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PubMed2000

[Imaging-guided needle puncture, infiltration and lavage of rotator cuff calcifications. Retrospective evaluation of 50 cases of treated periarthritis].

PURPOSE: To evaluate mid term efficiency of imaging-guided needle puncture trituration and lavage (RPTL) in rotator cuff calcifications after failure of medical treatment. Materials and Methods. Fifty shoulders with rotator cuff calcifications (supra and infra-spinatus: 97%) from 42 patients, mean of 50.2 year old (M/F=10/32), were treated by RPTL. To establish a satisfaction score and potential undesirable effects, the follow-up was obtained by a telephone questionnaire after a median interval of 29.2 months. RESULTS: Eighty-eight percent of patients had excellent or very good results (cured: 62%, very improved: 26%). Four percent felt partially better and 8% failed but did not undergo surgery. No complication was noted. 41% suffered acute pain in the 24 hours following the procedure even though they were on nonsteroidal anti-inflammatory drug therapy (NSAID). CONCLUSION: These good results after more than two years support the promotion of this economical ambulatory treatment.

Adult↗
PubMedDate not supplied

Muscle biopsy investigations on neuromuscular insufficiency of the rotator cuff: a contribution to the functional impingement of the shoulder joint.

The possibility that functional impingement results from muscular imbalance has been discussed. This study investigates whether disturbance of muscular coordination is reflected in a shift in the balance of fast-twitch and slow-twitch fibers, as fast-twitch fibers enable a rapid reaction or contraction and slow-twitch fibers enable slow contractions and sustained performance. The supraspinatus and deltoid muscles in 37 patients with a supraspinatus syndrome and partial or complete rupture of the rotator cuff underwent biopsy. All three groups of patients showed a reduction in size, increased variability, and change in the frequency distribution of fiber cross sections. The fast-twitch fibers were especially affected. These findings were confirmed objectively by morphometric measurements. It might be concluded from the changes mentioned above that disturbance in coordination of the musculature can cause a functional impingement. We term this neuromuscular insufficiency of the rotator cuff. The mechanical factors relating to subacromial impingement may only have a role in promoting its manifestation by restricting the compensatory range of the joint.

Adult↗
PubMed2006

Ultrasound of the rotator cuff with MRI and anatomic correlation.

Magnetic resonance imaging and high-resolution ultrasound (US) are frequently used for the detection of rotator cuff tears. The diagnostic yield of US is influenced by several factors as technique, knowledge of the imaging characteristics of anatomic and pathologic findings and of pitfalls. The purpose of this article is to illustrates that the standardized high-resolution US examination of the shoulder covers the entire rotator cuff and correlates with MR imaging and anatomic sections.

Humans↗
PubMed2005

Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair.

BACKGROUND: The contact pressure and contact area at the tendon-bone interface after the most commonly used rotator cuff repair methods have not been investigated. HYPOTHESIS: There are no significant differences among the transosseous, the single-row suture anchor, and the double-row suture anchor techniques in terms of contact pressure, contact area, and pressure patterns at the tendon-bone interface. STUDY DESIGN: Controlled laboratory study. METHODS: After creating a full-thickness supraspinatus tendon tear in 10 cadaveric shoulder specimens, we inserted pressure-sensitive film between the tendon stump and the bone, and we repaired the tear by (1) transosseous, (2) single-row suture anchor, and (3) double-row suture anchor techniques. RESULTS: The contact area of the double-row technique was 42% greater than that of the transosseous technique (P < .0001) and 60% greater than that of the single-row technique. The contact area of the transosseous technique was 31% greater than that of the single-row technique (P = .0015). The average pressures of the single-row and double-row techniques were 18% (P = .014) and 16% (P = .03) greater, respectively, than that of the transosseous technique, but there was no significant difference between the single-row and double-row techniques (P = .915). CONCLUSIONS: The double-row technique produced the greatest contact area and the second-highest contact pressure, whereas the single-row technique created the highest contact pressure and the least contact area. The transosseous technique produced the second-greatest contact area and the least contact pressure. CLINICAL RELEVANCE: The double-row suture anchor technique and the transosseous technique may provide a better environment for tendon healing.

Absorbable Implants↗
PubMed1999

Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears.

