[Shoulder injuries in sports. Interview by Christiane Wesloh].
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Athletic Injuries↗
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Results for “Rotator Cuff Injuries”
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Complications of humeral head replacement for proximal humeral fractures.
The indications for humeral head replacement in acute fractures and in chronic fracture problems have been studied over many decades and are reasonably well defined. Complications have probably been understudied. Many different complications occur, and their frequency and the need for reoperation is quite high. Because of the variety of complications that occur, familiarity with preventive measures and treatment options is important, not only to deal with complications arising from endoprostheses, but also to treat musculoskeletal infections, nerve injuries, fractures, instability, nonunion of tuberosities, malunion, and rotator cuff or capsule contracture or tearing. Physicians also must be able to integrate reparative/reconstructive surgery with a program of postoperative rehabilitation. The challenges are many. Treatment often provides considerable improvement for the patient, but often the extent of the improvement is somewhat less than optimal.
Adult↗
Impact of smoking on structural failure after arthroscopic rotator cuff repair: a systematic review and meta-analysis.
BACKGROUND: Rotator cuff tears cause significant shoulder pain and functional limitation. Arthroscopic rotator cuff repair improves symptoms, yet structural failure rates remain substantial. Smoking may impair tendon-to-bone healing, but clinical studies report mixed findings due to heterogeneous methodology. Therefore, a systematic synthesis of imaging-confirmed outcomes is needed to clarify the association between smoking and structural failure after arthroscopic rotator cuff repair. METHODS: This review followed PRISMA 2020 and was registered in PROSPERO (CRD420251246197). PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 12 December 2025. Comparative clinical studies of adults undergoing arthroscopic rotator cuff repair that reported imaging-confirmed structural integrity (magnetic resonance imaging or ultrasonography) at ≥6 months were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. The primary outcome (structural failure) was pooled as risk ratios using a random-effects model with the restricted maximum likelihood estimator and Hartung-Knapp adjustment. Secondary continuous outcomes were synthesized using Bayesian random-effects models; subgroup, sensitivity, and meta-regression analyses explored heterogeneity. RESULTS: Ten cohort studies (1,683 shoulders) were included. Smoking was associated with a higher risk of imaging-confirmed structural failure (risk ratio 1.53; 95% confidence interval 1.13-2.08; P = .011) with low heterogeneity (I2 = 24.7%). Subgroup and sensitivity analyses supported robustness, with no evidence of effect modification by region, follow-up duration, tear size, or smoking definition. Meta-regression showed no significant influence of age, smoking prevalence, or diabetes prevalence on the pooled effect. Secondary outcomes (3 studies) suggested slightly lower postoperative American Shoulder and Elbow Surgeons scores among smokers, while visual analog scale pain scores and forward flexion showed no clear between-group differences. No publication-bias signals were detected for the primary outcome. CONCLUSION: Smoking is associated with a higher risk of imaging-confirmed structural failure after arthroscopic rotator cuff repair. Functional outcomes were broadly similar between groups, with only a small, likely clinically negligible reduction in American Shoulder and Elbow Surgeons scores among smokers. These findings support careful smoking history assessment and perioperative risk modification, including smoking cessation strategies.
Humans↗
Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study.
PURPOSE: To critically compare arthroscopic and mini-open rotator cuff repair. TYPE OF STUDY: Retrospective case control study. METHODS: Nine patients who had an arthroscopic rotator cuff repair (ARCR) were matched for age, gender, dominance, side of injury, history of trauma, duration of symptoms, and type of rotator cuff injury, with 12 patients who had a mini-open rotator cuff repair (MOR). Comparison included a preoperative and postoperative physical examination as well as a completed Simple Shoulder Test (SST) questionnaire at the latest follow-up at a minimum of 27 months. RESULTS: Both groups had significant reductions in pain scores (P < .01) and there was no significant difference in preoperative or postoperative active flexion or external rotation between both groups (P > .20). Although the ARCR group showed a significant improvement in strength (P < .01) and the MOR group did not, no patient had less than 4/5 strength. The impingement sign remained positive in 1 MOR patient, but all patients had a negative Jobe's test result. Pain and Tasks assessment by SST questionnaire showed that neither group had night pain or discomfort when using their arms overhead. There were no significant differences in the overall SST scores between groups. CONCLUSIONS: Because all patients in each group were satisfied with the procedure and there were no objective differences in outcome, we conclude that there is no difference in outcome between ARCR and MOR. Thus, the choice of one approach over the other is best based on surgeon or patient preference. LEVEL OF EVIDENCE: Level III, Retrospective Case Control Study.
