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"Supraspinatus slide" for rotator cuff repair.

The supraspinatus slide procedure described by Debeyre et al. (1965) offers an opportunity for the surgeon to repair certain large and late ruptures of the rotator cuff. In order to re-appraise this procedure and clarify its indications, the authors performed the following study: Firstly 37 rotator cuff ruptures repaired by this method were reviewed. Most of the patients were supplied by the Workmen's Compensation Board of Ontario. The review period was from 1968 to 1977. Secondly, the surgical anatomy of the area was reviewed. Twenty-two (60%) of the patients obtained satisfactory results. They were relieved of pain, gained functional improvement and returned to their previous or a modified occupation. Although the vulnerability of the suprascapular nerve and artery was demonstrated in anatomical dissections, no neurological sequelae were noted and the muscle remained viable in all patients. Electro-myographical studies failed to show supraspinatus muscle denervation in any case. The procedure proved to be useful in the repair of large rotator cuff ruptures that are not amenable to other methods of repair. A young well motivated patient with chronic disability may benefit from this procedure.

Adult↗

Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment.

In this study, we assessed the functional results after arthroscopic excision of rotator cuff calcifications. Sixty-one shoulders in 57 patients with chronic calcifying tendinitis of the rotator cuff were treated with arthroscopic excision, subacromial bursa debridement and shaving. In patients with fraying or roughness of the coracoacromial ligament, an acromioplasty was also performed. Patients were evaluated after a mean follow-up of 15 months. The modified Constant score and DASH score significantly improved from 33.4 to 66.8 and from 49.7 to 17.3 respectively. Performing an acromioplasty did not influence the final outcome. Frozen shoulder was a frequent complication (18%) without significant effect on the final DASH or Constant score. The presence of residual calcifications after arthroscopic needling did not influence the final outcome. We therefore believe that the presence of residual calcifications can be accepted if this is deemed necessary to preserve the integrity of the tendon.

Arthroscopy↗

Evaluation of degenerative lesions of the rotator cuff. A comparison of arthrography and ultrasonography.

A prospective study was performed to determine the accuracy of arthrography compared with ultrasonography in the evaluation of thirty-two patients who had a degenerative lesion of the rotator cuff. Both tests were done preoperatively, and the condition of the rotator cuff was determined intraoperatively. Arthrography was accurate in the diagnosis of twenty-eight (87 per cent) of the thirty-two patients (twenty who had a full-thickness tear, seven who had a partial-thickness tear, and five who had an untorn rotator cuff and tendinitis), while ultrasonography was diagnostic in only twelve (37 per cent). In this specific population of patients, arthrography was found to be superior to ultrasonography.

Adult↗

Rotator cuff evaluation: imaging and diagnosis.

A variety of disorders can lead to disease and pathology of the rotator cuff tendons. The most important information is obtained during a careful history and physical examination. With the judicious use of various diagnostic modalities, evaluation of the cause of the rotator cuff disease is possible.

Humans↗

[Rupture of the rotator cuff in the elderly].

Rupture of rotator cuff in the elderly people is mostly degenerative. Due to the rupture, function of the arm may be disturbed up to pseudo-paralysis. Apart from the functional disturbances the patient is suffering from tormenting nightly pain. The therapy for the elderly people will almost always be a conservative one. Apart from symptomatic measures, physical therapy to prevent a frozen shoulder is essential. With old age operational indication should be particularly restrictive and only where conservative treatment has failed so far.

Aged↗

Tears of the rotator cuff.

The diagnosis of a torn rotator cuff can be readily established by arthrography. It must be suspected in any patient with should pain with or without a history of injury. Under circumstances in which spontaneous healing cannot be expected, early surgical repair should provide consistent satisfactory results. Late reconstruction now can yield good results with either the free biceps graft or the freeze dried cadaver graft.

Humans↗

Long-term follow up to patients with frozen shoulder after mobilization under anesthesia, with special reference to the rotator cuff.

UNLABELLED: In order to evaluate the efficacy of mobilization under anesthesia as a therapy for frozen shoulder, 43 patients with a mean age of 52.8 years were examined after an average time of 4.7 years. Since some authors have been concerned about rotator cuff tears, special attention--using sonography--was paid to rotator cuff lesions. RESULTS: Clinical and sonographic examinations were very similar and showed a perfect recovery in 27 of 37 patients (73.0%). The average time off work after mobilization was 6.2 weeks compared with expected spontaneous recovery of about 30 months. Outcome was worse in patients with previous trauma to their shoulder. In 2 patients (5.4%) the sonography revealed a slight rotator cuff tear, which is not uncommon in 60-year-old persons. Two additional patients (5.4%) underwent shoulder surgery two years after mobilization due to a persistent impingement syndrome and to a supraspinatus-tear. We conclude, that mobilization under anesthesia for frozen shoulder is an effective treatment modality causing little harm.

Adult↗

A less invasive surgery for rotator cuff tear: mini-open repair.

