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PubMedDate not supplied

[Rupture of the rotator cuff].

Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation in the shoulder joint. Both the classic technique of open surgery and the arthroscopic technique are employed to reconstruct the rotator cuff. This review tries to answer the question which of both surgical techniques is superior by a review of the literature. The recent literature demonstrates a shorter follow-up period for publications concerning arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results between 68 to 96%, open reconstruction between 77 and 91%. Longevity of reconstructed rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic technique was used. Several authors mentioned size of tear as a major factor influencing longevity. However in patients treated arthroscopically despite rerupture of the rotor cuff patient's satisfaction and clinical outcome is still very good in short-term follow-up. In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique seems to be superior. If large tears occur (two or three tendons) the open surgical technique may be more reliable with regard to longevity of the repair. For the future it seems necessary to obtain long-term results to be able to compare both principles of reconstruction of the rotator cuff. Furthermore these future studies should include quality of life scores as measurements tools besides the already employed parameters as size of the tear, age at surgery, patient satisfaction and outcome scores.

Arthroscopy↗
PubMed1994

MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm.

PURPOSE: To show the effectiveness of positioning the arm in abduction and external rotation (ABER) during magnetic resonance (MR) arthrography for depiction of tears of the rotator cuff. MATERIALS AND METHODS: Five throwing athletes with shoulder pain were prospectively imaged with standard MR imaging, MR arthrography, and ABER MR arthrography. The status of the rotator cuff was recorded; arthroscopic correlation was obtained. RESULTS: One partial tear of the distal infraspinatus tendon was detected with ABER MR arthrography only. One full-thickness tear was detected with both MR arthrography and ABER MR arthrography, but the component of the tear that extended into the infraspinatus tendon was depicted with ABER MR arthrography only. One partial tear was detected with both MR arthrography and ABER MR arthrography; no additional information was provided by either technique alone. CONCLUSION: The ABER position may be useful in detection and characterization of tears of the rotator cuff, especially partial tears of the undersurface. This information would be useful in selection of patients for conservative therapy, arthroscopy, or arthrotomy.

Adult↗
PubMedDate not supplied

Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears.

Patients with rotator cuff tears have varying degrees of symptom expression. Our purpose was to evaluate the differential firing patterns of the rotator cuff, deltoid, and scapular stabilizer muscle groups in normal control subjects and in patients with symptomatic and asymptomatic 2-tendon rotator cuff tears. Eighteen subjects were evaluated: six normal subjects and twelve with 2-tendon cuff tears (six asymptomatic and six symptomatic). All cuff tear patients had magnetic resonance imaging (MRI) scans documenting superoposterior tear configurations involving the supraspinatus and infraspinatus tendons; all normal subjects had an ultrasound examination confirming the absence of cuff pathology. Subjects were grouped based on shoulder examination and outcomes questionnaires. Asymptomatic patients had minimal pain (<3 on the visual analog scale and no loss of active range of motion compared with the contralateral side); symptomatic patients had pain greater than 3 on the visual analog scale and decreased range of motion compared with the contralateral side (>10 degrees of motion loss). Electromyographic activity from 12 muscles and kinematic data were collected simultaneously during 10 functional tasks. Both symptomatic and asymptomatic cuff subjects demonstrated a trend toward increased muscle activation during all tasks compared with normal subjects. During the internal rotation tasks, asymptomatic patients had significantly greater (P<.05) subscapularis activity than symptomatic patients (65% maximal voluntary contraction [MVC] vs 42% MVC). During the carrying task, asymptomatic patients demonstrated significantly less (P<.03) upper trapezius muscle activation than symptomatic patients (16% MVC vs 50% MVC). During shoulder elevation tasks, symptomatic patients had significantly greater supraspinatus (52% MVC vs 28% MVC, P<.03), infraspinatus (32% MVC vs 16% MVC, P<.05), and upper trapezius (39% MVC vs 20% MVC, P<.04) muscle activation compared with asymptomatic patients. During heavy elevation (8 lb), asymptomatic patients showed a trend toward increased activation (P<.06) of the subscapularis compared with symptomatic patients (34% MVC vs 21% MVC). Differential shoulder muscle firing patterns in patients with rotator cuff pathology may play a role in the presence or absence of symptoms. Asymptomatic subjects demonstrated increased firing of the intact subscapularis, whereas symptomatic subjects continued to rely on torn rotator cuff tendons and periscapular muscle substitution, resulting in compromised function.

