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PubMed2004

Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors.

INTRODUCTION: The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. MATERIALS AND METHODS: Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent arthroscopy by a single surgeon. The preoperative diagnosis was based on the clinical examination and MRI. Their mean age was 69 years (range 62-79 years), and the average follow-up was 31 months (range 24-46 months). If indicated, the performed arthroscopic debridement included acromioplasty, debridement of the cuff, resection of the distal part of the clavicle or tenotomy of the long head of the biceps. In 28 cases (85%) acromioplasties and in 6 cases (18%) biceps tenotomies were performed, 2 of which were a single tenotomy without any associated acromioplasty. One patient had been managed with concomitant resection of the distal part of the clavicle. RESULTS: The Constant and Murley Score improved by a mean of 30 points, from a mean of 37 points (range 21-52) preoperatively to a mean of 67 points (range 31-82) at the time of follow-up. Some 82% of the patients were satisfied with the procedure. The result was considered unsatisfactory because of inadequate pain relief in 4 shoulders, because of limited active abduction in 1 and because of limited external rotation in 1. A poor outcome was associated with a complete tear of the subscapularis tendon in 6 patients. The radiological study showed no significant narrowing of the subacromial space. CONCLUSION: Our early results suggest that arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands. However, its long-term consequences remain to be evaluated by studies with lengthy follow-up. Prognostic factors that may lead to a negative outcome are preoperative superior migration of the humeral head, presence of subscapularis tear, presence of glenohumeral arthritis and decreased range of motion.

Acromion↗
PubMed1992

A quantitative histological study of the vascularity of the rotator cuff tendon.

Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture.

Aged↗
PubMedDate not supplied

Responsiveness of self-report scales in patients recovering from rotator cuff surgery.

A consecutive series of patients (n = 149) completed 4 self-reporting scales (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire; Simple Shoulder Test [SST]; Western Ontario Rotator Cuff [WORC] questionnaire; and Short Form 36 [SF-36]) during the week before rotator cuff repair and 6 months after surgery. Patients were divided into 3 groups: those who had a positive response on all 3 upper extremity scales (n = 86) were classified as positive responders, those who did not demonstrate a consistent direction of response across scales were labeled as equivocal responders (n = 36), and those with a negative response across all 3 scales were labeled as negative responders (n = 15). Standardized response means (SRMs) were calculated. The WORC questionnaire (SRM, 2.0) and SST (SRM, 1.8) were most responsive to detecting improvement, followed by the DASH questionnaire (SRM, 1.6). The SF-36 was least responsive, with the largest effect on health being noted in the SF-36 subscale on bodily pain (SRM, 1.1). Pearson correlations indicated moderate associations between change scores across upper limb scales (r = 0.68-0.72) and lower associations with SF-36 physical summary scores (r = 0.40-0.50). Mental health scores were lower at baseline and changed more negatively in patients who did not have a positive response to surgery. No best scale can be identified at this time.

Female↗
PubMed1998

Glenohumeral osteoarthritis following a "color test" during rotator cuff repair. A case report and a review of the literature.

A case of glenohumeral osteoarthritis in a 35-year-old female following a color test during rotator cuff repair is described. The patients had a tear in the rotator cuff involving the supraspinatus muscle and rotator interval. A color test with a 0.4% aqueous solution of gentian violet was performed during the operation and the ruptured cuff was not tightly sutured. The patient developed glenohumeral osteoarthritis 25 months postoperatively. Plain film radiographs showed joint space narrowing and bone sclerosis of the humeral head, but there was no evidence of osteophytes. This pathology was thought to have been caused by the aqueous gentian violet solution.

Adult↗
PubMed2004

Glenoid version and rotator cuff tears.

The purpose of this study was to determine the relationship between rotator cuff (RC) tear and the orientation of the glenoid. Ninety-six shoulders (94 patients) that underwent open RC repair were grouped according to the type of tear. We measured on MRI the acromio-glenoid angle (AG) and the supraspinatus fossa glenoid angle on the anterior-posterior (SGAP) and axial (SGAX) views. RC patients had a smaller AG angle (76+/-7 degrees vs. 86+/-10 degrees ) and a larger SGAP angle (112+/-6 degrees vs. 102+/-7 degrees ) compared to controls (p<0.001). We also found a highly significant difference (p<0.001) in glenoid version measured by SGAX between anterior cuff tears (-5+/-4 degrees ) and posterior cuff tears (3+/-3 degrees ). Furthermore, we identified an association between RC tear and the orientation of the glenoid relative to the axis of the supraspinatus fossa. Greater retroversion is predictive of an anterior cuff injury and greater anteversion is predictive of a posterior cuff injury.

