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PubMed1997

[Echography of the shoulder with the patient supine in the diagnosis of rotator cuff rupture].

We report a new method for shoulder sonography (US): the patient lies supine and his/her arm is positioned so as to optimize tendon depiction. The supraspinatus tendon, which is the most frequently involved structure in rotator cuff tears, is studied with the patient's arm dropped, elbow extended and forearm prone. Our series consisted of 49 surgical patients (arthroscopy in 16 and open surgery in 33 patients): US sensitivity in tear depiction was 84.8%, specificity 100% and accuracy 89.8%. Medium-small tears appeared as transonic areas within tendon substance and/or tendon focal thinning. Large tears appeared as: (a) missed or markedly thinned rotator cuff, with deltoid muscle approximation to the humeral head surface, (b) plenty of fluid collected around bulky tear margins. The US images of 36 patients were then reviewed and the details discussed. A new sign was observed in medium-small tears, that is a sharp hyperechoic band encircling the humeral cartilage (the compass sign). In conclusion, we believe that US performed with the patient in supine recumbency is easier to perform and provides a bigger field of view of the supraspinatus tendon; it also permits to keep stretched rotator cuff, with consequent image quality improvement.

Adult↗
PubMed1995

Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender.

We studied the integrity of the rotator cuff in both dominant and non-dominant shoulders of 90 asymptomatic adults between the ages of 30 and 99 years using ultrasound. The criteria for diagnosis had been validated on unembalmed cadaver specimens. We found no statistically significant difference in the incidence of impingement findings between dominant and non-dominant arms or between genders. The prevalence of partial- or full-thickness tears increased markedly after 50 years of age: these were present in over 50% of dominant shoulders in the seventh decade and in 80% of subjects over 80 years of age. Our results indicate that rotator-cuff lesions are a natural correlate of ageing, and are often present with no clinical symptoms. Treatment should be based on clinical findings and not on the results of imaging.

Adult↗
PubMed1990

The use of magnetic resonance imaging in the diagnosis of rotator cuff tears.

One hundred consecutive patients with symptoms of chronic subacromial impingement syndrome were evaluated by both arthrography and magnetic resonance imaging (MRI) techniques. By comparing intermediate and T2 weighted images, the ability to identify the normal and abnormal anatomy of the rotator cuff with the MRI was excellent. All 51 patients with arthrogram-proven rotator cuff tears had abnormal MRI scans (100% sensitivity). However, six of the 49 patients with normal arthrograms had abnormal MRI scans (88% specificity). At arthroscopy, four of these patients were found to have moderate to severe partial thickness rotator cuff tears. These findings indicate that in patients with longstanding subacromial impingement syndrome the MRI has an exceptionally high sensitivity for damage to the rotator cuff.

Arthrography↗
PubMed2001

Cyclic loading of rotator cuff repairs: A comparison of bioabsorbable tacks with metal suture anchors and transosseous sutures.

PURPOSE: The purposes of the study were (1) to compare rotator cuff repair strengths after cyclic loading of 2 bioabsorbable nonsuture-based tack-type anchors, transosseous sutures, and a metal suture-based anchor, and (2) to correlate bone mineral density with mode of failure and cycles to failure. We hypothesized that specimens with a lower bone density would fail through bone at a lower number of cycles independent of the method of cuff fixation. TYPE OF STUDY: Ex vivo biomechanical study. METHODS: Standardized full-thickness rotator cuff defects were created in 30 fresh-frozen cadaveric shoulders that were randomized to 1 of 4 repair groups: transosseous sutures; Mitek Super suture anchors (Mitek Surgical Products, Westwood, MA); smooth bioabsorbable 8-mm Suretacs (Acufex, Smith & Nephew Endoscopy, Mansfield, MA); or spiked bioabsorbable 8-mm Suretacs (Acufex). All repairs were cyclically loaded from 10 to 180 N; the numbers of cycles to 50% (gap, 5 mm) and 100% (gap, 10 mm) failure were recorded. RESULTS: In comparing the repair groups, we found only 1 significant difference: the number of cycles to 100% failure was significantly higher (P <.05) for the smooth bioabsorbable tack than for the transosseous suture group. There were no statistically significant (P </=.05) differences in bone mineral densities with regard to each specimen's mode of failure. CONCLUSIONS: Our results suggested that immediate postoperative fixation provided by bioabsorbable tacks was similar to that provided by Mitek anchors and more stable than that provided by transosseous sutures. Therefore, the immediate postoperative biomechanical strength of bioabsorbable tacks seems comparatively adequate for fixation of selected small rotator cuff tears. However, additional evaluation in an animal model to examine degradation characteristics and sustained strength of repair is recommended before clinical use.

