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PubMed2006

Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction.

INTRODUCTION: Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( > or = 5 cm(2)) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements. PATIENTS AND METHODS: Of 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have co-morbidities that negatively impacted their ability to perform intense exercise underwent a comprehensive clinical examination of involved and uninvolved side shoulder and elbow active range of motion and strength (both isometric instrumented manual muscle testing and concentric isokinetic measurements). RESULTS: At 2 years following surgery, pre-operative UCLA Shoulder Scores improved from 10.6 +/- 3 to 27.4 +/- 5 and pre-operative ASES Function Scores improved from 20.1 +/- 10 to 43.2 +/- 5. However, isometric involved side shoulder abductor torque was decreased by 28.2% with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6% at 60 degrees/s and by 53.8% at 120 degrees/s with isokinetic testing. Isometric involved side elbow extensor torque was decreased by 39% with instrumented manual muscle testing, and concentric elbow extensor torque was decreased by 17.7% and 19.2% at 60 and 120 degrees/s, respectively, with isokinetic testing. Including three additional patients who were contacted via telephone, the majority of patients (21 of 22, 95.4%) were satisfied with their improved shoulder function and reduced pain. CONCLUSIONS: Despite reduced pain and improved shoulder function, residual involved side shoulder abductor; shoulder external rotator and elbow extensor strength deficits were evident at 2 years following surgery. This suggests the need for more focused rehabilitation, particularly for involved side elbow extensor strengthening to further improve patient function and minimize disability.

Aged↗

PubMedDate not supplied

Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears.

Forty patients underwent surgery by a single surgeon for chronic, symptomatic, full-thickness rotator cuff defects. The study evaluated preoperative and intraoperative factors that influence postoperative outcome. The study also correlated objective measures of shoulder function with postoperative symptoms, patient satisfaction, and disability. Follow-up history and physical examination and strength measurements were performed at 2 years after surgery by three independent observers. There were 88% good or excellent results. Postscores correlated most closely with preoperative tear size. Postoperative Constant scores also correlated significantly with the patient's subjective rating of the end result. Preoperative cuff tear size also correlated with the presence of postoperative fatigue symptoms and objective measures of shoulder strength. Preoperative cuff tear size strongly correlated with other prognostic factors including the quality of the tendon tissue, the difficulty for tendon mobilization, and the presence of a rupture of the long head of the biceps. Together these factors adversely affect postoperative function, patient satisfaction, and overall shoulder score. Neither premorbid activity level nor the presence of a worker's compensation claim adversely affected the postoperative Constant score. The premorbid activity level significantly influenced the postoperative disability rating and the ability to return to work. All patients who were gainfully employed before surgery returned to employment after surgery, although in some patients at a lesser activity level.

Activities of Daily Living↗

PubMed2002

Results of surgery after failed attempt at repair of irreparable rotator cuff tear.

Twelve patients who had surgery to repair a rotator cuff tear, which could not be repaired because the residual tendon tissue was of poor quality, insufficient, or both, were followed up for a mean of 33 months. At surgery, the deltoid was detached from the acromion for 4 to 6 cm and an acromioplasty was done. Preoperatively, all patients except one had mild to severe pain. The mean active forward flexion, abduction, and external rotation were 75 degrees, 61 degrees, and 22 degrees, respectively. After surgery, of the 11 patients who had shoulder pain preoperatively, 10 reported partial relief of pain and one was pain-free. However, shoulder function deteriorated in 11 patients and remained unchanged in one patient who had a pseudoparalytic shoulder before and after surgery. The mean postoperative values of forward flexion, abduction, and external rotation were 49 degrees, 43 degrees, and 16 degrees, respectively. Only one patient was satisfied with the result of surgery because of pain relief. Two patients had repeat surgery (total shoulder replacement or latissimus dorsi transfer) 6 and 4 months after the index surgery because of unsatisfactory functional results. Attempts at open repair of an irreparable cuff tear should be avoided because functional results generally are poor. When there is a risk that an irreparable tear will be found, open surgery should not be done or alternative procedures should be planned before surgery.