Humans↗
PubMed1993

Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study.

This study analyzes the midterm follow-up results of 40 full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and debridement. Patients were selected for this prospective study based on a variety of factors, including physiologic age, handedness, activity level in occupation or avocation, and preoperative estimate of repairability. Patients were divided into three groups based on the size of the tear as measured during surgery; results were evaluated on the UCLA shoulder rating scale. This study emphasizes the importance of patient selection when applying arthroscopic treatment for full-thickness rotator cuff tears. Small (0-2 cm) tears (n = 10) in older individuals not involved in strenuous activities did well (90% satisfactory). Patients with larger (2-4 cm) repairable tears (n = 8) did poorly (50% satisfactory) in comparison with our previous study of the results of open repair (84% satisfactory). Arthroscopic treatment in patients with massive, irreparable tears (n = 22) did not restore lost strength or range of motion, but there was significant pain relief, and 86% were satisfied with the results on a limited-goals basis. The study concludes that with proper patient selection, arthroscopic treatment has a valuable, but limited, role in the treatment of full-thickness rotator cuff tears.

Aged↗
PubMed1993

Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome)

OBJECTIVE: To compare the effectiveness of arthroscopic surgery, a supervised exercise regimen, and placebo soft laser treatment in patients with rotator cuff disease (stage II impingement syndrome). DESIGN: Randomised clinical trial. SETTING: Hospital departments of orthopaedics and of physical medicine and rehabilitation. PATIENTS: 125 patients aged 18-66 who had had rotator cuff disease for at least three months and whose condition was resistant to treatment. INTERVENTIONS: Arthroscopic subacromial decompression performed by two experienced surgeons; exercise regimen over three to six months supervised by one experienced physiotherapist; or 12 sessions of detuned soft laser treatment over six weeks. MAIN OUTCOME MEASURES: Change in the overall Neer shoulder score (pain during previous week and blinded evaluation of function and range of movement by one clinician) after six months. RESULTS: No differences were found between the three groups in duration of sick leave and daily intake of analgesics. After six months the difference in improvement in overall Neer score between surgery and supervised exercises was 4.0 (95% confidence interval -2 to 11) and 2.0 (-1.4 to 5.4) after adjustment for sex. The condition improved significantly compared with placebo in both groups given the active treatments. Treatment costs were higher for those given surgery (720 pounds v 390 pounds). CONCLUSIONS: Surgery or a supervised exercise regimen significantly, and equally, improved rotator cuff disease compared with placebo.

Adolescent↗
PubMed1989

The influence of distal clavicle resection and rotator cuff repair on the effectiveness of anterior acromioplasty.

Anterior acromioplasty, described by Neer in 1972, is generally accepted as the procedure of choice for symptomatic subacromial impingement. Subsequent authors have written little about the prolonged length of postoperative rehabilitation, residual strength deficits, and the effect of the addition of a distal clavicle resection and/or rotator cuff repair. The authors reviewed 50 patients with late Neer Stage II and Stage III impingement lesions who were treated with anterior acromioplasty. In addition to the acromioplasty, 13 shoulders had a distal clavicle resection, nine had a rotator cuff repair, and ten had a distal clavicle resection and rotator cuff repair. The average patient age was 53 years (range, 36-70 years), and the average duration of symptoms was 43 months. Overall, 92% of the patients were graded as good or excellent on the basis of pain relief, strength, range of motion, and ability to resume full activity. Prolonged rehabilitation was noted in all groups, averaging 8.5 months; however, patients with a distal clavicle resection and rotator cuff repair required a 25% longer rehabilitation before full activity was obtained. A residual strength deficit was also noted in 70% of the patients requiring cuff repairs versus 50% in the patients with intact cuffs. Pain relief was equally obtained in all groups.

Acromioclavicular Joint↗
PubMedDate not supplied

The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life.

The purposes of this study were to determine the reliability of strength and self-reporting measures, the relationship of different strength measures to function, and the impact of rotator cuff pathology on patients' quality of life. Patients with nonoperated rotator cuff pathology (n = 36) and unaffected control subjects (n = 48) were assessed by use of the LIDO dynamometer to determine isometric and isokinetic (concentric and eccentric) strength of the shoulder rotators. The Shoulder Pain and Disability Index and Short Form-36 were self-reported by patients. Intraclass correlation coefficients (ICCs) were used to assess reliability, and Pearson correlations and multiple linear regression were used to determine the relationship between strength and function. The findings of this study include the following: (1) measures of self-reported physical disability had high reliability (ICC = 0.89); (2) the LIDO dynamometer reliably measured internal and external shoulder rotation strength in both concentric and isometric modes of testing (ICC = 0.78-0.94), whereas eccentric muscle actions had lower reliability; (3) all shoulder rotation strength measures were predictive of disability, with isometric external rotation strength being the most predictive (r = 0.56); and (4) the presence of rotator cuff pathology was highly predictive of impaired physical health quality of life (R(2) = 0.71, P < .001).