Absorbable Implants↗
PubMed1985

Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report.

Thirty-six patients with partial tears of the supraspinatus portion of the rotator cuff underwent arthroscopic examination and debridement of the lesion. All patients, whose average age was 22 years, were involved in competitive athletics; 64% were baseball pitchers. The average duration of symptoms prior to arthroscopy was 12 months. The most common presenting complaint was pain felt in the shoulder during overhead activities. Associated pathology included tears of the glenoid labrum and partial tearing or tendinitis of the long head of the biceps tendon. Of the 34 patients available for follow-up, 26 (76%) had excellent results, three (9%) had good results, and five (15%) had poor results. Eighty-five percent of the patients returned satisfactorily to their preoperative athletic activity. Our preliminary experience with arthroscopy of the shoulder in the management of patients with partial rotator cuff tears is encouraging. Not only can a partial rotator cuff tear be debrided to initiate a healing response, but a definitive diagnosis can also be made and associated pathology identified, permitting the establishment of an appropriate rehabilitation program.

Adolescent↗
PubMed2004

Calcifying tendinitis of the rotator cuff with cortical bone erosion.

Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.

Adult↗
PubMedDate not supplied

Comparison of fat-saturation fast spin echo versus conventional spin-echo MRI in the detection of rotator cuff pathology.

The purpose of this study was to compare the diagnostic performance of fat-saturation fast-spin-echo (FSE) T2-weighted (T2W) sequences with conventional spin-echo (CSE) T2W sequences in the detection of rotator cuff pathology using surgery as the reference standard. Oblique coronal dual-echo CSE and FSE T2W images with fat saturation from 50 surgically confirmed MR shoulder examinations were acquired on a 1.5-T MR scanner. Blinded MR readers retrospectively analyzed each imaging sequence separately and ultimately correlated both sequences together with findings at surgery. FSE was 100% sensitive and 94% specific in detection of full-thickness tears (n = 19) and 73% sensitive and 97% specific in the detection of partial-thickness rotator cuff tears (n = 13). There was no statistically significant difference in the performance of FSE with fat saturation compared with CSE. The two discrepancies between imaging sequences related to the extent of partial-thickness tears. Our findings suggest that fat-saturation FSE imaging can effectively replace CSE imaging in the evaluation of rotator cuff pathology.

Female↗
PubMed2006

Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population.

OBJECTIVES: This study assessed the prevalence, incidence, and persistence of nontraumatic rotator cuff tendinitis and shoulder symptoms over a 1-year period in a working population and the predictive value of symptoms and physical findings. METHODS: A 1-year prospective study of 436 active workers was conducted at 12 different worksites. Detailed health interviews, psychosocial questionnaires, and physical examinations were conducted at baseline and again after 1 year, with shorter evaluations at 4 and 8 months. Individual observed exposure assessment of shoulder posture, arm-hand activity, and hand forces was conducted. RESULTS: The prevalence of rotator cuff tendinitis at baseline was 7.6% [95% confidence interval (95% CI 5.1-10.1%)] for the right and 4.8% (95% CI 3.0-7.0%) for the left, compared with shoulder symptoms of 18.6% (95% CI 14.9-22.3%) (right) and 11.2% (95% CI 8.2-14.2%) (left). The incidence of rotator cuff tendinitis was 5.5% (95% CI 2.8-6.8%) and 2.9% (95% CI 1.0-3.8%), respectively. Higher proportions of participants with current symptoms or physical findings at baseline became clinical cases after 1 year than those without symptoms or findings. The 1-year persistence of clinical case status was 31.3% (95% CI 26.9-35.7%) (right) and 31.6% (95% CI 27.2-36.0%) (left). There were significant differences at baseline between the asymptomatic participants and the clinical cases with respect to physical health on the 12-item Short-form Health Survey (P=0.0002), the perception of general health (P=0.0027), and the frequency of high hand force exposure (P=0.0177). CONCLUSIONS: Considerable movement occurs between different stages of shoulder problems. Symptoms and physical findings alone appear to predict clinical case status within 1 year. Frequent follow-up is necessary to capture changes in health and exposure status in prospective studies.

Adult↗
PubMedDate not supplied

Six surgery-correlated sonographic signs for rotator cuff tears: emphasis on partial-thickness tear.

