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PubMedDate not supplied

Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.

The purpose of this study is to define the prevalence of peripheral nerve injury associated with full-thickness tears of the rotator cuff presenting with shoulder muscle atrophy. Twenty-five patients with the diagnosis of full-thickness rotator cuff tear were included. Electrodiagnostic testing, including nerve conduction studies and needle examination, was performed on all patients. There were 7 abnormal electromyographic examinations. The most common diagnosis was upper trunk brachial plexopathy severely affecting the axillary nerve (4/7), followed by suprascapular neuropathy (2/7) and cervical radiculopathy (1/7). The prevalence of associated peripheral neuropathy was found to be 28%. Greater degrees of atrophy were significantly associated with the presence of neuropathy in these patients. Careful neurologic screening in all patients and electromyographic examination in clinically suspicious groups are recommended in patients with full-thickness cuff tears before surgical repair.

Adult↗
PubMed2006

Rotator cuff interval reconstruction.

Five pairs of cadaveric shoulders underwent posterior and anterior drawer and inferior sulcus tests in five progressive conditions: intact, vented, following opening of the rotator cuff interval, reconstruction of the interval, and transfer of the coracoacromial ligament. The surgical treatments--vented, open rotator cuff interval, reconstruction, and coracoacromial ligament transfer--had an effect compared to the intact shoulders on the inferior stiffness (P = .00002) and on the anteroposterior stiffness (P = .00031). The difference between the stiffness of the reconstructed rotator cuff interval compared to the coracoacromial ligament transfer was significant for loading in the AP direction (P = .006) and for loading in the inferior direction (P = .005).

Adult↗
PubMed1996

Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography, and at needle treatment.

RATIONALE AND OBJECTIVES: The author analyzes findings of consistency of rotator-cuff calcifications found at ultrasound (US)-guided needle treatment compared with findings of plain radiography, US, and computed tomography (CT). METHODS: Twenty patients had rotator-cuff calcifications (mean diameter, 1.5 cm; range, 1.1-2.6 cm) resistant to conservative therapy. At needle treatments, the consistency was assessed as hard or soft (slurry calcific deposit). In each imaging examination, the calcifications were divided into two groups. In radiographs, calcifications were divided into "well-defined" and "ill-defined." In US, they were divided into calcifications with acoustic shadow and calcifications with a faint shadow or no shadow. On CT, they were divided into homogeneous or nonhomogeneous calcifications. At CT, the density of the calcifications also was determined. The findings of consistency obtained at needle treatments were compared with the findings of plain radiography, US, and CT. RESULTS: At needle treatments, 45% (9 of 20) of the calcifications were soft or nearly liquid, and 55% (11 of 20) were hard. On plain radiographs, 67% (6 of 9) were as soft and 64% (7 of 11) as hard. On sonograms, 77% (7 of 9) were soft and 82% (9 of 11) were hard. On CT images, 77% (7 of 9) were soft and 91% (10 of 11) were hard; CT attenuation values were 77% (7 of 9) and 91% (10 of 11), respectively. CONCLUSIONS: Ultrasound and CT were reliable in predicting the consistency of rotator-cuff calcifications. Computed tomography attenuation values were the most accurate, and plain radiographs were the least accurate.

Acupuncture Therapy↗
PubMed1999

Indirect MR arthrography of the unexercised glenohumeral joint in patients with rotator cuff tears.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic utility of indirect MR arthrography of the unexercised glenohumeral joint in patients with rotator cuff tears confirmed by arthroscopy or arthrotomy as the gold standard. METHODS: Twenty-six patients underwent conventional MR imaging and indirect MR arthrography of the stationary glenohumeral joint using a wrap-around surface coil. Unenhanced T1-weighted spin echo/T2-weighted fast spin echo sequences and T1-weighted gradient echo sequences, adding spectral fat suppression after intravenous administration of contrast medium, were performed in the oblique coronal and oblique sagittal planes. Images were analyzed by three experienced radiologists in consensus. Levels of diagnostic confidence were evaluated using a four-point scale of diagnostic certainty. RESULTS: Performing indirect MR arthrography of the unexercised shoulder leads to a diagnostically efficient enhancement of joint fluid (120% at 4 minutes and 145% at 8 minutes after intravenous injection of gadodiamide). In terms of soft tissue delineation, characterization of rotator cuff tears was significantly improved by using enhanced fat-suppressed T1-weighted gradient echo sequences compared with conventional MR imaging. CONCLUSIONS: Indirect MR arthrography without glenohumeral joint exercise in the diagnosis of rotator cuff tears is feasible and represents a more convenient and less time-consuming alternative to indirect MR arthrography after joint exercise.

