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PubMedDate not supplied

Transplant of the teres major in the treatment of irreparable injuries of the rotator cuff (long-term analysis of results).

Purpose of this study is to evaluate the effectiveness of muscle transfer of the teres major in the treatment of irreparable posterosuperior injuries of the rotator cuff. Long-term monitoring of the results obtained in 20 patients treated at our clinic using this method are reported, comparing the data obtained in evaluations of results with preoperative values. Clinical evaluations were obtained using the Constant Score System, while X-ray examination showed the presence of osteoarticular modifications, and MRI and electromyography the preserved morphology and function of transplant. The mean Constant Score increased from 31.6 points preoperatively to 66.1 points postoperatively at the time of follow-up. At follow-up, MRI allowed us to evaluate any fatty degeneration of the muscle fibers of transfer and the integrity of tendinous insertion on the humeral greater tuberosity. The obtained results allowed us to reveal the advantages and the disadvantages of teres major transplant in irreparable posterosuperior ruptures of the cuff.

Adult↗
PubMedDate not supplied

The acromion-splitting approach for large and massive rotator cuff tears.

A retrospective review of 42 patients in whom a rotator cuff injury was diagnosed and who subsequently underwent surgery with the superior acromion-spitting approach technique was conducted. The average size of the tear was 4.2 cm with an average tear retraction of 4.1 cm. Thirty-seven (38 shoulders) of the 42 patients underwent a physical examination, interview, and radiographs at an average followup of 33.4 months (range, 15 to 66). Using the University of California, Los Angeles Shoulder Rating Scale, 27 shoulders were graded as excellent or good, and 11 shoulders were graded as fair or poor. Radiographic examination demonstrated bony union in 29 shoulders. The remaining 9 shoulders had evidence of fibrous union that could be characterized as clinically asymptomatic. Twenty patients had computed tomography scans that demonstrated decompression where the bony or fibrous union had occurred. In addition, some increased decompression in several patients with fibrous union indicated that the anterior acromion sought its appropriate level. Based on the results of this study, the acromion-splitting approach, used as an extension of the miniapproach for rotator cuff tears, can be successfully used when a large or massive rotator cuff tear is identified.

Acromion↗
PubMedDate not supplied

The magic-angle effect of the supraspinatus tendon.

CONTEXT: Rotator cuff injuries are common and result in either a tear or tendinopathy within the distal portion of the supraspinatus tendon. Magnetic resonance (MR) imaging shows the injury as a high signal region within the distal tendon. Similarly, a magic-angle effect also appears within healthy patients in this same region on T1- or proton density (PD)-weighted MR sequences. OBJECTIVE: This study was conducted to evaluate the prevalence of the magic-angle effect found with MR imaging within the supraspinatus tendon. METHODS: In this study, 300 consecutive patients were selected from those symptomatic patients referred for MR evaluation of the shoulder using a 1.5T unit and both PD and T2-weighted sequences. To eliminate patients with a real injury, the written reports were reviewed; those with positive findings for injury to the supraspinatus tendon were eliminated from the sample group, leaving 164 patients. Two radiographers independently examined the oblique coronal images nearest the center of the supraspinatus tendon and compared the signal on PD and T2-weighted images. Images found to have a higher signal with the PD sequence were classified as having the magic-angle effect since a real injury would be more likely to have a strong signal on T2-weighted images. RESULTS: Of the 164 patients evaluated, both reviewers found the same 8 patients to have the magic-angle effect. SUMMARY: Based on these results, our study suggests the artifact will appear in 5% of healthy patients and may lead to false-positive results on oblique coronal PD-weighted images through the supraspinatus tendon. In comparison with previous studies that have shown a much greater incidence rate, our findings also suggest that external rotation of the arm greatly reduces the incidence of the magic-angle effect.

Adult↗
PubMedDate not supplied

Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs.