Activities of Daily Living↗
Fortnightly review: Corticosteroid injections in tendon lesions.
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Achilles Tendon↗
Surgical treatment of shoulder injuries in tennis players.
There are a number of disorders that affect the shoulder of the tennis player. The majority of these disorders are approached conservatively at first, and surgery is generally reserved for those with advanced stages of disease, or those who fail conservative treatment. Most surgical procedures for the shoulder are done open; however, arthroscopic techniques are advancing rapidly, and are expected to eventually supersede open surgical procedures. In either case, the postoperative rehabilitation program is an essential part of the surgical treatment of these disorders, and should not be neglected.
Acromioclavicular Joint↗
Problems with the shoulder, knee, ankle and foot.
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Ankle Joint↗
The impact of MRI on our understanding of the pathology of sports injuries.
NMR imaging has become an important diagnostic tool in the evaluation of musculoskeletal disease. However, its ability to evaluate pathogenic mechanisms of disease may eventually have even a greater impact on patient care. NMR imaging has significantly affected our understanding of the clinical significance of meniscal tears and appropriate patient management. It has also extended our understanding of the prevalence and importance of x-ray and arthroscopically occult bone, tendon and ligament injuries. By knowing the pathogenic mechanisms of disease, we can more reliably diagnose and treat pathology. In particular, many horizontal degenerative tears in older patients may be asymptomatic and are best left in place. Many acute tears may be best treated with immediate meniscal repair. MR imaging can reliably different these tear types with non-invasive imaging. MR's ability to detect bone injuries may lead to aggressive early non-weightbearing on injured bone, thereby preserving the subchondral bone from collapse and the joint from secondary osteoarthrosis. MRI's ability to detect and stage degenerative tendonosis of tendons and ligaments, such as the rotator cuff, may lead to arthroscopic decompression or debridement which provides symptomatic relief and may preserve and protect the intact cuff.
Adolescent↗
Superior glenoid impingement. Current concepts.
In the current decade impingement syndrome is becoming a less precise diagnostic entity. It is splitting into several categories of more exact diagnoses. The concept development, clinical picture, and currently recommended treatment of 1 of these entities, the superior glenoid impingement is reviewed. The complaint may be acute or chronic and may involve 1 or more of 5 structures: (1) superior labrum, (2) rotator cuff tendon, (3) inferior glenohumeral ligament, (4) greater tuberosity, and (5) the bony glenoid. The most commonly seen clinical entity is chronic dorsal shoulder pain in an athlete who throws with a positive relocation test. Treatment consists of strengthening of the cuff and scapular rotators. When there has been excessive inferior ligament stretch this must be augmented by anterior reconstruction.
Arthroscopy↗
Surgical repair of chronic rotator cuff tears. A prospective long-term study.
