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PubMed1998

[Histological and electron microscopic study of rotator cuff tear].

OBJECTIVE: To understand the changes of rotator cuff during tear and observe the pathologic and ultramicroscopic structure of rotator cuff. METHOD: Histological and ultra thin slides of samples of 36 cases of rotator cuff were made. RESULT: The degeneration of rotator cuff happened in synovium side, and then extended to the middle and deep sides of tendon. The deep side of cuff tendon could degenerate without synovium. The repair of tendon could be achieved with two types of healing. CONCLUSION: It would be difficult to achieve full repair when complete tear and deep side tear occurred to the rotator cuff.

Adult↗

PubMed2006

Rehabilitation of the rotator cuff: an evaluation-based approach.

Rotator cuff disease of the shoulder, a common condition, is often incapacitating. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on anecdotal clinical observation. The available literature on shoulder rehabilitation, in conjunction with clinical observation that takes into consideration the underlying tissue quality and structural integrity of the rotator cuff, can be compiled into a set of rehabilitation guidelines. The four phases of rehabilitation begin with maintaining and protecting the repair in the immediate postoperative period, followed by progression from early passive range of motion through return to preoperative levels of function.

Biomechanical Phenomena↗

PubMedDate not supplied

Diagnosis, classification and treatment of partial-thickness rotator cuff tears.

Partial-thickness rotator cuff tears are a challenge for shoulder surgeons. There is still no standard treatment protocol. The recent introduction of new arthroscopic techniques and a better grasp of pathogenic mechanisms along with a greater functional demand from patients, have led to the need for a thorough analysis of the problem. This paper analyses the literature in order to simplify the approach to treating partial-thickness rotator cuff tears.

Arthroscopy↗

PubMed1989

Decompressive surgery in the tendinitis and tear stages of rotator cuff disease.

Eighty-six shoulders with rotator cuff disease (54 with tendinitis and 32 with rotator cuff tear stage) operated on to relieve the impingement exerted by the coracoacromioclavicular arch on the rotator cuff were analyzed. The median follow-up time was 5.0 years. Partial resection of the anterior undersurface of the acromion, excision of the coracoacromial ligament or of the lateral end of the clavicle (and most commonly a combination of all three measures), were the methods used to achieve decompression. The final results show a substantial improvement in 83% of the cases. The results were related to the extent of acromial resection, preoperative range of the painful arc, and age ; but no statistically significant prognostic signs could be determined. There was some evidence, however, that a wide painful arc and extensive resection of the acromion were associated with a poor outcome. The indications for clavicular resection remain somewhat uncertain. Clavicular resection combined with acromioplasty seemed to give somewhat fewer good results, but the procedure is nevertheless indicated in cases with subacromial impingement associated with acromioclavicular osteoarthrithis. Decompressive surgery proved to be as effective in the tendinitis stage of the disease as in the case of rotator cuff tear. Conclusive operative release of shoulder impingement in rotator cuff disease is a useful procedure in patients with painful arc symptoms resistant to conservative treatment. The result can be improved by refinement of both indications and techniques.

Adult↗

PubMed2003

Magnetic resonance imaging of the shoulder: rotator cuff.

Magnetic resonance imaging has proven to be useful in the assessment of rotator cuff injuries. Improvements in magnetic resonance techniques, including fast spin-echo imaging and fat saturation, have facilitated demonstration of tendinous abnormalities of the rotator cuff. Rotator cuff disease is multifactorial. Primary impingement within the coracoacromial arch, degeneration of the rotator cuff tendons, trauma, and glenohumeral instability may be contributing factors. Shoulder pain in athletes can be related to acute myotendinous and muscle injuries, which can be easily detected using magnetic resonance imaging.

Athletic Injuries↗

PubMed2000

Tendon-Defect and muscle-unloaded models for relating a rotator cuff tear to glenohumeral stability.

Rotator cuff tear and glenohumeral instability are closely related. Any tear may disturb muscle force generation due to pain inhibition. In addition, a full-thickness tear may foster instability by removing a structural element constraining the joint. It was hypothesized that the loss of both dynamic force and static constraint with a rotator cuff tear will affect glenohumeral stability. In a tendon-defect model, dynamic and static elements of the joint were sacrificed. In a muscle-unloaded model, only the dynamic element was removed. The location and size of the defect were also investigated. The effect on instability of a small tendon defect was less than that of muscle unloading, implying that a patient with a small tear would have less instability than a patient with weak or nonfunctioning supraspinatus and infraspinatus muscles. On the other hand, with a larger tear the defect had a greater effect than muscle-unloading because sectioning of the glenohumeral and coracohumeral ligaments was included in the model. Clinically, such a defect in the front is critical for anterior stability because it might insult the important anterior capsule ligamentous complex. Orthopaedic surgeons should pay attention, therefore, to the effect of possible associated lesions of static constraints based on the size and location of the tear in addition to the dynamic stabilizer.

