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PubMedDate not supplied

[Efficiency of a postoperative treatment after rotator cuff repair with a continuous passive motion device (CPM)].

AIM: The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff. METHOD: The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients. RESULTS: Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy). CONCLUSION: The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.

Double-Blind Method↗
PubMed2000

Mechanical properties of the posterior rotator cuff.

BACKGROUND: The infraspinatus is an important active and passive stabilizer of the glenohumeral joint. It functions as external rotator and participates in elevation of the arm. As its main posterior component, it is frequently involved in rotator cuff tears. OBJECTIVE: The purpose of this study was to determine the structural and mechanical properties of the infraspinatus tendon structure, including the midsubstance and insertion regions, in the superior, mid-superior, mid-inferior, and inferior portions, in two joint positions. METHODS: The infraspinatus tendons from 22 fresh frozen cadaver shoulders were divided into four strips. The tendons were held in a cryo-jaw and tested with a material-testing machine in 0 degrees or 60 degrees of glenohumeral abduction corresponding to 90 degrees arm abduction. Ultimate load, displacement and failure mode were recorded. Stiffness, ultimate stress and elastic modulus were calculated. RESULTS: Significant differences between glenohumeral abduction positions were detected only for the elastic modulus. The mid-superior (676.5 N, S.D. 231.0 N) and the inferior portion (549.9 N, S.D. 284.6 N) had the highest failure loads while the superior (462.8 N, S.D. 237.2 N) and the mid-inferior portions (315.3 N, S.D. 181.5 N) were weaker. Similar trends across the tendon strips were shown for stiffness, ultimate stress and elastic modulus. RELEVANCE: Position dependent changes in mechanical properties of the infraspinatus tendon probably do not play a role in the pathomechanism of posterior shoulder dislocation. Peaks in stiffness in mid-superior and inferior tendon sections explain the low incidence of posterior dislocations. The low ultimate failure loads in the superior portions might explain the frequent extension of rotator cuff ruptures into the infraspinatus tendon.

Aged↗
PubMed2004

Anterior glenohumeral force/translation behavior with and without rotator cuff contraction during clinical stability testing.

OBJECTIVE: Measure stiffness of the glenohumeral joint during clinical laxity testing with and without muscular contraction of the Internal rotators. DESIGN: Cross-sectional study of normal shoulders. BACKGROUND: Clinical examination for shoulder instability is based on subjective impression, and is only performed passively. Our study presents a method for quantitative clinical examination of the shoulder under both passive and active muscle contraction conditions. We hypothesized that in a normal shoulder, contraction of the internal rotators will increase the stiffness of the glenohumeral joint, effectively constraining the head of the humerus against anterior directed forces. METHODS: Ten subjects were instrumented with electromagnetic sensors to record glenohumeral linear displacements. A mini-force transducer recorded forces applied to subjects during anterior drawer testing (forced anterior glenohumeral displacement), which was performed passively, and during isometric contraction of internal rotators. RESULTS: Only mild contraction of the internal rotators is needed to significantly increase the stiffness to anterior directed forces. Greater muscular activation does not result in further increased stiffness. CONCLUSION: Objective measurement of glenohumeral stiffness during passive and active muscular contraction may be useful for evaluating the capacity of rotator cuff muscles to stabilize the shoulder. The concept of more strength is better, for rotator cuff strengthen programs is questioned.

Adult↗
PubMed1999

Arthroscopic assisted rotator cuff repair.

The advent of the arthroscope has revolutionized orthopaedic surgery, particularly for injuries to the knee or shoulder. The enhanced visualization accompanied by minimal soft tissue injury afforded by the arthroscope has been applied successfully to the treatment of many shoulder girdie pathologies, most notably impingement syndrome and rotator cuff injuries. As such, the traditional open surgery with the incumbent morbidity, while still utilized for more complex tears is finding less application in smaller tears to the rotator cuff. This review will address the history, indications, technique, and results of arthroscopic rotator cuff repair.

Journal Article↗
PubMed1991

Rotator cuff pathology. Arthroscopic assessment and treatment.