Investigation of shoulder pain is important before surgical treatment. The presence or absence of a full-thickness rotator cuff tear (FTRCT) may determine the type of surgical treatment. Both MRI and conventional arthrography can be used, but little is known about their relative diagnostic and therapeutic impact. We performed a prospective trial assessing: (a) the influence of MRI and arthrography results on the clinician's diagnostic thinking (diagnostic impact); (b) the influence of the results on the clinician's therapeutic thinking (therapeutic impact); and (c) the diagnostic performance of the two techniques in patients with surgical confirmation. A total of 104 consecutive patients with shoulder problems referred to a specialist orthopaedic shoulder clinic underwent pre-operative investigation with MRI and arthrography. The surgeon's diagnosis, diagnostic confidence and planned treatment were measured before the investigation, and then again after the results of each investigation. Before the presentation of the investigation, results, the patients were randomised into two groups. In one group MRI was presented first; in the other group, arthrography. The MRI results led to fewer changes in diagnostic category (14 of 46, 30%) than arthrography (20 of 54, 37%), but the difference was not significant (P > 0.5). Magnetic resonance imaging led to slightly more changes in planned management (17 of 47, 36%) than arthrography (14 of 55, 25%), but again the difference was not statistically significant (P > 0.3). The results of the second investigation always had less diagnostic and therapeutic impact than the first. The accuracy of MRI for FTRCT in 38 patients with surgical confirmation was 79%, sensitivity 81% and specificity 78%; the accuracy of arthrography was 82%, sensitivity 50% and specificity 96%. The clinical diagnosis and management plan can be adequately defined by a single radiological investigation. Magnetic resonance imaging and arthrography had fairly similar diagnostic and therapeutic impact and comparable accuracy, although MRI was more sensitive and less specific. Magnetic resonance imaging may be the preferred investigation because of its better demonstration of soft tissue anatomy.

Adult↗
PubMed1988

Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.

Thirty-one patients who were unable to abduct the involved arm after reduction of a primary anterior dislocation of the glenohumeral joint were found to have a ruptured rotator cuff. All of the patients were more than thirty-five years old. Twenty-nine of them were initially presumed to have had an injury to the axillary nerve, although this injury was confirmed in only four of the twenty patients who had electrodiagnostic studies. In eight patients, the subscapularis tendon and anterior part of the capsule had ruptured from the lesser tuberosity. Recurrent instability developed in all eight patients, and repair of these structures alone was successful in restoring stability. The association between primary anterior dislocation of the glenohumeral joint and rupture of the rotator cuff in the older patient who cannot abduct the arm after reduction is poorly appreciated, as it is often missed. In our series of such patients, the incidence of injury to the axillary nerve was 7.8 per cent, as compared with 100 per cent for rupture of the rotator cuff. However, the comparative rates of occurrence of these two entities in older patients who have an anterior dislocation have not been determined.

Adult↗
PubMed2002

The use of the impingement test as a predictor of outcome following subacromial decompression for rotator cuff tendinosis.

PURPOSE: To evaluate the use of the impingement test as a predictor of outcome following subacromial decompression for patients with rotator cuff tendinosis. TYPE OF STUDY: Observational study. METHODS: An impingement test was administered to each patient immediately before surgery. Patients underwent a subacromial decompression and were assessed postoperatively at 3 and 6 months. The primary outcome measure was the Western Ontario Rotator Cuff Index (WORC). RESULTS: Thirty patients (mean age, 47.0 years; range, 29.4 to 71.2 years) took part in this study. There was no significant correlation between the classic impingement test (Neer's impingement sign before and after subacromial injection of local anesthetic) and the change in WORC score (r = -.174, P =.358). Similar results were obtained for the aggregate impingement test (pain at rest plus Neer's impingement sign plus Hawkins sign plus resisted abduction) before and after subacromial injection of local anesthetic (r = -.208, P =.270). When divided into categories of improvement following the classic impingement test (worse 0%-25%, 26%-50%, 51%-75%, 76%-100% better), there was no significant difference between groups for outcome as indicated by WORC score (P =.203). Results were similar for the aggregate impingement test (P =.271). CONCLUSIONS: The impingement test is a poor tool for predicting the success of subacromial decompression. There are 6 assumptions discussed that must hold true in order for the impingement test to be a useful predictor of outcome following subacromial decompression. If one or more of these assumptions are not met, or are only partially met, the impingement test would be rendered invalid as a predictor of outcome, as this study suggests.

Adult↗
PubMedDate not supplied

Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology.