BACKGROUND: Rotator cuff disease or injury is one of the most frequently seen orthopaedic conditions, and surgical repair of rotator cuff tears is a common procedure. A prospective analysis of the operation, with consistent assessment of patient characteristics, variables associated with the rotator cuff tear and repair techniques, and outcome factors, was performed. METHODS: One hundred and five shoulders with a chronic rotator cuff tear underwent open surgical repair and acromioplasty between 1975 and 1983. The patients were followed for an average of 13.4 years (range, two to twenty-two years). There were sixteen small tears, forty medium tears, thirty-eight large tears, and eleven massive tears. The tears were repaired directly (seventy-two tears), by V-Y plasty (twelve), by tendon transposition (twenty), or by reinforcement with a fascia lata graft (one). The long head of the biceps had been previously torn in eleven shoulders and was tenodesed in three other shoulders. In fifty-six shoulders, the distal part of the clavicle was excised for treatment of degenerative arthritic changes, often associated with osteophyte formation. RESULTS: Satisfactory pain relief was obtained in ninety-six shoulders (p < 0.0001). There was significant improvement in active abduction (p < 0.001) and external rotation (p < 0.007) as well as in strength in these directions of movement (p < 0.03 and p < 0.002, respectively). At the latest follow-up evaluation, the result was rated as excellent for sixty-eight shoulders, satisfactory for sixteen, and unsatisfactory for twenty-one. Tear size was the most important determinant of outcome with regard to active motion, strength, rating of the result, patient satisfaction, and need for a reoperation. Older age, less preoperative active motion, preoperative weakness, distal clavicular excision, and a transposition repair technique were all associated with larger tear size. There were eight reoperations; five were for rerepair of a persistent or recurrent rotator cuff tear. CONCLUSIONS: Standard tendon repair techniques combined with anterior acromioplasty, postoperative limb protection, and monitored physiotherapy can produce consistent and lasting pain relief and improvement in range of motion. Improving the results of this procedure will depend upon the development of new techniques to address the active motion and strength deficiencies following repair of massive rotator cuff tears.
Acromion↗
Shoulder injuries in tennis players.
The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. A well balanced action of the rotator cuff muscles and capsular structures is necessary to obtain a stable centre of rotation during the overhead action. This review concerns shoulder injuries, related to the overhead motion in tennis players, which can be explained by the same mechanism as thrower's shoulder.
Biomechanical Phenomena↗
Postoperative eccentric and concentric isokinetic strength for the shoulder rotators in the scapular and neutral planes.
Considerable variability exists for isokinetic testing of the shoulder rotators, leaving the clinician in a quandry concerning the most appropriate method for patient evaluation. The purpose of this study was to evaluate concentric and eccentric rotational strength in the scapular and neutral planes for the surgical and nonsurgical shoulders. Fifteen males consented to be tested during a 90-minute isokinetic session. Both shoulders for each patient were tested concentrically (240 degrees/sec) and eccentrically (120 degrees/sec) in the scapular and neutral planes. Patient positioning was maintained through the use of a goniometer, plumb line, and floor grid system. Following a warmup, five maximal effort reciprocal internal and external rotation concentric and eccentric contractions were evaluated using multiple two-way analyses of variance (shoulder x plane) with repeated measures. Results indicated no statistically significant differences between the surgical or nonsurgical shoulders for either concentric (p = .063-.247) or eccentric (p = .460-.840) modes, regardless of test plane. No statistically significant differences were observed eccentrically between test planes (p = .06-.470), but the scapular plane produced significantly higher (p = .005) peak torques concentrically. Generally, the external rotators were 53.0% (concentrically) and 63.0% (eccentrically) of the internal rotator strength for either shoulder. Clinically, concentric and eccentric testing of the postoperative shoulder patient can occur in either the scapular or the neutral plane. However, the scapular plane may be preferred since it is more functionally relevant and less injurious to the rotator cuff. A full, functional recovery may be expected for the rotator cuff repair patient.
Adult↗
[Anything new in sports traumatology? Round table].
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Ankle Injuries↗
Diagnosis and treatment of rotator cuff tears in the emergency department.
This article will review the diagnosis and management of rotator cuff tears in the emergency department. Rotator cuff disease is a common source of shoulder pain. It encompasses a wide range of pathology of the rotator cuff tendons. These lesions can include impingement or tendinitis, and may progress to rupture of the tendons. In considering the emergency department management of cuff tears, it is useful to classify patients by the mechanism of their injury. Proper classification of patients requires a careful history and physical examination. Interpretation of these data is based on an understanding of the entire range of pathology that can affect the tendons of the rotator cuff.
Diagnosis, Differential↗
[Complex trauma of the shoulder girdle].