The results of 50 operative arthroscopies for impingement syndrome were reviewed. Preoperative arthrography was correlated with arthroscopic findings, which were pathologically graded. Results of arthroscopic surgery were assessed. Preoperative arthrography predicted 78% of the complete tears of the rotator cuff and only 25% of the partial tears. Of 40 shoulders followed for at least one year postoperatively, 87.5% had satisfactory results. Arthrography was not as reliable as arthroscopy in predicting partial tears of the rotator cuff. Arthroscopy permitted detailed intraarticular and subacromial visualization and classification of partial and complete tears of the rotator cuff. The early results of arthroscopic acromioplasty and debridement are comparable to those obtained with open operations.

Adolescent↗
PubMed2006

Patient-controlled analgesia after arthroscopic rotator cuff repair: subacromial catheter versus intravenous injection.

BACKGROUND: No study has compared pain control results between patient-controlled subacromial infusion and intravenous injection after arthroscopic shoulder surgery. HYPOTHESIS: Subacromial infusion of analgesics are more effective in pain alleviation than intravenous injection. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: The authors prospectively analyzed 40 cases of arthroscopic rotator cuff repair that received patient-controlled analgesia. They divided the 40 cases into 2 groups: subacromial infusion group with 0.5% bupivacaine (group 1, 20 cases) and intravenous injection group with fentanyl and ketorolac tromethamine (group 2, 20 cases). The visual analog scale was used to record the patient's level of pain every 12 hours until postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analog scale score during motions was 6.8 in group 1 and 5.8 in group 2. The immediate postoperative visual analog scale score was 7.6 and 7.4, respectively, for each group. At postoperative time periods, most of the scores of subacromial infusion at rest and during motions were lower than those of intravenous injection, but significant differences were not found between groups 1 and 2. CONCLUSION: Patient-controlled analgesia after arthroscopic rotator cuff repair showed that both subacromial infusion of bupivacaine and intravenous injection of fentanyl and ketorolac tromethamine were equally effective and clinically equivalent pain control methods.

Adult↗
PubMedDate not supplied

Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds.

The purpose of this study was to compare the effect of increasing loads and doubling speed on the deltoid and rotator cuff muscles during isotonic scapular plane abduction (scaption) with neutral humeral rotation. These muscles were studied in 16 volunteers with asymptomatic shoulders with the use of fine wire electromyography. The addition of load to the arm during scaption caused an increase in electromyographic activity during the first 90 degrees of motion. Furthermore electromyographic activity decreased during the final 30 degrees of motion with each increase in load. Doubling the speed caused an increase in electromyographic activity during the first 60 degrees of motion while causing a decrease in activity in the final 60 degrees. This study demonstrates the response of the rotator cuff and deltoid muscles to varying loads and speeds during the most basic shoulder motion. With the data obtained in this study, rehabilitation exercises and experimental shoulder models can be refined to reflect this more physiologic situation.

Adult↗
PubMed2003

The significance of subacromial arthrography to verify partial bursal-side rotator cuff ruptures.

BACKGROUND: The purpose of this study was to verify a partial bursa-side rupture of the rotator cuff (RC) using different imaging techniques with special emphasis on the validity of a specific method of subacromial arthrography (SAA). METHODS: Patients (n=92, mean age 53.8 years) with a subacromial impingement syndrome underwent sonography, magnetic resonance imaging (MRI), and SAA. All diagnostic results were checked by subsequent arthroscopic surgery. RESULTS: Of 31 surgically verified ruptures, 17 showed a partial rupture located towards the bursa. These had been detected by MRI and ultrasound with a sensitivity of 64% and 41%, respectively, while SAA as a diagnostic tool yielded a sensitivity of 82%. In 14 cases of complete RC ruptures, all imaging techniques had a similar sensitivity of 86-93%. CONCLUSION: It appears that SAA is an adequate and valid diagnostic tool for the detection of partial bursa-sided RC ruptures. Ultrasound and MRI showed a comparably lower sensitivity. It is therefore concluded that SAA has clear advantages in the diagnosis of this defect with the consequence that open surgical techniques can be avoided.

Female↗
PubMedDate not supplied

Arthroscopic repair of large and massive rotator cuff tears.