The purpose of the study is to correlate the sonographic signs of rotator cuff tears (RCTs) with surgical findings, with emphasis on partial-thickness tear. We prospectively performed ultrasonography (US) on 50 patients with suspected RCTs and comparison with operative findings. Six US signs, which included "nonvisualization", "focal depression", "focal thinning", "focal hypoechoic cleft", "floating bright spots" and "focal heterogeneous hypoechogenicity" in rotator cuffs (RCs), were emphasized, but only "focal heterogeneous hypoechogenicity" favored partial-thickness tear (10/14, 71%). All the other five signs, including "floating bright spots" (not pointed out in literatures), were suggestive of full-thickness tear. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy for US to detect RCTs were 95%, 90%, 97%, 82% and 94%, respectively. US is effective to detect RCTs and differentiate full- from partial-thickness tear.

Adolescent↗
PubMedDate not supplied

Rotator cuff repair in patients with type I diabetes mellitus.

Insulin-dependent diabetes mellitus is associated with shoulder stiffness and a propensity toward postoperative wound complications and infection. We compared our results of open repair of full-thickness rotator cuff tears in 30 diabetic patients with those of a matched, nondiabetic population. No differences were observed in preoperative range of motion, although at a mean of 34 months, significant differences in shoulder active range of motion and passive range of motion were found postoperatively at 6 weeks, 6 months, and final follow-up (P <.05). On the basis of American Shoulder and Elbow Surgeons shoulder scoring, there were 27 (90%) and 28 (93%) good or excellent results in the diabetic and comparison groups, respectively. Complications occurred in 5 diabetic patients (17%), with 2 failures (7%) and 3 infections (10%), as compared with 1 failure (3%) and no infections in the comparison group. Repair of the diabetic rotator cuff may be performed with the expectation of improved motion and function, although less than nondiabetic counterparts. The surgeon should remain cognizant that a higher rate of complications, infection in particular, may occur after rotator cuff repair in the diabetic population.

Adult↗
PubMed1991

The incidence of rotator cuff rupture. An anatomic study.

To evaluate the incidence of rotator cuff ruptures, we examined 122 autopsy specimens of the shoulder and compared our results with those reported in the literature. The incidence of partial tears in our study was 28.7%; the incidence of complete rupture was 30.3%. The frequency increased with age. We found no cuff rupture without supraspinatus tendon involvement. Very often, the cuff tear was bilateral. We do not share the opinion that the rupture of the rotator cuff is primarily an injury of men. We found a higher incidence in female than in male shoulders.

Aged↗
PubMedDate not supplied

Anterior shoulder dislocation and injuries of the rotator cuff in patients aged over 40 years. Clinical and sonographic study.

A total of 39 patients with a mean age of 64 years (41 to 88) who had had anterior shoulder dislocation were followed-up an average of 2 years after trauma in order to evaluate the conditions of the rotator cuff. All of the patients were evaluated clinically, radiographically, and sonographically. Clinical evaluation revealed significant differences between the dislocated shoulders and the contralateral ones: the mean Constant score was 67 in the group with dislocated shoulders and 87 in the contralateral group. Ultrasound revealed partial injury of the cuff in 31% of cases and complete injury in 28%. Mean score was 81.4 in the group with a normal ultrasound, 67.1 in that with partial injury of the cuff, and 46.5 in that with complete injury of one or more tendons. These data confirm the high frequency of partial or complete injuries of the rotator cuff in patients aged over 40 years that have undergone anterior shoulder dislocation. Ultrasound confirms it is an excellent diagnostic method in the pathology of the rotator cuff, demonstrating good correlation with the clinical evaluation.

Adult↗
PubMed1988

Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report.

Symptomatic irrepairable rotator cuff tears usually entail complete loss of the substance of the supraspinatus and infraspinatus tendons. Loss of external rotation control and cranial migration of the humeral head on attempted flexion or abduction of the shoulder are the functional hallmarks. Transfer of the latissimus dorsi tendon from the humeral shaft to the superolateral humeral head provides a large, vascularized tendon that can be used to close a massive cuff defect and that exerts an external rotation and head-depressing moment that allow more effective action of the deltoid muscle. This procedure was carried out in 14 patients without any significant complications. Pain relief and functional results in those four cases with a minimum follow-up period of one year (average, 14 months) compared favorably with alternative treatment methods and warrant further anatomic, electromyographic, and clinical investigation.