Complex injuries of the shoulder require differentiated management. Interestingly there is a relative lag of warranted information on this subject. Generally the different lesions are discussed separately. However it is not acceptable to simply add the standard diagnostic and therapeutic measures, because major tactic, strategic and rehabilitation incompatibilities could occur. Diagnostic and therapeutic difficulties are frequent for the following injuries: complex proximal humerus dislocation fractures, dislocation fractures with associated lesions of the rotator cuff, posterior dislocation fractures, peri- and intraarticular segmental fractures and fractures or dislocations associated with major neurovascular lesions. Increased awareness of the most relevant diagnostic and therapeutic aspects should contribute to optimize treatment protocols.
Fracture Fixation, Internal↗
The presence of smooth muscle actin in fibroblasts in the torn human rotator cuff.
The rotator cuff frequently sustains athletic and occupational injury, often resulting in chronic pain and disability. However, despite the high incidence of such shoulder problems, the pathophysiology of rotator cuff injury and healing has not yet been fully elucidated. The notable finding of this study was the presence of a contractile actin isoform, alpha-smooth muscle actin (SMA), in nonvascular cells in all of the seven torn human rotator cuff specimens evaluated immunohistochemically. Up to 95% of cells in any one region, and over 95% of elongated cells found in association with crimped collagen, contained SMA. Most of the cells staining positive for SMA in these sections had morphological features of the fibroblast, though a small number were chondrocyte-like. Treatment of cells growing out from human rotator cuff explants with TGF-beta1 significantly increased the amount of SMA evaluated by Western blot analysis. PDGF-BB and IFN-gamma had no effect on the cell content of SMA. This is the first documentation of the presence of SMA-positive cells in the human rotator cuff tendon. SMA has been found in a number of other healing connective tissues including skin, ligament, meniscus, cartilage, and other types of tendon. Of importance are previous findings that SMA-positive cells can contract a collagen-glycosaminoglycan analog of extracellular matrix in vitro. The results of the present study thus suggest that SMA-containing cells could contribute to the retraction of the torn ends of a ruptured rotator cuff and play an important role in healing.
Actins↗
Glenoid version and rotator cuff tears.
The purpose of this study was to determine the relationship between rotator cuff (RC) tear and the orientation of the glenoid. Ninety-six shoulders (94 patients) that underwent open RC repair were grouped according to the type of tear. We measured on MRI the acromio-glenoid angle (AG) and the supraspinatus fossa glenoid angle on the anterior-posterior (SGAP) and axial (SGAX) views. RC patients had a smaller AG angle (76+/-7 degrees vs. 86+/-10 degrees ) and a larger SGAP angle (112+/-6 degrees vs. 102+/-7 degrees ) compared to controls (p<0.001). We also found a highly significant difference (p<0.001) in glenoid version measured by SGAX between anterior cuff tears (-5+/-4 degrees ) and posterior cuff tears (3+/-3 degrees ). Furthermore, we identified an association between RC tear and the orientation of the glenoid relative to the axis of the supraspinatus fossa. Greater retroversion is predictive of an anterior cuff injury and greater anteversion is predictive of a posterior cuff injury.
Humans↗
The influence of the acromial coverage index in rotator cuff tears.
Several intrinsic and extrinsic factors have been advocated in the pathogenesis of rotator cuff tears, but it is still unclear whether the origin of the tear is related to tendon degeneration itself or induced by several morphologic changes. The purpose of this study is to determine the relationship between the acromial coverage of the humeral head and the presence of a cuff tear. We evaluated 148 shoulders, including 45 that underwent surgical rotator cuff repair (group I), 26 with documented rotator cuff tears treated conservatively (group II), and 77 with no cuff pathology as a control group (group III). The mean acromial coverage index was 0.68 in group I, 0.72 in group II, and 0.59 in group III, giving a highly significant difference (P < .0001) between the control group and both cuff tear groups. Patients with a cuff tear have a significantly higher acromial coverage index than the control group.
Acromioclavicular Joint↗