Aged↗

PubMed2005

The factor validity of the Western Ontario Rotator Cuff Index.

BACKGROUND: The Western Ontario Rotator Cuff Index (WORC) is a self-report questionnaire developed specifically to evaluate disability in persons with pathology of the rotator cuff of the shoulder. The authors created items in 5 categories based on a model of quality of life, but never validated this structure. The purpose of this study was to examine the validity of the original 5-domain model of the WORC by performing factor analysis. METHODS: Three hundred twenty nine subjects (age, mean: 52, SD: 12) were tested prior to undergoing surgery for rotator cuff pathologies. They completed the WORC, a self-report questionnaire, which has 21 items on the effect of the rotator cuff problem on symptoms, activities and emotions. Statistical calculations included correlations between items, Cronbach's alpha of the total scale and subscales, and principal component factor analysis with oblique rotation. RESULTS: Correlations ranged from .09 to .70 between all the items, from .29 to .70 between items within a subscale, and from .53 to .72 between subscale scores. Cronbach's alpha was .93 for the total scale, and .72 to .82 for the subscales. The factor analysis produced 3 factors that explained 57% of the variance. The first factor included symptoms and emotional items, the second included strength items and the third included daily activities. CONCLUSION: The results of this study did not support the 5-domain model of the WORC.

Adult↗

PubMedDate not supplied

Current concepts in arthroscopic rotator cuff repair.

The interest in arthroscopic rotator cuff repair has increased exponentially over the last 5 years. Although the operative technique of repair continues to evolve, there are now several studies reporting excellent results after arthroscopic repair of rotator cuff tears. In this review, we focus on new concepts and techniques related to arthroscopic rotator cuff repair that have been recently introduced.

Arthroscopy↗

PubMedDate not supplied

Arthroscopically enhanced "miniapproach" to rotator cuff repair.

The results of rotator cuff repair through a lateral deltoid splitting approach combined with arthroscopic subacromial decompression are presented in 18 patients with an average followup of 46 months. Sixteen patients (88%) scored good or excellent on the University of California at Los Angeles shoulder rating scale. Pain scores improved from an average of 1.6 to 7.6. Function scores improved from 2.5 to 8.4. Two patients had poor results; both had workers' compensation cases pending. One patient with a poor result had 2 complications: superficial infection and failure of repair that required reoperation. No other complications were encountered. Seventeen patients (94%) were satisfied with their results. This surgical technique, when used for patients with chronic impingement and rotator cuff tear, provides acceptable clinical results with minimal morbidity.

Accidental Falls↗

PubMed2025

The effects of N-acetylcysteine and adipose-derived stem cells on tendon healing in chronic rotator cuff tears: a rabbit model study.

BACKGROUND: Rotator cuff tears are associated with significant morbidity, and retear rates after surgical repair remain high, largely due to chronic degenerative changes such as muscle atrophy and fatty infiltration. This study aims to evaluate the effects of locally injected adipose tissue-derived stem cells and orally administered N-acetylcysteine, individually and in combination, on tendon healing in a rabbit model of chronic rotator cuff rupture. METHODS: Thirty-two male New Zealand white rabbits were used as models of chronic rotator cuff tear, surgically established by detaching the supraspinatus tendon and delaying repair to create a chronic defect. The rabbits were divided into four groups: Group A (control, saline-treated), Group B (N-acetylcysteine-treated), Group C (adipose tissue-derived stem cells-treated), and Group D (combined adipose tissue-derived stem cells and N-acetylcysteine-treated). Chronic rotator cuff tear repairs were conducted after six weeks. Histological, immunohistochemical, and biomechanical assessments were performed 12 weeks post-repair. Key outcomes included collagen organization, fatty infiltration, type I collagen expression, and tensile strength. RESULTS: Histopathological analysis revealed significantly improved collagen fiber alignment, reduced fatty infiltration, and decreased inflammation in Groups C and D compared to Groups A and B (p < 0.001). Immunohistochemical analysis revealed higher Type I collagen reactivity in Groups C and D, with Group D exhibiting the highest reactivity (p < 0.001). Biomechanical testing confirmed significantly increased load to failure in Groups C and D, with Group D achieving the highest values (p < 0.001). CONCLUSIONS: Adipose tissue-derived stem cells and N-acetylcysteine independently promote tendon healing, with adipose tissue-derived stem cells showing superior effects on collagen organization and fatty infiltration reduction. Combined treatment with adipose tissue-derived stem cells and N-acetylcysteine demonstrated synergistic effects, resulting in optimal tendon regeneration and strength. These findings support the potential of adipose tissue-derived stem cells and N-acetylcysteine as complementary therapies for chronic rotator cuff injuries. Further research is warranted to explore their mechanisms of action and clinical applications.