As a less invasive surgery of the shoulder, the mini-open repair was carried out from March 1997 through December 1998 in 22 patients (mini-open repair group) for all types of rotator cuff tears, except massive tears. A transacromial skin incision about 3 cm long was made. The anterior deltoid was split along its muscle fibers, and an anterior acromioplasty was accomplished by using a specially designed bone rasp. The rotator cuff was repaired with use of the McLaughlin technique. The results were compared with those obtained in 36 patients subjected to conventional open surgery from April 1994 through February 1997 (control group). No significant difference was seen between the UCLA (University of California, Los Angeles) shoulder scores of the two groups 1 year after the repair. However, active forward flexion in the mini-open group was significantly greater than in the control group 3 and 6 months after surgery. With mini-open repair, patients seem to be able to return to sports or social activities earlier than with conventional open surgery.

Adult↗

Os acromiale associated with tear of the rotator cuff treated operatively. Review of 33 patients.

Os acromiale is a rare anatomical abnormality and treatment is controversial. Our retrospective study analyses the outcome of excision, acromioplasty and bony fusion of the os acromiale when it is associated with a tear of the rotator cuff. After a mean follow-up of 41 months, 33 patients were radiologically and clinically assessed using the Constant score. The surgical procedure was to repair the rotator cuff together with excision of the os acromiale in six patients, acromioplasty in five, and fusion in 22. Of the 22 attempted fusions seven failed radiologically. The Constant scores were 82%, 81%, 81% and 84% for patients who had excision, acromioplasty, successful fusion and unsuccessful fusion respectively. There were no statistically significant differences. We conclude that a small mobile os acromiale can be resected, a large stable os acromiale treated by acromioplasty and a large unstable os acromiale by fusion to the acromion. Even without radiological fusion the clinical outcome can be good.

Acromion↗

Tears of the anterior portion of the rotator cuff (the subscapularis tendon): MR imaging findings.

OBJECTIVE: Tears of the most anterior portion of the rotator cuff, the subscapularis tendon, are reported to be uncommon and rarely occur in isolation. The MR findings of subscapularis tendon tears have received little attention in radiologic publications. Accordingly, the objective of this study was to describe the MR imaging findings in the shoulders of patients with tears of the subscapularis tendon. MATERIALS AND METHODS: Preoperative MR images of nine patients with surgically confirmed rotator cuff tears that predominantly or exclusively involved the subscapularis tendon were analyzed. RESULTS: In all patients, MR imaging showed the contours of the subscapularis tendon to be poorly defined and the tendon itself to be of abnormally high signal intensity on T2- or T2*-weighted images. Discontinuity and frank retraction of the tendon were evident in seven patients (78%). Thickening of the distal portion of the tendon (n = 3) and calcification (n = 1) were seen less frequently. Associated abnormalities of the biceps tendon were common, seen in seven patients (78%), five of whom had medial dislocation of the tendon. Bone and labral injuries were uncommon. CONCLUSION: Tears of the subscapularis tendon can be identified on MR images as areas of disorganized tendon morphology and abnormal high signal intensity on T2- or T2*-weighted images. Abnormalities of the biceps tendon also are seen commonly. When subscapularis tears are recognized, the long head of the biceps tendon should be scrutinized for associated injury or malposition.

Humans↗

Tear of an ossified rotator cuff of the shoulder. A case report.

A 57-year-old man with an ossified rotator cuff with acute tears was treated by resecting the ruptured part, as well as the ossicles, and by repairing the massive cuff defect with Teflon felt. Six years after surgery, the pain had been completely relieved, and shoulder motion and muscle strength had been recovered.

Humans↗

Pre- and postoperative evaluation of the metabolic activity in muscles associated with ruptured rotator cuffs by F-FDG PET imaging.

We examined uptake of 2-[(18)F]-fluoro-2-deoxy-D-glucose (FDG) using positron emission tomography (PET) into the bilateral shoulder muscles of four patients before and after unilateral rotator cuff repair. The relative ratio of the subtracted standardized uptake value on the supraspinatus with a torn supraspinatus tendon to that of the subscapularis on the ipsilateral side was significantly lower than that on the normal side (0.69 +/- 0.05 versus 1.06 +/- 0.36). The relative ratio of the infraspinatus on the rupture side was also significantly lower than that on the normal side (0.91 +/- 0.09 versus 1.41 +/- 0.35). However, by 6 months postoperative, the reduced glucose metabolism in these muscles had recovered to the same levels as those on the normal side. As indicated by FDG PET, muscle metabolism in rotator cuff tears was reduced, subsequently recovering to the level of the normal side after operative repair.

Aged↗

Tensile properties and biological response of poly(L-lactic acid) felt graft: an experimental trial for rotator-cuff reconstruction.