Surgical reconstructions of anterior-inferior shoulder instabilities and rotator cuff injuries require secure fixation of soft tissue to bone. Sutures are inserted directly through transosseous tunnels in current techniques, which are surgically complex and not always adequate for fixation strength. Using fresh-frozen cadaveric human specimens, our objectives were 1) to compare immediate pull-out strength of two versions of polyacetal suture anchors (wedge and rod) with conventional suture-only attachment techniques in Bankart lesion and rotator cuff repairs, and 2) to compare pull-out strength of the two polyacetal suture anchors with a metallic suture anchor. Our results indicate no significant differences in fixation strength of Bankart lesions or rotator cuff repairs using sutures only, or using wedge or rod polyacetal suture anchors (P = 0.70). Pull-out force did not differ significantly (P = 0.37) between the two polyacetal anchors. Polyacetal anchors exhibited higher pull-out forces than metallic anchors when inserted into metaphyseal regions of the tibia and significantly higher pull-out forces (P < 0.001) when inserted into metaphyseal regions with thicker cortical walls. Our results indicate that both polyacetal suture anchors provide adequate immediate fixation for soft tissue repairs in the human shoulder.

Acetals↗
PubMed2000

Posterior shoulder dislocation: avoiding a missed diagnosis.

Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.

Accidental Falls↗
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↗
PubMedDate not supplied

Clinical and ultrasound results after arthroscopic repair of the rotator cuff.

The literature reports good functional results obtained with arthroscopic repair of the rotator cuff, but the incidence of anatomical healing has not been sufficiently studied. Ultrasound examination makes it possible to accurately document the healing process of the tendon at the bone, gathering information that may be useful in a comparison with clinical data. A total of 43 consecutive arthroscopic repairs of rotator cuff injuries were considered, that had made use of anchors and non-resorbable suturing. A total of 42 patients were willing to undergo clinical monitoring with an associated ultrasound examination after 3, 6 and 12 months. When ultrasound examination after 6 and 12 months was carried out, 36 patients presented with anatomical healing of the rotator cuff. The total percentage of repair failures was 14.3% and increased to 23% if we take into consideration the subscapular tendon alone. Constant score went from a preoperative mean of 51.25 to a mean of 78.21 after 12 months (p<0.001). Arthroscopic repair of the rotator cuff leads to anatomical healing of the tendons in a high percentage of cases, obtaining good functional results. The absence of healing is associated with lower values for recovery of strength at clinical follow-up. The advanced age of the patients (p<0.001) and the extensive injuries that involve several tendons (p=0.002) are negative prognostic factors.

Adult↗
PubMed1988

Shoulder impingement syndrome: MR findings in 53 shoulders.

The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred. In an attempt to determine if MR can be used to depict the abnormalities associated with impingement syndrome (subacromial bursitis, supraspinatus tendinitis, and rotator cuff tear), we reviewed 107 MR scans of painful shoulders. Changes consistent with impingement syndrome were found in 53 patients (50%), 32 of whom underwent subsequent arthrography or surgery. MR was found capable of depicting several soft-tissue and bony abnormalities that have been clinically described in impingement syndrome. In regions of inflammation, we found that the supraspinatus tendon and/or the subacromial bursa were compressed by spurs (25 shoulders), capsular hypertrophy of the acromioclavicular joint (six shoulders), and/or low-lying acromion (14 shoulders). While T1-weighted MR imaging was highly sensitive to abnormalities of the supraspinatus tendon, tendinitis could be differentiated from a small tear of the supraspinatus tendon only with T2-weighted imaging. Large, full-thickness tears, especially if chronic, produced characteristic MR findings on both T1- and T2-weighted images. We conclude that MR can be used to detect several abnormalities associated with the shoulder impingement syndrome.

Bursitis↗
PubMed1981

Suprascapular nerve injury following trauma to the shoulder.

Four cases of suprascapular nerve injury following various types of trauma are reported. This nerve is subject to damage where it passes through the suprascapular notch. Initially, main complaints are vague shoulder area pain, weakness in shoulder abduction and external rotation, followed by atrophy of the shoulder girdle muscles innervated by the suprascapular nerve. Electromyography confirms the diagnosis. The literature was reviewed for possible mechanisms of the suprascapular nerve injury, which should not be confused with cervical radiculopathy, brachial plexopathy, or rotator cuff injury. Early active and passive range of motion exercises are recommended, to retard muscle atrophy and prevent secondary joint problems. If regeneration does not occur, surgical exploration should be considered.