We sought to determine the accuracy of ultrasound for the preoperative evaluation of shoulder impingement syndrome, rotator cuff tear, and abnormalities of the long head of the biceps tendon. The findings in 42 consecutive surgical cases were compared with the preoperative sonographic readings. Ultrasound detected all of the 10 full-thickness cuff tears identified at surgery (sensitivity 1.0, specificity 0.97) but detected only 6 of 13 partial-thickness cuff tears (sensitivity 0.46, specificity 0.97). A full-thickness tear was falsely diagnosed in one case of severe cuff abrasion. Dynamic scan criteria correctly diagnosed impingement in 27 of 34 cases (sensitivity 0.79, positive predictive value 0.96). Abnormalities of the long head of the biceps were accurately diagnosed with the exception of low-grade tendinitis and the superior labral tear, anterior to posterior, lesion. We concluded that ultrasound is a sensitive and accurate method of identifying patients with full-thickness tears of the rotator cuff, extracapsular biceps tendon pathology, or both. Dynamic ultrasound can help confirm, but not exclude, a clinical diagnosis of impingement.

Adult↗
PubMed2001

Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players.

Internal impingement is a primary cause of shoulder pain in throwers; however, instability, internal rotation deficit, scapula muscle dysfunction, and core muscle dysfunction are also important elements of the internal impingement process. Articular surface rotator cuff tears, posterior superior labrum tears, SLAP lesions, anterior capsular ligament attenuation, and posterior capsular ligament contracture are commonly seen in throwers. Each of these conditions must be recognized and appropriately treated to ensure the best possible outcome. There is little potential for spontaneous healing of rotator cuff tears and SLAP lesions after debridement.

Arthroscopy↗
PubMed2003

[Rehabilitation after shoulder rotator cuff surgery: in-patient or day-hospitalization (about 76 cases)].

OBJECTIVE: To define criteria of orientation in day-hospitalized or in-patient after shoulder rotator cuff surgery. METHOD: Population of 71 patients (53.2 years +/-7) (76 shoulders) operated for rotator cuff tear by the same surgeon, then treated by physical therapy either in day-hospitalization or in-patient. Weekly, evaluation until the second month after surgery by setting as criteria: pain, passive and active range of motion and complications. RESULTS: Fifty-three shoulders benefited from rehabilitation therapy in hospitalization and 23 in day-hospitalization. There is no significant difference for criteria studied between the 2 populations except for pains at the fifteenth day after surgery. Pain and articular steepness seem more frequent if the surgery is complex. DISCUSSION: Day-hospitalization and in-patient give equivalent results, which explain themselves by the possibility of identical physical medicine and rehabilitation performances. The knowledge of the social context is important to choose the most adapted rehabilitation type because patients can benefit from assistance for the acts of the daily life and the domestic tasks. In-patient allows more comfort but implies a familial break.

Female↗
PubMedDate not supplied

Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results.

Shoulder surgery is often associated with severe postoperative pain. Previous results in which single or continuous subacromial infiltration of local anesthetics was used as a method of postoperative pain relief have been contradictory. This study was initiated to evaluate the postoperative analgesic effect of a subacromial continuous 0.25% bupivacaine infusion at a rate of 6 mL/h after elective open shoulder surgery. We hypothesized that this procedure would improve postoperative analgesia while reducing morphine requirements. By use of a prospective, double-blind, randomized study design, 50 consecutive patients undergoing acromioplasty and rotator cuff repair surgery received a multiorifice catheter placed in the subacromial space. Twenty patients received 0.25% bupivacaine (group 1), and twenty-two patients received saline solution (group 2). The primary endpoints in the two groups were total morphine consumption administered by patient-controlled analgesia and the patient's subjective pain level evaluated by a visual analog scale during the first 48 postoperative hours. No major technical or pharmacologic side effects were noticed, and the indwelling pain catheter was well tolerated by all patients. There was no statistically significant difference (P < .05) either in total cumulative morphine consumption microg/48 h (73.2 +/- 43.1 vs 60.9 +/- 35.9) or in subjective pain perception 10-point visual analog scale (3.2 +/- 1.4 vs 3.1 +/- 1.5) between the two study groups. The continuous subacromial infiltration of 0.25% bupivacaine at a rate of 6 mL/h is concluded to be ineffective in providing pain relief supplementary to patient-controlled analgesia after open rotator cuff repair and acromioplasty surgery.

Adult↗
PubMed1988

Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency.

Seven cases of total shoulder arthroplasty exhibiting major glenoid radiolucent lines or actual translation of the glenoid component were evaluated to identify factors associated with glenoid loosening. The average time from arthroplasty was 30 months (range, 14-44 months). Six of the patients had severe, incompletely reconstructable rotator cuff tears present at the time of surgery, and one patient developed a cuff tear within 1 year of surgery. The amount of superior migration of the humeral component was closely correlated with the degree of glenoid loosening. With superior displacement of the humeral component, superior tipping of the glenoid component was observed: a "rocking horse" glenoid. For comparison, a contemporary group of 16 consecutive total shoulder arthroplasty patients with intact rotator cuffs were reviewed. The control group had no glenoid loosening an average of 5 years after operation. Upward riding of the prosthetic humeral head in patients with rotator cuff deficiency may contribute to loosening of the glenoid component in total shoulder arthroplasty.