Animals↗

PubMed1995

The rotator cuff.

The functional anatomy of the rotator cuff and its relationship to the mechanism of shoulder joint movements and control is now becoming more clearly understood. Common variations in the anatomy of the acromion and the subacromial region, particularly the coraco-acromial ligament, and its relationship to the tendon of the supraspinatus are now seen to be major determinants of degenerative changes in the rotator cuff. Changes in the matrix of the musculotendinous region, which may be related to mechanical interference with the vascular supply to the tendon are now a possible determinant of early degenerative changes (both primary, and those secondary to trauma) in the rotator cuff. The relationship of these findings to the management of lesions of the rotator cuff is discussed.

Humans↗

PubMed2003

The rotator cuff: biological adaptations to its environment.

The rotator cuff is a common source of shoulder pain in individuals who rely on overhead activities for work and sport. As diagnostic and treatment measures continue to advance, it is important for the physician to retain a knowledge of the anatomy and biological properties of the rotator cuff in its surroundings. The collagen composition, proteoglycan and glycosaminoglycan content, and cellular activity of the rotator cuff reflect its mechanical function. Also, the rotator cuff maintains fibrocartilagenous properties as it is under compression in its normal state. While many of these characteristics appear to be adaptive and occur in the healthy rotator cuff, some may predispose the tendon complex to pathology.

Adaptation, Physiological↗

PubMed1989

[The rotator cuff syndrome--a frequent disease caused by loading].

The rotator cuff syndrome is defined as a cronical pain syndrome, originating from the rotator cuff with characteristic pain and referred pain. Disorders evolving from the rotator cuff and the rotator muscles comprise between 70 og 90% of the shoulder disorders. The rotator cuff syndrome may be of occupational origin, particularly in heavy work with tasks at or above shoulder level, e.g. shipyard welders and plate workers. Biomecanically surveys show that continuous blood flow in the rotator muscles ceases at about 30 degrees of flexion or abduction of the upper arm. Electromyographic examinations have shown high muscle tension in the same muscles in assembly plant employees. High prevalences of shoulder pain have been shown in these groups and it is considered that the workers are actually suffering from disorders in the rotator cuff and its muscles. The rotator cuff syndrome is on the list of occupational disorders in the Danish Workers' Compensation Act but, in the authors' experience knowledge on etiology, examination and treatment is insufficient. Diagnostic criteria are proposed with the object of improving clinical practice and medical insurance declarations.

Female↗

PubMed2004

Biomechanical evaluation of arthroscopic rotator cuff stitches.

BACKGROUND: The suture configurations in arthroscopic rotator cuff repairs have been limited to simple and horizontal stitches. Recent objective evaluations have demonstrated high failure rates of arthroscopic repairs of rotator cuff tears. A novel stitch for arthroscopic repair of the rotator cuff, the massive cuff stitch, was developed to increase the strength of the suture-tendon interface. The goal of this study was to determine the biomechanical properties of the massive cuff stitch and to compare it with other stitches commonly used for rotator cuff repair. METHODS: Eight pairs of sheep infraspinatus tendons were harvested and split in half to yield a set of four tendon specimens from each animal. Four stitch configurations (simple, horizontal, massive cuff, and modified Mason-Allen) were randomized and biomechanically tested in each set of tendon specimens. Each specimen was first cyclically loaded on an MTS uniaxial load frame under force control from 5 to 30 N at 0.25 Hz for twenty cycles. Each specimen was then loaded to failure under displacement control at a rate of 1 mm/sec. Cyclic elongation, peak-to-peak displacement, ultimate tensile load, and stiffness were measured with use of an optical motion analysis system and load-cell output. The type of failure (suture breakage or pull-out) was also recorded. A repeated-measures analysis of variance was performed on the results, with the alpha level of significance set at p < 0.05. RESULTS: There was no difference in cyclic elongation or peak-to-peak displacement among the four stitches. Ultimate tensile load was significantly higher (p < 0.05) for the massive cuff stitch (233 +/- 40 N) and the modified Mason-Allen stitch (246 +/- 40 N) than it was for either the simple stitch (72 +/- 18 N) or the horizontal stitch (77 +/- 15 N). There was no significant difference in the ultimate load between the massive cuff and modified Mason-Allen stitches. There was also no difference in stiffness among the four stitches. The simple and horizontal stitches failed by tissue pull-out, whereas the massive cuff and Mason-Allen stitches failed by a mixture of suture breakage and pull-out. CONCLUSIONS: The massive cuff stitch provides strength comparable with that of the modified Mason-Allen stitch commonly used in open rotator cuff repair. The ultimate tensile load before failure of the massive cuff stitch was significantly higher (p < 0.05) than that of the simple and horizontal stitches.