Adult↗
PubMed1996

Rotator cuff disorders.

The supraspinatus, infraspinatus, teres minor and subscapuĺaris muscles form a musculotendinous rotator cuff that provides dynamic stability to the shoulder joint. Symptoms of rotator cuff injury include limitation of motion, weakness and pain that often radiates down the upper arm and is present at night. Examination may reveal deltoid and rotator cuff atrophy, tenderness, limited passive range of motion and weakness on abduction and external rotation. Radiographs may show degenerative changes of the acromion or acromioclavicular joint, cysts, sclerosis and spurs of the greater tuberosity, and calcific deposits within the supraspinatus tendon. In most patients with subacromial impingement, conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs and subacromial injections, is successful. Failure of conservative therapy after six to 12 weeks merits further evaluation with magnetic resonance imaging or arthrography, and consideration of surgery.

Humans↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed1996

Operative release of the impingement syndrome. Indication, technique, results.

We examined the long-term results of two different methods of shoulder decompression (Neer acromioplasty and resection of the coracoacromial ligament) after an average observation period of 8 years. Clinical and radiological features were evaluated in 48 patients with 50 treated shoulders, as was the subjective result of the treatment in 58 patients with 61 operated joints. Pain was substantially eased in 93% (acromioplasty) and 100% (ligamentary resection), mobility improved in 76% and 83%, respectively. A favourable result was achieved in 86% of the acromioplasty cases and in 75% of the ligament resection cases. In one-third of the shoulders, an increasing degeneration of joint structures could be demonstrated radiologically; the degree depended on the severity of the initial rotator cuff injury, not on the method of shoulder decompression. The differences between both surgical methods examined were not statistically significant, but acromioplasty provides a superior extension of the subacromial space and protection for the reconstructed rotator cuff tendons. Our results compare favourably with other published studies. The methods described are suitable for the treatment of subacromial impingement.

Activities of Daily Living↗
PubMed2002

Effect of rotator cuff exercise on humeral rotation torque in healthy individuals.

Conservative management of rotator cuff pathology often involves certain therapeutic exercises. Although a major goal of these exercises is to increase strength of the rotator cuff, little empirical evidence supports this assertion. In this study, 34 nonpathologic young adults were pretested using a LIDO Multijoint II isokinetic device for average and peak torque generated during internal and external rotation. Subjects were arbitrarily assigned to a right-arm- or left-arm-trained group, exercised for 4 weeks, and then posttested for changes in humeral rotation torque. Moderate but significant increases in torque (8-10%) as well as in total work done were observed in both groups, only in the trained arm. Subjects who trained the nondominant (left) arm experienced gains similar to those who trained the right arm. Gains were significant in the case of both internal and external rotation (also average as well as peak torque), with men and women experiencing the same relative increases. These data, in addition to supporting the use of selected exercises to increase humeral rotation torque in a healthy population, offer a potential model for the rehabilitation of patients with rotator cuff injury.

Adult↗
PubMed1985

Anterior dislocation of the shoulder in patients over 50 years of age.

Six patients over 50 years of age were treated and followed for traumatic, first-time anterior dislocation of the shoulder. Early post injury examination following the subsidence of acute pain due to the injury demonstrated passive motion that exceeded active motion. Later follow up, however, revealed that active motion was equal to passive motion. The author concludes that these patients injured their rotator cuffs at the time of the shoulder dislocation and that such rotator cuff injuries healed satisfactorily without surgical repair.

Aged↗
PubMed1993

[Echography in diseases of the rotator cuff].

The diagnostic accuracy of shoulder US was investigated in 69 patients with a "painful shoulder" and the results compared with those of MR imaging. In our experience, US exhibited 95% sensitivity, 69% specificity, 83% positive predictive value, 90% negative predictive value and 85% accuracy. The analysis of the single US patterns proved the difficult distinction of small tears from focal tears, whereas complete ruptures were always easy to identify. In summary, all cases of rotator cuff degeneration or tear were always detected but not always correctly identified. False negatives on US included inflammatory processes of cuff structures but never ruptures or degenerations. Therefore, in our diagnostic protocol, US appeared to be a valuable screening method in the exclusion of rotator cuff injuries; other imaging techniques--i.e., arthrography, MR imaging, arthroscopy--were employed only in questionable/positive cases on US.