PURPOSE: The purpose of this study was to evaluate the outcome of arthroscopically repaired large and massive rotator cuff tears at 1- to 5-year follow-up. TYPE OF STUDY: Retrospective chart review. METHODS: Sixty consecutive patients who had arthroscopically repairable large or massive tears were identified by retrospective chart review. Large tears are defined as defects in the cuff measuring from 3 to 5 cm and massive tears measuring greater than 5 cm. Ten of these patients were lost to follow-up before 1 year postoperatively and were excluded from the study. The remaining 50 were the focus of this study. RESULTS: Thirty-seven patients had large tears and 13 had massive tears. Follow-up averaged 32 months (range, 12 to 63 months). Based on the University of California Los Angeles shoulder rating, 88% of patients had good or excellent outcomes. Although 6 patients were considered failures based on the UCLA score, 98% of patients were satisfied with the result. Only 1 of these failures underwent a second operation for revision repair. There was no significant difference in final scores when comparing the massive tears to the entire group, but all preoperative scores were lower for those with massive tears than the large tears. CONCLUSIONS: Arthroscopic management of large and massive tears results in good or excellent outcomes in 88% of patients, which is comparable to reported outcomes following open repairs.

Arthroscopy↗
PubMed1996

Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study.

PURPOSE: To determine the effect of continuous passive motion (CPM) on rotator cuff repair (RCR). METHODS: A prospective, randomized, blinded, controlled study was performed on all patients undergoing primary RCR between December 1992 and January 1994. A preoperative "shoulder score" was calculated for each patient based on four scales: function (50%), pain (20%), muscle strength (15%), and range-of-motion (ROM) (15%). A standard questionnaire and single blinded physical therapist were employed. At the time of operation, patients were randomized into the control group (postoperative physical therapy [PT]) or the study group (PT plus CPM). Postoperative shoulder scores were then calculated by repeat questionnaires and physical examinations at 3-month follow-up. RESULTS: Twenty-six patients (12 control, 14 study; 24/26 tears were full thickness) underwent RCR and completed 3-month follow-up. Both groups had similar age and sex distributions; the study group had larger tears than the control group. All patients underwent RCR and subacromial decompression. No statistically significant difference in shoulder score increases was seen between the two groups at follow-up. A statistically significant (P = 0.0138) increase in ROM subscore was seen in the study group. Other subscores showing improvement with CPM included pain relief in female patients (P = 0.0185), and pain relief in patients > or = 60 years of age (P = 0.0364). CONCLUSIONS: CPM has no effect on overall shoulder score at 3-month follow-up. CPM has a beneficial effect on ROM for all patients, as well as on pain relief in female patients and patients > or = 60 years of age.

Activities of Daily Living↗
PubMed1994

Os acromiale associated with rotator cuff impingement: MR imaging of the shoulder.

PURPOSE: To evaluate the magnetic resonance (MR) imaging findings of os acromiale in rotator cuff disease. MATERIALS AND METHODS: Retrospective analysis was performed of 10 shoulder MR studies of 10 patients older than 25 years with os acromiale. The authors subdivided these patients into three types on the basis of seven possible configurations. RESULTS: Eight of the 10 patients with os acromiale showed failure of fusion between the mesoacromion and meta-acromion (type A), one between the preacromion and mesoacromion (type B), and one between the meta-acromion and basiacromion (type C). Osteophytic lipping was seen at the margins of the acromial gap in nine cases. The os acromiale could be detected on the oblique sagittal image, oblique coronal image, or both, and in each case, there was a lesion in the supraspinatus tendon: tendinitis in four patients and tendon tear in six. CONCLUSION: Os acromiale can be an important cause of rotator cuff impingement and can be detected with routine MR imaging of the shoulder.

Acromion↗
PubMed2000

Bone marrow edema in the greater tuberosity of the humerus at MR imaging: association with rotator cuff tears and traumatic injury.

UNLABELLED: The purpose of this study was to determine the prevalence of bone marrow edema in the greater tuberosity of the humerus on MR imaging, the association with other findings at MR imaging and the injury mechanism which can lead to this finding. SUBJECTS AND METHODS: MR reports from 863 patients referred for shoulder MRI over 74 months were reviewed to identify patients with marrow edema in the greater tuberosity. The MR images from patients with greater tuberosity marrow edema were reviewed by consensus of two radiologists for the extent of marrow edema and for associated injuries. Marrow edema in the greater tuberosity was seen in 11 of 863 patients (1.3%). Nine patients (82%) had associated rotator cuff tear by MR imaging (four full thickness and five partial thickness), one patient had avulsion of the greater tuberosity from the humerus, and one had no rotator cuff abnormality. History of trauma was reported by eight patients including fall without direct blow to the shoulder (6), car accident (1) and direct blow to the top of the shoulder (1). Marrow edema in the greater tuberosity is an infrequent finding. Marrow edema most often is associated with a history of trauma and with rotator cuff abnormalities including full thickness tears. The history of trauma without direct blow to the shoulder and the location of the edema indicates that marrow edema often results from avulsion injury by the supraspinatus tendon.