Adult↗
PubMed2006

Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.

INTRODUCTION: Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS: A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS: Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION: The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS: Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.

Aged↗
PubMed2006

Magnetic resonance imaging of the rotator cuff interval.

The rotator cuff interval (RCI) is an important and anatomically complex region of the rotator cuff that is critically important to normal glenohumeral function. Recognition of common pathologies in this region on imaging examinations is especially important as injuries may be difficult to detect on clinical examination and even at arthroscopy. Familiarity with the magnetic resonance imaging appearance of the normal and abnormal RCI and the ability to convey findings to orthopedic and sports medicine referrers are essential to facilitate prompt creation of effective treatment plans.

Humans↗
PubMed1997

Evaluation and management of failed rotator cuff repairs.

Revision rotator cuff reconstruction should be based on the clinical problem, not the mere presence of a cuff defect. A functional deltoid is critical to the success of such surgery. Reconstructive procedures on the cuff include direct repair, interpositional grafting, and tendon transfers associated with an appropriate decompression. Decompression without repair-merely de bridement of the cuff-carries a significant risk of creating a severe functional loss and a poor outcome.

Acromion↗
PubMed2004

Interrater reproducibility of clinical tests for rotator cuff lesions.

BACKGROUND: Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use. OBJECTIVE: To study interrater reproducibility of standard tests for shoulder evaluation among a rheumatology specialist, rheumatology trainee, and research nurse. METHODS: 136 patients were reviewed over 12 months at a major teaching hospital. The three assessors examined each patient in random order and were unaware of each other's evaluation. Each shoulder was examined in a standard manner by recognised tests for specific lesions and a diagnostic algorithm was used. Between-observer agreement was determined by calculating Cohen's kappa coefficients (measuring agreement beyond that expected by chance). RESULTS: Fair to substantial agreement was obtained for the observations of tenderness, painful arc, and external rotation. Tests for supraspinatus and subscapularis also showed at least fair agreement between observers. 40/55 (73%) kappa coefficient assessments were rated at >0.2, indicating at least fair concordance between observers; 21/55 (38%) were rated at >0.4, indicating at least moderate concordance between observers. CONCLUSION: The reproducibility of certain tests, employed by observers of varying experience, in the assessment of the rotator cuff and general shoulder disease was determined. This has implications for delegation of shoulder assessment to nurse specialists, the development of a simplified evaluation schedule for general practitioners, and uniformity in epidemiological research studies.

Adult↗
PubMed1995

[In-vitro stability of rotator cuff repair techniques].

Rotator cuff repair techniques were examined in vitro. First, the mechanical properties of nine different tendon-grasping techniques were compared using 159 normal infraspinatus sheep tendons. The clinically most frequently used simple stitch and mattress suture failed at low-to-moderate loads (two stitches, 184 N and 269 N) with the sutures pulling out of the tendons. A modification of the Mason-Allen grasping technique improved the ultimate tensile strength to 359 N (two stitches) without allowing relevant gap formation. Augmentation with synthetic materials did not improve the mechanical properties of the tendon-grasping techniques tested. The mechanical properties of different anchoring techniques to bone were assessed using osteoporotic bone specimens with mechanical properties comparable to those of proximal humeri with long-standing cuff defects. Single as well as double transosseous suture fixation (139 N and 146 N) and suture anchor fixation (142 N) were weak. Tying the knots over a plate-like cortical bone augmentation device improved the failure strength to 329 N. Some of these data were presented in the English literature in 1994. Considering the excellent preliminary experience in the clinical application of the modified Mason-Allen grasping technique and cortical augmentation, it seemed appropriate to present them in German as well.

Animals↗
PubMedDate not supplied

Surgical and nonsurgical management of rotator cuff tears.

Although rotator cuff tears may be asymptomatic, symptomatic tears have had treatment varying from nonoperative therapy and debridement with subacromial decompression to operative repair. The benchmark for comparison should be nonoperative treatment when deciding to proceed to operative repair. This review will analyze the recent peer-reviewed publications describing results of operative repair, how this regimen differs with nonoperative treatment, and any outcome differences between operative and nonoperative treatment. Operative repair has consistently shown a higher rate of pain relief in patients (85%) and a better return of strength. Nonoperative treatment is expected to produce satisfactory relief of pain in only 50% of patients and no improvement in strength at long-term follow-up.