Adult↗
PubMedDate not supplied

Shoulder function after surgical repair of rotator cuff tears.

Shoulder function was assessed in 37 patients with a mean age of 57 years after acromioplasty and repair of full-thickness rotator cuff tears were performed. The cuff tears were closed without transfer of other muscles or use of synthetic materials. At review 2 years after surgery 32 patients had significant pain relief and improved shoulder function. Range of motion, muscle strength, and endurance were increased. The mean Constant score was 77, and 80% of the patients were graded as having mild or disability. Radiographic measurements disclosed an increased supraspinatus outlet area after surgery. It is concluded that in patients with impingement syndrome and a full-thickness rotator cuff tear, shoulder function will be improved after acromioplasty and cuff repair, but a slight decrease in range of motion and muscle strength will remain when compared with the contralateral side.

Adult↗
PubMed1992

[MR imaging of rotator cuff tears].

A total of 115 patients with clinical symptoms and signs suggesting rotator cuff tears underwent MR imaging with a 1.5-Tesla system. The body coil was used as the receiver coil in 24 patients and a single 10 cm surface coil in 91. Arthrography or MR imaging with intra-articular Gd-DTPA (MR arthrography) was performed in 95 of the 115. T2-weighted images with the body coil showed high signal intensity lesions in rotator cuffs in only seven of the 10 patients who had tears demonstrated by arthrography or MR arthrography. On the other hand, T2-weighted images with the surface coil demonstrated high signal intensity lesions in cuffs in all 27 patients who were diagnosed to have tears by arthrography or MR arthrography. In 12 patients, T2-weighted images with the surface coil showed high signal intensity lesions in cuffs, while arthrography and MR arthrography did not show tears. Surgery was performed in four of the 12 patients and partial tears were confirmed. A single 10 cm surface coil, 3 mm slice thickness and 2.5 second repetition time seem to account for the fine visualization of cuff tears by the T2-weighted images. These results suggest that T2-weighted images obtained with the surface coil are superior to arthrography and MR arthrography.

Adult↗
PubMed1995

[MRI of the rotator cuff: evaluation of a new symptomatologic classification].

The different classifications use for the rotator cuff pathology seem to be incomplete. We propose a new classification with many advantages: 1) Differentiate the tendinopathy between less serious (grade 2A) and serious (grade 2B). 2) Recognize the intra-tendinous cleavage of the infra-spinatus associated with complete tear of the supra-spinatus. 3) Differentiate partial and complete tears of the supra-spinatus. We established this classification after a retrospective study of 42 patients operated on for a rotator cuff pathology. Every case had had a preoperative MRI. This classification is simple, reliable, especially for the associated intra tendinous cleavage.

Female↗
PubMed1997

Prediction of rotator cuff repair results by magnetic resonance imaging.

Thirty chronic rotator cuff tears were repaired consecutively and evaluated prospectively using a precise anatomic description of the tear that included the rotator interval, the Constant functional score, and an assessment of the tendon state and the atrophy of the supraspinatus muscle by preoperative and postoperative magnetic resonance imaging. Early correlations (mean followup, 21.1 months) attempted to define predictive factors of the final outcome of the repair, physical factors indicative of final tendon state, and postoperative evolution of supraspinatus atrophy. Magnetic resonance imaging oblique sagittal views showed that supraspinatus atrophy correlated with the sagittal and coronal extent of the tear and represented a strong predictive factor of postoperative retearing. At followup, 15 (50%) cuffs were continuous and thick, seven (23%) were continuous but thin, and six (20%) were retorn. Two (7%) cuffs had been repaired only partly. In the group with a persistent tear, flexion strength and differential Constant score were correlated with the final tendon state with no excellent or good results, and with less than 4 kg of strength. Supraspinatus atrophy improved in 18 of the 22 postoperative continuous cuffs, but never decreased in persistent tears, although there was pain relief and functional gain.

Adult↗
PubMed2002

Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results.