Adult↗
PubMed1997

Three dimensional reconstruction of the fibrous frame of the rotator cuff.

The authors present the methodology and the results of a trial of 3D-reconstruction of the fibrous frame of the rotator cuff taken from high resolution MRI. The accuracy of the method used is discussed. A precise reconstruction of the soft tissues is possible and provides an interesting model to study the mechanical role of the rotator cuff muscles. An example of biomechanical application of the 3D images is given.

Cadaver↗
PubMed1996

Sonographic detection of tears of the anterior portion of the rotator cuff (subscapularis tendon tears).

We studied the value of ultrasonography in identifying tears of the most anterior portion of the rotator cuff (subscapularis tendon tears). Shoulder sonography was performed on 1640 patients with shoulder symptoms, 435 of whom underwent surgery. Among the patients who were operated on, 17 had predominantly or exclusively subscapularis tendon tears; 14 of these were full-thickness and three were partial-thickness tears. Ultrasonography demonstrated 82% (14 of 17) of the subscapularis tendon tears; 86% (12 of 14) of the full-thickness tears and 67% (2 of 3) of the partial-thickness tears were correctly diagnosed with ultrasonography. Sonography can diagnose and show the size of subscapularis tendon tears reliably, but it necessitates that the arm can be externally rotated to the maximum extent when performing the study.

Adult↗
PubMed2003

Arthroscopically insertable force probes in the rotator cuff in vivo.

In vivo loading data for the rotator cuff would be of value to scientists and clinicians interested in the shoulder. The Arthroscopically Insertable Force Probe (AIFP; Microstrain, Burlington, VT) offers a potential method for collecting this information. A technique for insertion and retrieval of the AIFP from the subscapularis is described. The method was initially established in a cadaveric model. The AIFP was inserted into the subscapularis tendon in 3 volunteers during diagnostic shoulder arthroscopy. After the motor effects of interscalene block had worn off, dynamic data relating to subscapularis tendon loading was collected. The AIFPs were removed through a port site by traction on a 0 (3.5 metric) nylon suture without complications.

Arthroscopes↗
PubMed2005

Use of direct introduction of allograft anchors for rotator cuff repair.

Allograft anchors that can be inserted directly through the greater tuberosity were developed, tested, and used clinically for rotator cuff repair. Mechanical strength testing was performed, and allograft anchors were used in 63 consecutive procedures by a single surgeon. The insertion technique involved directly impacting the allograft anchor through the greater tuberosity without drilling a hole in the bone. Results of mechanical testing showed strengths comparable with those of other anchors (155.8 N), and the anchors locked consistently. This direct insertion technique saves time and procedural steps over traditional anchor insertion techniques while using an allograft anchor that reincorporates into host bone.

Adult↗
PubMedDate not supplied

[Neuromuscular failure of the rotator cuff as a contribution to the functional impingement of the shoulder - a muscle biopsy investigation].

AIM: The possibility that functional impingement results from muscular imbalance is under discussion. This study investigates whether the disturbance of muscular coordination could be demonstrated as a shift in the balance of FT and ST fibers, since the FT fibers enable a rapid reaction or contraction, and ST fibers enable slow contractions and sustained performance. METHOD: In 37 patients with a supraspinatus syndrome, partial or complete rupture of the rotator cuff, we took biopsies from the supraspinatus and deltoid muscles and did morphometric measurements.< RESULTS: All three groups of patients showed a reduction in size, increased variability and change in frequency of the fiber cross sections. The FT fibers are especially affected. These findings are objectively confirmed by morphometric measurements. CONCLUSION: A disturbance in coordination of the musculature which can bring about functional impingement might be inferred from the above changes. We term this "neuromuscular insufficiency of the rotator cuff". The mechanical factors relating to subacromial impingement probably only have a role in promoting its manifestation by restricting the compensation range of the joint.

Adult↗