The LHB was altered or disrupted in 77% of cases, dislocated or subluxated in 44% of cases. Acromioplasty was associated to tear debridement in 183 cases (88%) and to a tenotomy of the LHB in 38 cases (19%) of which 15 did not benefit from an associated acromioplasty. Global objective results shown by the corrected CS reached 79.7% and were satisfying in 73% of cases. Poor clinical factors were preoperative shoulder stiffness, postoperative painful crises, worker compensation, a preoperative history longer than 4 years, and young age. The poor anatomic factors were osteoarthritis, a lesion of the acromioclavicular joint or of the LHB tendon. An isolated supraspinatus tear will produce much better results than a triple-tendon tear. The persistence of an aggressive acromion was a prejudicial factor. The benefits of LHB tenotomy were evident and could be isolated in case of massive rotator tears. It seems that LHB tenotomy was particularly effective for massive tears of two or more tendons. Arthroscopic acromioplasty is an excellent indication for elderly patients without professional activity, functionally less demanding that a younger patient.

Acromion↗
PubMed2000

Comparison of conservative and operative treatments of massive rotator cuff tears.

The results of conservative and operative treatment of massive rotator cuff tears were compared. All 9 men and 5 women who were treated conservatively (group I) had a Hamada Gpoup 4 arthrographic tear. The mean follow-up period was 4 years. The operative group (group II) was composed of 23 men and 3 women who had cuff tears of more than 5.0 cm in longest dimension. The mean age range at surgery was 62 years. Following anterior acromioplasty (n = 26), additional procedures included tenorrhaphy (n = 12), fascial grafting (n = 8), laterl transfer of the long head of the biceps brachii tendon (n = 2), muscle transfer of the teres minor (n = 3), muscle transfer of the supraspinatus (n = 1). The mean follow-up period was 4 years. The results were assessed using the Japanese Orthopaedic Association score. The JOA score was increased from 53.2 to 71.1 in group I, and from 58.8 to 85.9 in group II. More improvement in painrelief, muscle strength, and range of motion was obtained in group II than in group I. There was a significantly better final result in the patients without rupture of the tendon of the long head of the biceps brachii muscle.

Aged↗
PubMed1996

Magnetic resonance imaging for evaluation of failed repairs of the rotator cuff. Relationship to operative findings.

We used magnetic resonance imaging to evaluate thirty shoulders in twenty-nine patients who had unacceptable pain and loss of function after at least one operative procedure for a lesion of the rotator cuff. A preoperative history was recorded and physical and radiographic examinations were performed before magnetic resonance imaging. All patients had a reoperation two to 156 months (average, thirty-two months) after the operation. The results of the magnetic resonance imaging and the findings at the most recent operation were then compared with regard to the integrity of the rotator cuff, the deltoid muscle, and the long head of the biceps tendon. The sensitivity and specificity of magnetic resonance imaging for the diagnosis of full-thickness tears, partial-thickness tears, and intact rotator cuffs were 84 and 91 per cent, 83 and 83 per cent, and 80 and 100 per cent, respectively. The positive and negative predictive values were 94 and 77 per cent, 56 and 95 per cent, and 100 and 96 per cent, respectively. Three shoulders had a clinically detached and retracted origin of the deltoid muscle that was identified correctly on magnetic resonance imaging, and this finding was confirmed operatively. A rupture of the long head of the biceps tendon was identified correctly in four of six shoulders. In one of the two remaining shoulders, the rupture was obscured on magnetic resonance imaging because of a so-called balloon artefact from a nearby metal suture anchor. Magnetic resonance imaging detected two unexpected lesions: a denudation of the articular cartilage in one shoulder and a ganglion cyst in the supraspinatus muscle in another.

Adult↗