Adult↗
PubMed1994

Concomitant rotator cuff tear and brachial plexus injury in association with anterior shoulder dislocation: unhappy triad of the shoulder.

High incidences of nerve lesions or rotator cuff tears in association with shoulder dislocations have been reported. However, the simultaneous occurrence of these three lesions has only been reported once previously. This case is an example of a not so uncommon injury, which emphasizes the importance of looking for associated brachial plexus and rotator cuff lesions when examining a patient with shoulder dislocation.

Brachial Plexus↗
PubMed2004

Effects of acupuncture and placebo TENS in addition to exercise in treatment of rotator cuff tendinitis.

OBJECTIVE: To compare the effect of acupuncture with placebo transcutaneous electrical nerve stimulation (TENS) when added to the exercise treatment of rotator cuff tendinitis with respect to pain, shoulder movements and function. DESIGN: Prospective alternate allocation controlled trial. SETTING: Outpatient department. PATIENTS: Thirty-three patients (12 women and 21 men) were included in the study. All had clinically diagnosed rotator cuff tendinitis. INTERVENTION: Both groups underwent a standardized training programme. Each patient received in addition either 10 treatments with acupuncture or placebo TENS, 1-2 times per week. MAIN OUTCOME MEASURES: The parameters investigated were intensity of pain (measured with visual analogue scale), active, passive as well as functional movements in the shoulder (hand in neck (HIN) and pour out of a pot (POP)). Patients were tested before treatment, after treatment and at a six-month follow-up. Medicine intake, ability to lie on the affected side and sleep disturbances were evaluated. A subjective assessment was made after the treatment and at follow-up. RESULTS: Sixteen patients had acupuncture, 17 placebo TENS. Eight patients endured pain at rest in the placebo TENS group, and 10 in the acupuncture group. After treatment both groups improved, the improvement persisted at the six-month follow-up. Both groups increased range of movement. Except for the functional test HIN in the acupuncture group, there were no differences between the groups regarding other parameters investigated directly after treatment or at six-month follow-up. CONCLUSION: There is no difference between the effect of additional acupuncture treatment and placebo TENS in the treatment of rotator cuff tendinitis.

Acupuncture Therapy↗
PubMed1997

[Constant point evaluation for reconstruction of the rotator cuff].

Thirteen patients aged 36-63 years underwent surgery for full thickness rotator cuff rupture. The average follow-up was 21.1 months (range 12-36 months). Supraspinatus tendon was torn in 7 cases, supraspinatus and infraspinatus in 4, subscapularis in 1 and all three tendons were ruptured in 1 patient. Subacromial decompression and cuff reconstruction was done in 11 cases, decompression combined with cuff debridement and partial subscapularis tendon reconstruction in 1 case and subscapularis reconstruction in 1 patient. Constant Score (version corrected for age and sex) was used for shoulder function evaluation. There were 6 very good, 4 good, 1 fair and 2 bad results. Recurrence of cuff tear was diagnosed sonographically in 2 cases of both supra- and infraspinatus rupture. Statistical analysis disclosed significant correlation between extent of the tear and final functional result. Constant Score can be recommended as an objective and useful method for shoulder function assessment.

Adult↗
PubMedDate not supplied

Clinical significance of sonographic findings in the abnormal but intact rotator cuff: a preliminary report.

Shoulder pain is a common orthopedic problem. Clinical examination is often nonspecific and arthrography is normal in those patients with the most frequent cause of shoulder pain--noncalcific tendonitis secondary to impingement. Ultrasonography has recently shown itself to be of value in the diagnosis of rotator cuff tears. In addition to the diagnosis of tears, however, sonography can demonstrate abnormalities within the intact rotator cuff tendon. These abnormalities consist of changes in echogenicity and thickness of the tendon. The patterns of abnormality demonstrated correlate with pathologic changes seen in tendonitis. This preliminary study suggests that the ability to demonstrate an abnormal rotator cuff tendon has potential for becoming a valuable aid to the orthopedist in allowing confident diagnosis of rotator cuff disease in the presence of nonspecific symptomatology and an intact tendon.