Acromion↗

PubMed1989

Rotator cuff sonography: a reassessment.

This study is both a retrospective and prospective evaluation of the clinical usefulness of shoulder sonography. Ninety-eight patients suspected of having rotator cuff tears underwent sonography of both shoulders. Sixty-two patients underwent double-contrast arthrography performed on the same day as sonography, and 38 patients underwent surgery after sonography. A comparison of the results from ultrasound and arthrography, using published diagnostic criteria, demonstrated a sensitivity of 75% and a specificity of 43% for detection of a rotator cuff tear. In this study, use of more restricted criteria, a subset of the published criteria, yielded a sensitivity of 68% and a specificity of 90%. A comparison of sonography with surgery, using this study's criteria, demonstrated a sensitivity of 57% and a specificity of 76%. This report shows that shoulder sonography is less reliable than previously reported and appears to have a very limited role in the evaluation of rotator cuff injuries.

Adult↗

PubMed1997

Estimation of total collagen and types I and III collagen in canine rotator cuff tendons.

The collagen composition of the supraspinatus, infraspinatus, and subscapularis tendons, which form part of the rotator cuff of the shoulder, was determined. Tendons were obtained from adult, male beagle dogs and total collagen was estimated by measurement of hydroxyproline. There was little variation in collagen content among the three major cuff tendons and the quantity approximated that cited in the literature for other tendons. However, the collagen content in the insertion zone of the supraspinatus tendon was significantly higher than in the tendon proper. NaCl fractionation of supraspinatus collagen indicated that type I was the predominant collagen but significant amounts of type III and possibly some type II and type V were also present. Interestingly, there appeared to be more type III collagen in the insertion zone than in the tendon proper, cyanogen bromide digestion and peptide mapping confirmed this finding. The differential collagen composition of the supraspinatus tendon may contribute to the high incidence of tear that is associated with this rotator cuff tendon.

Animals↗

PubMed1997

Influence of sports discipline on shoulder rotator cuff balance.

Isokinetic shoulder rotational strength was evaluated in four groups of subjects as follows: 12 nonathletes, 12 runners, 15 tennis players, and 12 baseball players for a total of 51 subjects. The tests were performed in the seated 45 degrees abducted test position in the scapular plane at 60, 180, and 300 degrees.s-1 for both shoulders. Peak torque and mean power values were gathered, and from these values the internal/external rotation ratios were calculated. Intergroup comparison showed a progression of the ratio related to the sports discipline. The nonathletes and runners had ratios close to those reported for nonathletes (1.3 to 1.5). The tennis players had ratios close to 1.5, whereas the baseball players had ratios from 1.6 to 2.2. The comparison between dominant and nondominant side showed no significant differences in the tennis players and higher values for the dominant side in the nonathletes and runners under certain conditions (180 degrees.s-1 for the nonathletes and 300 degrees.s-1 for the runners). Regarding the baseball players, the ratio was systematically higher for the dominant side. These results raise questions about the influence of sports discipline on the internal/external rotator muscle ratio and indicate the need to establish normative values based on the characteristics of the population under study.

Adult↗

PubMed1991

[Relationship of acromial architecture and diseases of the rotator cuff].

Variations in the architecture of the coraco-acromial arch can lead to a clinically symptomatic rotator cuff lesion. Differences in the shape and slope of the acromion, anterior acromial spurs and inferior protruding acromio-clavicular osteophytes decrease the volume of the subacromial space, leading to impingement. Recent anatomic, radiographic, biomechanic and stereophotogrammetric studies have confirmed these architectural variations and their effect on the contents of the subacromial space. Abnormal contact between the acromion and these soft tissues can result in pathological lesions. Surgical procedures should be aimed at increasing the space beneath the coraco-acromial arch to reduce wear on the rotator cuff.

Acromioclavicular Joint↗

PubMed1993

[Ultrasonographic appearance of the rotator cuff in elderly subjects].