Adult↗
PubMed2005

Complications associated with the use of corticosteroids in the treatment of athletic injuries.

BACKGROUND: The potent anti-inflammatory pharmacologic effects of the corticosteroids (cortisone and synthetic derivatives) has led to their extensive usage in the management of rheumatologic diseases and athletic musculoskeletal injuries. The efficacy and risks of locally injected or systemically administered corticosteroids in the treatment of athletic injuries are unclear. OBJECTIVE: To review critically the medical literature and determine complications and risks associated with corticosteroid treatment of athletic injuries. DATA SOURCES: A search of 3 databases-MEDLINE, CINAHL, and Cochrane Clinical Trial Register-was performed using the OVID interface for all years between 1966 and 2003. The search first combined all references under the medical subject headings adrenal cortex hormones, glucocorticoids, and glucocorticoids, synthetic. A second search combined all references under the medical subject headings athletic injuries, sprains and strains, tendon injuries, shoulder injuries, rotator cuff disease, tennis elbow, and lateral epicondylitis. The references identified by these 2 searches were intersected and limited to human only to produce 130 articles. Relevant review articles were scanned, references reviewed, and additional articles retrieved for consideration of inclusion. STUDY SELECTION: For inclusion in this critical review, articles must meet the following criteria: (1) subjects were human, (2) subjects had athletic-related injuries, and (3) subjects received corticosteroid treatment. Ultimately, 43 studies met inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Selected articles were then categorized as to whether the primary focus was usage/efficacy of corticosteroid injection therapy, occurrence of complications of corticosteroid injection therapy, or usage or complications of systemic corticosteroid therapy. MAIN RESULTS: Twenty-five selected studies primarily examined the usage/efficacy of corticosteroid injections in the treatment of various athletic injuries. Of the 983 total subjects who received corticosteroid injections among these studies, only minor complications of treatment were reported. Eighteen selected studies primarily described complications of corticosteroid injections in the treatment of athletic injuries. Of these, tendon and fascial ruptures were the predominant complications reported. The search identified no articles that addressed the usage of or complications of systemic corticosteroids in the treatment of athletic injuries, although tibial stress fracture and multifocal osteonecrosis occurred in individuals being treated for nonathletic injury conditions. CONCLUSIONS: This critical review reveals that the existing medical literature does not provide precise estimates for complication rates following the therapeutic use of injected or systemic corticosteroids in the treatment of athletic injuries. Tendon and fascial ruptures are often reported complications of injected corticosteroids, whereas tibial stress fractures and multifocal osteonecrosis were described with systemic corticosteroids.

Administration, Oral↗
PubMed1998

Shoulder impingement syndromes.

OBJECTIVE: Not all shoulder pain conditions are a consequence of rotator cuff injuries secondary to anterior subacromial impingement. Additional causative forms have been identified and classified as posterosuperior glenoid rim, subcoracoid and suprascapular nerve (at spinoglenoid notch) impingement syndromes. MATERIAL AND METHODS: We reviewed 206 consecutive magnetic resonance examinations carried out with conventional T1- and T2-weighted spin-echo and gradient-echo sequences in patients complaining of shoulder pain. Adjunctive sequences were acquired with the involved arm positioned in abduction and external rotation. RESULTS: Anterior subacromial impingement is only one of the possible causes of shoulder disorders. Posterosuperior glenoid rim impingement is the most frequent cause of shoulder pain in young throwers. Subcoracoid and spinoglenoid notch suprascapular nerve impingement are additional forms that must be considered in the differential diagnosis because of their frequent occurrence in routine clinical practice. CONCLUSION: Magnetic resonance imaging is the most useful diagnostic modality for shoulder disorders.

Disease Progression↗