Humans↗
PubMedDate not supplied

Influence of provider volume on length of stay, operating room time, and discharge status for rotator cuff repair.

Length of hospital stay, operating room time, and disposition of patient on discharge are important determinants of health care resource utilization. We examined the relationship between these determinants and hospital/surgeon volume for rotator cuff repair. A total of 9,973 patients undergoing rotator cuff repair were extracted from the New York State Ambulatory Surgery Databases for the years 1997 through 2000. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate regression models were used to estimate the risk-adjusted association between provider volume and outcomes. Patients operated on by low-volume surgeons had significantly higher likelihood for an extended length of stay when compared with those operated on by high-volume surgeons (adjusted odds ratio for extended length of stay, 2.3; 95% confidence interval, 1.2-4.4). There was a linear trend for a higher proportion of routine patient discharge with increasing surgeon volume. The mean operating room times for low- and intermediate-volume surgeons were significantly higher than that for high-volume surgeons (P < .001). We conclude that high-volume providers use health care resources more efficiently.

Adult↗
PubMed1995

Digital subtraction shoulder arthrography in determining site and size of rotator cuff tear.

RATIONALE AND OBJECTIVES: To evaluate the value of digital subtraction arthrographic techniques in assessing the precise size and site of rotator cuff tear. PATIENTS AND METHODS: Prospectively interpreted findings of 29 digital arthrographs were compared with results after surgery in 22 patients and with results after arthroscopy in 7 patients. RESULTS: Surgery or arthroscopy revealed 14 full-thickness and 2 partial-thickness tears. Digital subtraction arthrography showed 88% (14 of 16) of the rotator cuff tears, 86% (12 of 14) of the full-thickness tears, and 100% (2 of 2) of the partial-thickness tears. The site of a tear could be shown in 86% (12 of 14), but the size was evaluated to be less extensive than that seen at surgery in most tears (63%, 10 of 16). CONCLUSIONS: The site of tears could be demonstrated in supraspinatus tendon tears, but measurements of the size of the tears were accurate only in small full-thickness and in partial-thickness tears. Very anterior and posterior tears may not be diagnosed with this method, and postexercise films were necessary to avoid false-negative findings.

Adult↗
PubMed2005

Case reports: ossified mass of the rotator cuff tendon in the subacromial bursa.

Unlike calcification, ossification is infrequent in the rotator cuff. We describe the clinical, radiographic, and pathologic findings in 64-year-old man with an ossified mass arising from a calcified portion of the rotator cuff tendon within the subacromial bursa. Mechanical stress and ischemic events are possible causes of cartilage formation followed by endochondral ossification, producing a mass causing outlet impingement.

Acromion↗
PubMed1991

Full-thickness rotator-cuff tear. An analysis of results.

A retrospective review is reported on 68 patients with 72 full-thickness rotator-cuff tears treated surgically. Duration of symptoms before surgery averaged 18 months (range, one month to ten years). Tears of the rotator cuff were divided into small (12 shoulders), medium (26 shoulders), large (17 shoulders), and massive (17 shoulders). Rotator-cuff tears were repaired by use of a bony trough in 88% of patients. All patients were treated with decompression acromioplasty. In addition, an acromioclavicular arthroplasty was performed in 29 patients. Forty-seven men and 21 women with an average age of 58 years (range, 31-76 years) were followed for an average of 24 months (range, nine to 57 months). Excellent results are reported in 46 shoulders, good in 20, fair in four, and poor in two. The size of tear and duration of symptoms did not significantly affect results.

Adult↗
PubMed2001

Shockwave therapy under ultrasonographic guidance in rotator cuff calcific tendinitis.

OBJECTIVES: This is the first efficacy evaluation in patients with rotator cuff calcific tendinitis treated with shockwave therapy delivered using a dedicated extracorporeal lithotripter and ultrasonographic guidance. PATIENTS AND METHODS: Thirty-two patients with rotator cuff calcific tendinitis received shockwave therapy delivered using a lithotripter specifically designed for the musculoskeletal system (DORNIER EPOS ULTRA), under ultrasonography guidance (which is not part of the conventional procedure). The cumulative dose per patient was 1300 mJ/mm2 divided in two or three sessions. Three, six, 12, and 24 weeks after treatment, the patients were evaluated using a visual analog scale for pain, the ASES self-questionnaire, Constant's score, and plain radiographs. RESULTS: Improvements in the pain and self-questionnaire scores were noted in 36.6% of patients after 12 weeks and 55.1% after 24 weeks. Plain radiographs were changed in 26.6% of patients after 12 weeks (with complete clearance of the calcific deposits in 6.6%) and in 24.1% of patients after 24 weeks (complete clearance in 17.2%). CONCLUSION: These results seem less favorable than those reported with dedicated lithotripters and computed tomography guidance.