Adult↗
PubMed1991

Sonography for diagnosis of rotator cuff tear. Comparison with observations at surgery in 58 shoulders.

To investigate the correlation between ultrasonographic and anatomic changes of the rotator cuff of the shoulder, we studied the findings in 58 surgical cases. Fifteen cases had a full thickness tear, 10 of which had a positive and 5 a negative ultrasonogram. Nine cases had partial tears of the cuff on the bursal side. Ultrasonographically, 3 of these were normal. Among the 34 cases that proved to be normal at surgery, 9 had positive ultrasonograms. The predictive value of a negative examination was 0.8, whereas the predictive value of a positive examination was 0.6. A cautious attitude towards ultrasonography for evaluation of the rotator cuff seems appropriate.

Adult↗
PubMed1991

Surgical repair of rotator cuff ruptures. The importance of the subacromial bursa.

We examined biopsy specimens obtained during surgery on 115 patients with complete rotator cuff rupture. The vascularised connective tissue covering the area of rupture and the proliferating cells in the fragmented tendons reflected more of the features of repair than of degeneration and necrosis. The main source of this fibrovascular tissue was the wall of the subacromial bursa. These features clearly indicated a vigorous reparative response which might play an important role in tendon reconstitution and remodelling. We therefore suggest that extensive debridement along with subtotal bursectomy, commonly practised during surgical repair of rotator cuff rupture, should be avoided. Although strong suture margins are essential for good operative results, debridement should be judicious and preserve as much as possible of the bursa and the associated fibrovascular tissue.

Acromioclavicular Joint↗
PubMed2001

Evaluation of the rotator cuff and glenoid labrum using a 0.2-Tesla extremity magnetic resonance (MR) system: MR results compared to surgical findings.

The purpose of this investigation was to evaluate the diagnostic capabilities of magnetic resonance imaging (MRI) performed using a dedicated-extremity MR system in detecting lesions of the rotator cuff and glenoid labrum. This retrospective study compared the MR results obtained in 47 patients that underwent MRI using a 0.2-Tesla extremity MR system (E-scan) to the surgical findings. MR images of the shoulder were obtained as follows: shoulder coil, T1-weighted, coronal-oblique and axial images; short Tau inversion recovery (STIR), coronal-oblique images; and T2-weighted, coronal-oblique, sagittal-oblique, and axial images. The MR examinations were interpreted by three highly experienced, musculoskeletal radiologists. Open surgical (N = 26) or arthroscopic (N = 21) procedures were performed within a mean time of 33 days after MRI. The surgical findings revealed rotator cuff tears in 28 patients and labral lesions in 9 patients. For the rotator cuff tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 89%, 100%, 100%, and 90%, respectively. For the labral lesions, the sensitivity, specificity, positive predictive value, and negative predictive value were 89%, 95%, 80%, and 97%, respectively. The findings indicated that there was good agreement comparing the MR results obtained using the low-field extremity MR system to the surgical findings for determination of lesions of the rotator cuff and glenoid labrum. Notably, the statistical values determined for the use of this MR system were comparable to those reported in the peer-reviewed literature for the use of whole-body, mid- and high-field-strength MR systems.

Adolescent↗
PubMed1985

US evaluation of the rotator cuff.

Ultrasonographic (US) evaluation of the moving shoulder is a new method for evaluating the integrity of the rotator cuff. In the past, contrast arthrography has provided the only nonoperative technique for demonstrating defects in the rotator cuff. We present the details of this new technique and describe 79 patients whose US results were correlated with the findings at arthrography and/or surgery. US allows evaluation of both shoulders at once, an advantage over arthrography, where usually only one side is evaluated at a single sitting. Improvements in US instrumentation, especially the introduction of high-resolution linear-array devices and the use of experienced ultrasonographers, have improved the accuracy of US. Because US is rapid, safe, noninvasive, and inexpensive, we advocate its use instead of arthrography as the routine test of rotator cuff integrity.

Adult↗
PubMedDate not supplied

[An x-ray study in the diagnosis of rotator cuff injuries].

The author has studied 142 x-ray films and 132 arthrograms of patients with various lesions of the rotator cuff and has found that in none of the cases has a correct roentgenological diagnosis been made outside his own department. The main routine x-ray and arthrographic signs of such lesions are described. The conclusion is made that in spite of inability of each particular x-ray method to reveal precise dimensions of the gap of the rotator cuff a combined roentgenological examination permits one to determine indications to surgery and elaborate an adequate operative strategy.

Arthrography↗