Some special points must be taken into consideration when diagnosing complaints of the shoulder joint in older patients by means of sonography. Such patients not only have a higher incidence of systemic disease, but also--as we know from autopsies--a large percentage of rotator cuff tears. These changes--with the exception of small partial tears--can be recognized sonographically with a high degree of certainty. Prospective sonographic studies have provided us with information that the incidence of rotator cuff tears rises from 25% in patients in their fifties to 50% in patients in their seventies. These studies enabled us to explain the hitherto unknown clinical relevance of these changes. In general, the patients complained of little pain, but when large tears were present, there was usually a clear loss of function, which however was astonishingly well tolerated. These findings would call for caution in indicating complicated reconstructive surgery.

Aged↗

PubMed1994

Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging.

Most magnetic resonance (MR) studies evaluating the rotator cuff for tears have used T2-weighted imaging in the coronal oblique and sagittal oblique planes. T2*-weighted gradient echo imaging, however, has advantages over spin echo imaging, including contiguous slices without cross-talk, high contrast around the cuff, and intrinsically shorter imaging times which can be used to increase the number of signals averaged and thus improve the signal-to-noise ratio. We reviewed the shoulder MR scans of 87 consecutive patients who underwent both a MR scan and a shoulder arthroscopy during which the size of tears, if present, was graded. The reviewers were blinded as to the history and arthroscopic results. The MR scans included oblique coronal T2*-weighted gradient echo and oblique sagittal T2-weighted spin echo images. MR cuff grades were correlated with arthroscopic findings. For complete tears, the sensitivity of MR was 0.91 and the specificity 0.95. For partial tears, the sensitivity was 0.74 and the specificity 0.87. This accuracy is similar to two-plane T2-weighted imaging as previously reported in the literature. There was a statistically significant correlation (p < 0.0005) between the cuff grade as determined by MR and the arthroscopic findings.

Adult↗

PubMed2006

Outcomes after arthroscopic rotator cuff repairs.

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic.

Adult↗

PubMed2000

[Diagnostic value of arthrography and MRI in rotator cuff tears].

OBJECTIVE: To prospectively compare arthrography with MRI to determine the sensitivity and specificity in detecting rotator cuff tear. METHODS: 53 shoulders were studied. All patients underwent both arthrography and MRI. The results were compared with the findings of arthroscopy or open surgery. RESULTS: The sensitivity in demonstrating partial-thickness tears was 70% for arthrography and 80% for MRI; the specificity was 75% for arthrography or MRI. The sensitivity in detecting full-thickness tears was 87% for arthrography and 90% for MRI, and the specificity was 100% for arthrography and 75% for MRI. CONCLUSION: The sensitivity of arthrography and MRI in detecting rotator cuff tears was identical. The specificity of arthrography in detecting full-thickness tears was higher that of MRI.

Adult↗

PubMed1998

Rotator cuff tear associated with an acromioclavicular cyst in rheumatoid arthritis.

We report two cases of a full-thickness rotator cuff tear followed by acromioclavicular cyst formation in patients with longstanding erosive polyarticular rheumatoid arthritis. One of the consequences of a rotator cuff tear is articular instability with upward migration of the humeral head. The ensuing chronic friction against the undersurface of the acromioclavicular joint caused by arm movements can lead to a non-inflammatory effusion of the acromioclavicular joint with cyst formation. Clinical and ultrasonographic features and a pathogenetic hypothesis are discussed.

Acromioclavicular Joint↗

PubMed1977

Resection of the acromion in the treatment of persistent rotator cuff syndrome of the shoulder.

Partial or complete excision of the acromion was performed in 25 patients (29 shoulders) with long-standing pain in the shoulder typical of rotator cuff syndrome. There was no verified history of trauma in nine cases (13 shoulders), while injury was the cause of pain in 16 patients (16 shoulders). In nine shoulders there was a small and in two a large rupture of the rotator cuff. Twelve of the 13 non-traumatic shoulders became painless postoperatively and the pain was relieved in one. In the 16 traumatic shoulders the relief of pain was complete in six, partial in nine, and one remained unchanged. The condition was not aggravated in any of the cases. Mobility increased postoperatively in four cases and was in no case decreased by the operation. In this series the results were as favourable after partial as after complete excision of the acromion alone or excision in combination with other procedures appears to be a promising method of treatment of patients with long-standing rotator cuff syndrome.