Activities of Daily Living↗
PubMed1994

Arthroscopically-assisted rotator-cuff repair.

We reviewed 44 patients with 44 full-thickness rotator-cuff tears at an average of 4.2 years after arthroscopically-assisted repair. There were 25 women and 19 men aged between 35 and 76 years (average 58); 35% of the shoulders had other intra-articular lesions. Most of the patients (85%) had been discharged from hospital immediately after the operation. The result was rated good or excellent in 84%, 88% of the patients were satisfied, and 64% of the athletes returned to their previous sports. The size of the tear was a determining factor in the outcome.

Adult↗
PubMed2005

Pathological Teres Major activation in patients with massive rotator cuff tears alters with pain relief and/or salvage surgery transfer.

BACKGROUND: Massive rotator cuff tears impose restraints on overhand arm functionality and are often accompanied by pain. After musculotendinous Teres Major transfer, overhand arm function is generally restored and pain is reduced. The assumed mechanical abduction insufficiency and Teres Major muscle function adaptation will be experimentally verified. METHODS: Principal Teres Major muscle activation (surface IEMG averaged over 3s) is recorded for 12-24 isometric and isotonic force directions perpendicular to the 60 degrees forward flexed humerus in three conditions: prior to surgery (n = 6 patients), prior to surgery and after subacromial anaesthetic (n = 6) and post-surgery (n = 3). Principal direction and on-, offset directions were estimated. FINDINGS: Teres Major activation adapts both to pathological and post surgery conditions: the normal activation during adduction changes into activation during forward flexion or abduction. Glenohumeral stabilisation, not abduction torque, seems to be the explanation for post surgery Teres Major transfer success. INTERPRETATIONS: The pathological absence of Supraspinatus and Infraspinatus forces during forward flexion result in increased upward glenohumeral instability. The superior translations are compensated for by Teres Major activity during forward flexion. This translation-'force' function conflicts with the adduction-generating rotation-'torque' function. This may explain the pain-induced reduction of arm elevation in these patients. Musculotendinous transfer solves the force-torque conflict by changing the moment arm of the Teres Major from adduction to abduction. Teres Major can now both compensate for the loss of Supraspinatus and Infraspinatus forces needed for glenohumeral stabilisation and contribute to forward flexion of the arm.

Biomechanical Phenomena↗
PubMed1997

Arthroscopic debridement and acromioplasty versus mini-open repair in the management of significant partial-thickness tears of the rotator cuff.

Treatment options for partial-thickness rotator cuff tears have included debridement and acromioplasty or open repair. The outcome of these two treatments has been difficult to assess from the literature. The results of a retrospective review of arthroscopic versus open treatment are reviewed with recommendations for a treatment algorithm.

Arthroscopy↗
PubMedDate not supplied

Arthroscopically assisted mini-open rotator cuff repairs. Functional outcome at 2- to 7-year follow-up.

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N = 19) were satisfied with the results of surgery and 95% (N = 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living.

Activities of Daily Living↗
PubMed2001

Pedicle island flaps of latissimus dorsi. Applications in surgical repair of ruptures of the rotator cuff.

There are considerable problems in repair of major ruptures of the rotator cuff tendons particularly those of the supra and infraspinatus mm. The Gerber technique only transfers the tendinous insertion of the latissimus dorsi onto the greater tuberosity in massive cuff ruptures. We have extended this approach. In 12 shoulders, we studied the feasibility of a latissimus dorsi transfer harvested to fit and bearing muscle and tendon detached at its two extremities and transposed as a neurovascular island. The muscular part is transferred to the infra or supraspinous fossae and the tendon to the greater tuberosity with the aim of reactivating the infra and supraspinatus muscles. The lateral bundle of the latissimus dorsi is always transferable on its neurovascular pedicle into the infraspinous fossa, even into the supraspinous fossa, or into both if transfer is used as a bilobed flap. This anatomical work allowed a parallel study of the different possibilities of transposing the neurovascular pedicle, which might limit the technique, and also to determine the most appropriate surgical approach.

Adult↗