Aged↗
PubMedDate not supplied

[Rotator cuff ruptures with predominant involvement of the subscapular tendon].

Among the all rotator cuff tears, the subscapularis lesions are quite rare. But a careful analysis leads to recognize them specially in case of antero-medial impingement between the coracoid process and the head of the humerus. This study of 25 observations where the rupture of the subscapularis was the predominant lesion, allows to emphasize some characteristics of them. The patients are often younger than for the other ruptures, a traumatic experience is not rare at the beginning of the history, the pain is usually the first symptom before the functional disability, the alterations of the rotator-interval and of the biceps tendon are very frequent, the arthroscanner is a very good help for the diagnosis and satisfying stitches are possible in case of early diagnoses. Lastly, the prognosis of these limited lesions is quite different than the one of very large cuff tears including the suscapularis tendon.

Adult↗
PubMed1987

The rotator cuff tear: MR evaluation.

Magnetic resonance imaging (MRI) is evolving as a particularly valuable diagnostic procedure in the evaluation of musculoskeletal pathology. To assess the role of MRI as applied to the shoulder, we examined eight normal volunteers, six patients with seven arthrographically proven rotator cuff tears and two patients with impingement symptomatology but with negative double contrast conventional and computed tomographic arthrography. The studies were performed on a 1-Tesla magnet operating at 0.5 Tesla. Coronal T1-weighted images were obtained in all cases and coronal spin density and T2-weighted pulse sequences were employed in two cases. In the normal individuals, the supraspinatus muscle and tendon could be consistently demonstrated. The proximal humeral marrow, the superior glenoid labrum, and the acromioclavicular joint could also be examined. Findings in patients with rotator cuff tears included: (1) hypointense gap within the supraspinatus muscle-tendon complex on T1-weighted sequences, (2) absence of a demonstrable supraspinatus tendon with narrowing of the subacromial space secondary to elevation of the humeral head, and (3) increased signal within the supraspinatus tendon on T2-weighted images. In the patients with impingement syndrome and negative arthrography, MR demonstrated elevation of the supraspinatus tendon with subacromial impingement in one case and a normal supraspinatus tendon in the other. Impingement on the coracoacroaminal arch causes progressive fibrosis, atrophy, and eventual tear of the rotator cuff. The potential applications of MRI relative to the shoulder include assessment of tendon retraction in patients with supraspinatus tears and noninvasive evaluation of patients with impingement syndrome, permitting etiologic determinations, hopefully before irreversible tendon injury has occurred.

Arthrography↗
PubMed2000

Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

OBJECTIVES: To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). DESIGN: Retrospective chart review SETTING: Orthopedic practice limited to disorders of the shoulder PARTICIPANTS: 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period MAIN OUTCOME MEASURE: Presence of partial or complete RCT on arthrogram RESULTS: 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P < .001), weakness with either elevation (P < .001) or external rotation (P < .001), arc of pain (P = .004), and impingement sign (P = .01). Stepwise logistic regression based on a derivation dataset (n = 191) showed that weakness with external rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age > or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. CONCLUSIONS: The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

Aged↗
PubMed1993

Treatment of rotator cuff impingement.

The author performed 497 shoulder decompression procedures between 1978 and 1989. Of these procedures, 252 (51%) had tears of the rotator cuff that were repaired concomitantly. The results were successful in over 90% of the cases. It is suggested that articular-surface tears or intratendinous tears are the possible cause of some of the failures of the open procedure. The findings also suggest that the use of arthroscopy or magnetic resonance imaging may be indicated in selected cases. However, for the appropriate patient, open shoulder decompression continues to be an excellent treatment.

Arthroscopy↗
PubMed1991

Carbon fiber for repair of the rotator cuff. A 4-year follow-up of 14 cases.

Thirteen patients with 14 large rotator cuff tears were operated on using carbon fiber to cover the defect. The median follow-up time was 4 years. In 11, 1, and 2 cases the results were respectively excellent or good, fair, and poor. In 2 cases where the carbon fiber was anchored to the major tuberosity, a bone cyst was seen, but it did not influence the result. A carbon fiber tow application combined with Neer's anterior acromioplasty seems useful in the reconstruction of large tears of the rotator cuff.

Acromion↗