Acromion↗

PubMed1990

Roentgenographic findings in massive rotator cuff tears. A long-term observation.

It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based on these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.

Acromion↗

PubMed1995

Titanium anchors for the repair of rotator cuff tears: preliminary report of a surgical technique.

We used titanium anchors for the surgical repair of rotator cuff tears in 34 selected patients, all of whom were < 60 years of age, had good bone quality, and had no known metabolic bone diseases. Nine tears were repaired within 6 months, 15 within 6-12 months, and 10 later than 12 months after injury. Tear size was graded as small (10 patients), medium (15 patients), and large (nine patients) during open operation. After 6-24 months of follow-up, 30 patients reported satisfactory pain relief, function, active forward flexion, and muscle strength [18 excellent and 12 good results based on the University of California at Los Angeles rating system (UCLA scores)]; there were no implant failures (p < 0.001). Two patients had unsatisfactory function but good relief of pain, whereas two patients were dissatisfied with their overall result (four poor results based on UCLA scores). Although trans-bone suturing is presently the most common and successful surgical technique for rotator cuff tears, we found that use of titanium anchors shortens operative time and has results comparable with the traditional technique. Titanium anchors should not be used when bone quality is poor or good patient compliance is doubtful. They are also contraindicated, as our four poor results indicate, when the tear is old (> 6 months) and large (diameter > 5 cm with significant tissue degeneration).

Adult↗

PubMed2005

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis.

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11 mJ/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session, functional state of shoulder was assessed at 1 and 6 months after the end of procedure. All patients underwent radiographs and sonography imaging. No systemic or local complications. Thirty-eight patients (70%) reported satisfactory functional results. Radiographs and sonographs showed a disappearance of calcium deposit in 29 patients (54%) and in 19 patients (35%) it appeared to be reduced more than a half. A correlation was found between residual calcium deposit and the clinical outcome, but some patients showed a reduced pain without modification of calcium deposit. These results were unmodified at 6 months follow-up. Our protocol of medium-energy ESWT provides good results overall about pain modulation.

Adult↗

PubMed2004

Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval.

OBJECTIVE: The objective of this article is to describe a simplified fluoroscopically guided technique of shoulder joint injection that uses the rotator cuff interval. CONCLUSION: Shoulder arthrography using an anterior approach through the rotator cuff interval is an effective, rapid, and easy-to-perform injection technique. In most patients, this technique can be performed using a 1.5-inch (3.8-cm), 22-gauge needle.

Adolescent↗

PubMed1999

Transfer of the latissimus dorsi muscle after failed repair of a massive tear of the rotator cuff. A two to five-year review.

INTRODUCTION: Seventeen patients with an average age of fifty-five years (range, thirty-two to seventy-seven years) who had ongoing pain and impaired function following failed operative treatment of a massive tear of the rotator cuff were managed with a transfer of the latissimus dorsi muscle as a salvage operation. METHODS: The patients were examined at an average of fifty-one months (range, twenty-four to seventy-two months) after the operation. Pain, function, and satisfaction were assessed with use of a questionnaire, visual analog and ordinal scales, physical examination, and the University of California at Los Angeles shoulder score. RESULTS: Fourteen of the seventeen patients were found to have significant relief of pain (p<0.0001) and a significant improvement in function (p<0.001 for all activities except lifting more than fifteen pounds [6.8 kilograms], for which the p value was <0.0036) and were satisfied with the result of the operative procedure. Fifteen patients stated that they would have the operative procedure again under similar circumstances. Seven of eight patients with a detached or nonfunctional anterior portion of the deltoid had substantial improvement. Three operations were classified as failures because the patients were not satisfied with the result and had ongoing pain and impaired function. All three failures were in patients who had a work-related injury. Overall, six patients had a work-related injury, and only three of them had a satisfactory result. There were three complications, all related to contracture of a hypertrophic axillary scar. CONCLUSIONS: The results in this series indicate that transfer of the latissimus dorsi muscle is a reasonable approach for salvage after failed operative treatment of a massive tear of the rotator cuff.

Adult↗