Animals↗

PubMed2003

The difficulties of ambulatory interscalene and intra-articular infusions for rotator cuff surgery: a preliminary report.

PURPOSE: Rotator cuff repair may result in severe postoperative pain. We compared a continuous intra-articular infusion to a continuous interscalene block with ropivacaine for patients undergoing outpatient rotator cuff repair. METHODS: Seventeen patients were randomized to one of two groups: 1) interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative intra-articular infusion or; 2) interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative continuous interscalene infusion. Infusions were 0.2% ropivacaine at 10 mL x hr(-1) for both groups. Infusions were maintained for 48 hr. Patients were discharged on the day of surgery. Verbal analogue pain scores (VAS) and postoperative oxycodone consumption were measured for 48 hr. RESULTS: Eight patients (47%; four in each group) had side effects or logistical problems complicating care. The mean VAS scores at rest and with movement in the postanesthesia care unit and at 12 hr, 24 hr, and 48 hr were not different (P > 0.1). Inadequate analgesia was reported in 50-75% of all study patients. Time until first oxycodone use was similar between groups 829 min +/- 432 (interscalene) and 999 min +/- 823 (intra-articular; P = 0.6). Total oxycodone consumption was also similar 49 mg +/- 48 and 59 mg +/- 51 (P = 0.7), respectively. CONCLUSIONS: This study demonstrates the difficulties of ambulatory interscalene and intra-articular infusion for rotator cuff surgery. The high VAS scores and need for additional medical care suggest that intra-articular administration may not be reasonable for this magnitude of surgery. Further refinement of the perineural local anesthetic infusion is necessary to consistently provide analgesia after ambulatory rotator cuff surgery.

Amides↗

PubMed2001

Technique of open rotator cuff repair.

With current surgical techniques, open rotator cuff repair can provide significant functional improvement and pain relief in the majority of patients. Important principles include performing anterior acromioplasty, bursal resection, rotator cuff mobilization, tension-free repair to the greater tuberosity with nonabsorbable sutures, and meticulous deltoid repair. In massive rotator cuff tears, the coracoacromial ligament should be repaired to prevent anterosuperior instability, and partial repair of the rotator cuff is recommended over performing transfer procedures. Postoperative rehabilitation requires the patient to avoid active exercises for 6 weeks and weights for 3 months. With these techniques, 85% to 90% satisfactory results can be expected.

Decompression, Surgical↗

PubMed1986

Rotator cuff injuries.

The rotator cuff lends stability to the glenohumeral joint and provides active motion. The cuff is susceptible to attritional disease, and as a result, injuries tend to fall into an age-related spectrum. Symptoms and treatment vary with the severity of the injury. Full-thickness cuff tears are suspected clinically, diagnosed by arthrography, and treated surgically by decompressing the impingement interval and repairing the defect. Postoperative care includes six weeks of immobilization, followed by an intensive physiotherapy program designed to regain shoulder range of motion, strength, and functional use. First-time surgery is associated with 70% to 90% good to excellent results. Repeat surgery, however, is far less successful.

Arthrography↗

PubMed1981

Tears of rotator cuff.

Tears of the rotator cuff can be very challenging for the surgeon. He should be aware of the variations in the pathologic lesions that can be encountered and should understand the functions of the cuff-capsule mechanisms so that deficiencies can be appropriately defined and treated. A definite diagnosis, based on the history, physical examination, roentgenography, and arthrography, should be made. In some patients with acute tears of the rotator cuff, early operative treatment is warranted. Chronic cuff disease is often treated conservatively. When operative invervention is justified, the anterior or anterosuperior surgical approach is most useful, and the classic plastic surgery flap techniques provide a model for planning and executing the repair. Postoperative external support and the physical therapy program should be tailored to the complexity and the security of the cuff repair.

Humans↗