Arthroscopy↗
PubMed1986

Pitfalls of rotator cuff sonography.

Experience with rotator cuff sonography in 106 patients was analyzed to identify the causes of scan misinterpretation. Possible interpretive errors may be classified into four categories: those from failure to recognize normal anatomy, those caused by soft-tissue abnormalities, those caused by bony abnormalities, and those caused by technical limitations of the study. Errors in recognition of normal anatomy are easily overcome by experience and comparison to the normal, contralateral rotator cuff. Errors resulting from soft-tissue abnormalities were seen in two patients with calcific tendinitis simulating rotator cuff tears. Problems in interpretation resulting from fractures in two patients and inferior glenohumeral subluxation in two other patients could have been avoided by review of the plain films before performing sonography. The major technical limitation of the study arises from the inability to image the rotator cuff beneath the acromion. Fortunately, rotator cuff tears are rarely isolated in this location, and passive maneuvers often allow otherwise hidden parts of the cuff to be imaged.

Adolescent↗
PubMed1997

Biomechanics of the rotator cuff.

Thorough understanding of rotator cuff mechanics is important for effective treatment and/or prevention of cuff injuries. This understanding is achieved through knowledge of normal cuff structure and mechanics. Only then, can the effects of injuries and pathologic processes on normal cuff function be carefuly assessed. Rotator cuff structures are viewed and analyzed on a number of different levels. This article presents current knowledge of rotator cuff mechanics through review of cuff structure and anatomy, corocoacromial arch structure and biomechanics, and biomechanical models.

Acromion↗
PubMed1993

Arthroscopic management of rotator cuff disease.

The etiology of rotator cuff disease is controversial, but is not always secondary to cuff impingement between the humeral head and the coracoacromial arch. Rotator cuff disease, and not impingement syndrome, more accurately describes this process. The spectrum of rotator cuff disease begins with rotator cuff inflammation (Stage I) and progresses to tendinitis (Stage II) and partial or full thickness tears (Stage III). Refractory Stage II and III disease without rotator cuff tears undergoes subacromial bursectomy and acromioplasty. Partial thickness tears are debrided with an acromioplasty, bursectomy, and removal of inferior clavicular osteophytes. Full thickness tears are treated arthroscopically or open, depending on the tear size and the patient expectations. In general, tears from 0 to 5 cm in active patients undergo subacromial decompression and a mini-open repair. Low demand patients with 0 to 5 cm tears or tears greater than 5 cm are treated with subacromial decompression and rotator cuff debridement.

Acromion↗
PubMed1997

[The biceps-/rotator cuff-index in ultrasound diagnosis of chronic rupture of the rotator cuff].

PURPOSE: Diagnosis of old lesions of the rotator cuff is clinically and sonographically challenging. To improve the sonographic diagnosis of old rotator cuff tears the index was developed. METHOD: In a prospective study 100 patients were examined by ultrasound to evaluate standard measures of rotator cuff diameters in relation to the long biceps tendon. The compensating hypertrophy of the biceps tendon was sonographically quantified in relation to the rotator cuff diameter. RESULTS: The pathological study group included 50 patients with an old lesion of rotator cuff (> 3 months). The control group consisted of 50 patients without any lesions. Comparison of both groups revealed a significantly higher biceps/rotator cuff ratio (p < 0.05). Data higher than 0.8 represent a pathological ratio (Index positive), the standard is 0.5. The index is independent of sex and age. There are no significant index changes measurable in acute tears of the rotator cuff. CONCLUSION: The index helps to improve sensitivity in diagnosis of old rotator cuff tears by ultrasound.

Adult↗
PubMed2004

Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model.

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood. A rat model was used to investigate the supraspinatus tendon organizational and mechanical property changes that occur with time post-injury to understand the natural injury response in the absence of repair. It was hypothesized that increased time post-injury would result in increased detrimental changes to tendon organizational and mechanical properties. Tendons were detached at the insertion on the humerus without repair and the quantitative organizational and mechanical properties were analyzed at 1, 2, 4, 8, and 16 weeks post-detachment. Tendon detachment resulted in a dramatic decrease in mechanical properties initially followed by a progressive increase with time. The quantitative collagen fiber orientation results provided corroborating support to the mechanical property data. Based on similarities in histology and mechanical properties to rotator cuff tears in humans, the animal model presented here is promising for future investigations of the tendon's natural injury response in the absence of repair.