Poly(L-lactic acid) felt (PLLA felt) was prepared for reconstruction of the rotator cuff in animal models. Small changes were found in the tensile strength of both the cultured PLLA felt and the PLLA felt implanted on the paravertebral muscle of rabbits up to 16 postoperative weeks. The stiffness of the felt implanted on the muscle from 6 to 16 weeks showed a statistically significant increase. When the infraspinatus tendons of beagle dog were reconstructed with the PLLA felt, the ultimate strength of PLLA felt increased threefold, and the stiffness increased fivefold by 16 postoperative weeks compared to that of the initial PLLA felt. They were statistically significant (p < 0.01). All the implanted specimens ruptured at the junction between the bone and the PLLA felt. Histological examination demonstrated infiltration of fibrous tissue into the interstices of the PLLA felt fibers. Connection between the infraspinatus tendon and the PLLA felt was tight with the formed scar tissue, but the connective tissue between the bone and PLLA felt fibers was sparse even at 16 and 32 postoperative weeks. A few deteriorated PLLA felt fibers were observed at 32 postoperative weeks. It was concluded that the degradation rate of PLLA felt was low and the tensile recovery of the PLLA felt graft in beagle dogs was excellent. Thus, PLLA felt might be a useful bioabsorbable material for rotator-cuff reconstruction.

Animals↗

Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods.

BACKGROUND: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances. OBJECTIVE: To determine the most effective training for altering strength ratios in the shoulder rotator cuff. METHODS: Forty eight physical education students were randomly assigned to four groups (12 per group): (a) experimental group who carried out multijoint dynamic resistance training for shoulder internal and external rotation movement (pull ups or lat pull downs, overhead press, reverse pull ups, push ups) (MJDR group); (b) experimental group who exercised the same muscle group using dumbbells weighing 2 kg (isolated group); (c) experimental group who followed an isokinetic strengthening programme for the rotator cuff muscle group (isokinetic group); (d) control group who had no strength training. Testing was performed in the supine position with the glenohumeral joint in 90 degrees of abduction in the coronal plane, with a range of motion of 0-90 degrees of external rotation and 0-65 degrees of internal rotation at angular velocities of 60, 120, and 180 degrees /s. The test procedure was performed before and after the exercise period of six weeks. RESULTS: One way analysis of variance found no differences between the groups for the initial tests. Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement. CONCLUSIONS: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle.

Adult↗

Suprascapular nerve block for persistent rotator cuff lesions.

The suprascapular nerve supplies sensory nerves to the posterosuperior aspect of the shoulder, including major portions of the rotator cuff. Suprascapular nerve block using steroid/bupivacaine is temporarily effective in reducing pain in rotator cuff tendinitis and tears, improving movement range in tendinitis and is possible in an outpatient setting with little or no complication risk.

Adult↗

Use of 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) imaging for the evaluation of muscle metabolic activity in ruptured rotator cuffs: Identification of shoulder muscles by fusion imaging studies involving both FDG PET and magnetic resonance imaging.

The uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) into shoulder muscles was studied in 11 patients with rotator cuff tears. FDG was injected under resting conditions, and cuff muscle exercises were performed followed by evaluation of the standardized uptake value (SUV) in shoulder muscles bilaterally. Analysis was performed with a subtracted SUV, obtained by subtracting the SUV of the muscle at rest from that after exercise. Fusion imaging studies involving FDG positron emission tomography (PET) and magnetic resonance imaging would provide a novel strategy with the potential of improving on the limited resolution of PET images. In this study this relatively new strategy revealed a similar decrease in the supraspinatus SUV in cases involving both complete and partial tears. The SUV in the infraspinatus and subscapularis also decreased, regardless of whether these muscles were intact or ruptured; the SUV in the deltoid remained basically unchanged. With the use of this exercise protocol, FDG PET might prove useful for objective evaluation of rotator cuff muscle activity.

Aged↗

Biomechanical evaluation of a new technique for rotator cuff repair.

BACKGROUND: In recent studies, investigators have used a cyclic loading model to investigate the efficacy of rotator cuff fixation modalities. HYPOTHESIS: A bioabsorbable poly-D-lactic acid screw and toothed washer implant will provide more stable fixation of rotator cuff repairs than standard suture anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Forty bovine shoulders (ages 3 to 6 months) had 1 x 2 cm defects created in the infraspinatus tendon. There were five repair groups (eight specimens per group) consisting of either two screw and washer implants or two suture anchors. Four suture techniques were tested: single-loaded anchors with simple sutures, double-loaded anchors with simple sutures, single-loaded anchors with horizontal mattress sutures, or single-loaded anchors with modified Mason-Allen sutures. Repairs were loaded at 5-second cycles from 10 to 180 N with use of a hydraulic testing machine. The number of cycles to gap formation of 5 and 10 mm was recorded. RESULTS: Gap formation of 5 and 10 mm occurred significantly later for the screw repair group than for any of the suture anchor groups. There was no significant difference between suture groups. CONCLUSIONS: The bioabsorbable screw and washer provided more stable fixation than suture anchor techniques under isometric cyclic loading conditions. CLINICAL RELEVANCE: This is a time-zero study of implant performance. The results indicate that the implant may decrease clinical failures in the early postoperative period under standard rehabilitation protocols.

Analysis of Variance↗