PURPOSE: To determine the characteristics of horizontal components of partial-thickness tears of the rotator cuff at magnetic resonance (MR) arthrography and to determine whether use of the abduction and external rotation (ABER) position improved detection of a horizontal component in partial-thickness tears. MATERIALS AND METHODS: MR studies in 16 patients (mean age, 32 years) who had partial-thickness tear with a horizontal component were retrospectively evaluated. All 16 patients had undergone arthroscopic surgery. The depth and extent of the horizontal component were measured on MR images, and the presence or absence of articular surface tear was recorded. The characteristics of the horizontal component on ABER views were compared with those on oblique coronal views. RESULTS: A horizontal component (24 lesions; one tendon involved in eight patients and two tendons involved in eight patients) was observed in 100% of the lesions on ABER views and in 21% of the lesions (n = 5) on oblique coronal images. The mean length of the horizontal components, measured on ABER views, was 1.9 cm (range, 0.6-4.5 cm). Thirteen (54%) of the 24 lesions were classified as grade I (<3 mm) in depth, four (17%) were classified as grade II (3-6 mm), and seven (29%) were classified as grade III (>6 mm). Articular separation sites with a flap lesion were visualized in 15 (62%) of 24 lesions on ABER views. CONCLUSION: MR arthrography of the shoulder with patients in the ABER position may provide additional information in cases of partial-thickness tears of the rotator cuff with a horizontal component.

Adult↗
PubMed1998

Rotator cuff repair during shoulder arthroplasty in rheumatoid arthritis.

A prospective study of 40 shoulder arthroplasties in patients with rheumatoid arthritis was performed to evaluate the results of rotator cuff repair at the time of arthroplasty. A large cuff tear was present in 21 shoulders, and good repair of the cuff was performed in 9. In the other shoulders the repair was considered insufficient. All patients were clinically evaluated using the Hospital for Special Surgery 100-point scoring system. The minimum follow-up period for inclusion in this study was 2 years. The quality of the repair of the ruptured cuff at the time of surgery had a significant influence on the postoperative clinical score (linear regression model, P = .002). The clinical score of the shoulders with good repair of the rotator cuff improved considerably and continued to improve even after the first-year follow-up examination. Meticulous repair of the ruptured cuff at the time of arthroplasty is recommended.

Adult↗
PubMed1993

Rotator cuff: evaluation with fat-suppressed MR arthrography.

Thirty-seven shoulders with rotator cuff diagnoses proved at arthrography, arthroscopy, or open surgery were examined prospectively with magnetic resonance (MR) arthrography. T1-weighted MR images were obtained with and without fat suppression after intraarticular injection of gadopentetate dimeglumine. Without fat suppression, overall accuracy was 84%. False-positive full-thickness tears were diagnosed in three patients who were proved to have partial tears. False-negative normal tendons were diagnosed in two patients who had partial tears. The corresponding sensitivity and specificity were 90% and 75%, respectively. With the aid of fat-suppressed imaging, full-thickness and partial cuff tears were identified with 100% sensitivity and specificity. Fat-suppressed images also showed intratendinous contrast material imbibition in three torn cuffs with frayed, friable tendon margins. Fat suppression in MR arthrography is valuable in the differentiation of partial from full-thickness cuff tears and in the detection of small partial tears of the inferior tendon surface.

Adolescent↗
PubMed1988

Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results.

The surgical pathology and clinical results of 78 reconstructions of chronic rotator cuff tears were reviewed retrospectively. The predominant complaint preoperatively was chronic pain with impaired shoulder function, resistant to repeated conservative treatment. Results according to a functional assessment were excellent or satisfactory in 71% of the patients, unsatisfactory in 12%, and failed in 17%. Relief of pain including night pain and pain with activity was obtained. Surgery should include a thorough exploration of the rotator cuff and the adjacent tissues. Accompanying problems, including biceps tendon disorders or impingement factors, must be recognized and treated at the time of the reconstruction procedure. Repair of the torn rotator cuff and treatment of concomitant lesions are effective operative procedures when symptoms are persistent and fail to respond to conservative treatment.

Adult↗
PubMed1981

Intra-articular steroids in the treatment of rotator cuff tear: reappraisal by arthrography.

Previous studies have cast doubt on the efficacy of intra-articular steroids in the treatment of rotator cuff tears. This investigation re-evaluated the question, using shoulder arthrography both to substantiate the diagnosis of rotator cuff tear and to assure accurate intra-articular injection of steroid. Successful results followed in 13/15 patients so treated. Intra-articular steroid administration is appropriate therapy for rotator cuff tear providing the steroid is properly injected into the shoulder joint cavity.

Adult↗