Animals↗
PubMed2003

[Classification of rotator cuff tears].

Classification of rotator cuff tears may yield useful information on diagnosis, treatment, prognosis, and evaluation of treatment results. The shape, localization, etiology, size, topography, pathology, and history of rotator cuff tears, together with the involvement of specific tendons in the occurrence of a tear may be of great value in the hand of expert interpreters. This article intends to give a brief description of rotator cuff tears by way of illustration.

Arthroscopy↗
PubMed2006

Expression of bioactive bone morphogenetic proteins in the subacromial bursa of patients with chronic degeneration of the rotator cuff.

Degeneration of the rotator cuff is often associated with inflammation of the subacromial bursa and focal mineralization of the supraspinatus tendon. Portions of the supraspinatus tendon distant from the insertion site could transform into fibrous cartilage, causing rotator-cuff tears owing to mechanical instability. Indirect evidence is presented to link this pathology to ectopic production and secretion of bioactive bone morphogenetic proteins (BMPs) from sites within the subacromial bursa. Surgically removed specimens of subacromial bursa tissue from patients with chronic tears of the rotator cuff were analyzed by immunohistochemistry and reverse transcription-PCR. Bioactive BMP was detected in bursa extracts by a bioassay based on induction of alkaline phosphatase in the osteogenic/myogenic cell line C2C12. Topical and differential expression of BMP-2/4 and BMP-7 mRNA and protein was found in bursa tissue. The bioassay of C2C12 cells revealed amounts of active BMP high enough to induce osteogenic cell types, and blocking BMP with specific antibodies or soluble BMP receptors Alk-3 and Alk-6 abolished the inductive properties of the extract. Sufficient information was gathered to explain how ectopic expression of BMP might induce tissue transformation into ectopic bone/cartilage and, therefore, promote structural degeneration of the rotator cuff. Early surgical removal of the subacromial bursa might present an option to interrupt disease progression.

Adult↗
PubMed1994

[Evaluation of the rotator cuff with magnetic tomography].

Rotator cuff tears are difficult to diagnose clinically, both in the acute and the chronic phase. Both conservative and surgical treatment give the best results if the injury is detected early. Magnetic resonance imaging (MRI) has recently been introduced for diagnoses of cuff tears. The purpose of this study was to establish the accuracy of MRI in relation to surgical findings in the same patient group. MRI was used in the diagnosis of 25 patients who later underwent surgery for injury to the rotator cuff. During the surgery, 19 total tears were identified, of which 15 had been described by MRI. MRI showed a sensitivity of 79% and a specificity of 83%. The predictive value of a positive test was 83%. In experienced hands, MRI is extremely accurate for detecting rotator cuff injuries, but ultrasonography should still be the first method of diagnosis in Norway, because of its accuracy when used by experienced practitioners, and its availability and low cost.

Adult↗
PubMed1997

Diagnosis of tears in rotator-cuff-injuries.

Pathology of the rotator cuff is the cause of most common problems at the shoulder joint. Acute injuries are not as frequent as chronic cuff disease, but often they aggravate inflammatory or degenerative tendon alterations, even if they are of minor severity. Traumatic rotator cuff tears predominantly affect the supraspinatus tendon or the rotator interval. The subscapularis tendon is involved in anterior dislocations of the glenohumeral joint or in direct trauma. Plain film radiography still remains the base of all further imaging studies. If only full-thickness tears must be ruled out, double-contrast arthrography and ultrasound are acceptable imaging modalities. However, the former has a drawback in being invasive and does not detect partial tears at the bursal site of the cuff or rotator cuff tendinopathy, whereas the latter heavily depends on the experience of the radiologist and is restricted to the rotator cuff. Nowadays the most comprehensive imaging method is magnetic resonance (MR) imaging. MR imaging enables the detection or exclusion of complete rotator cuff tears with a reasonable accuracy and is also suitable to diagnose further pathologies of the shoulder joint. MR arthrography is valuable in the detection of subtle anatomic details and further improves the differentiation of rotator cuff diseases. Although in comparison MR imaging is still the most expensive imaging method, its high negative predictive value for the diagnosis of complete rotator cuff tears and its reliability evaluating different shoulder joint pathologies make it the preferred imaging modality.

Humans↗