[Acromial obstructions and the rupture of the rotator cuff. Indications and results of surgical treatment (author's transl)].
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Adult↗
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Results for “Rotator Cuff”
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[Value of arthropneumotomogrhy in the preoperative assessment of ruptures of the rotator cuff posing a surgical problem].
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Humans↗
Rotator-cuff tear of the hip.
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Femoral Neck Fractures↗
Arthroscopic biceps tendon tenodesis: the anchorage technical note.
Treatment of long head biceps (LHB) tendon pathology has become an area of renewed interest and debate among orthopaedic surgeons in recent years. The background of this manuscript is a description of biceps tenodesis which ensure continual dynamic action of the tendon which depresses the head and impedes lateral translation. A new technique has been developed in order to treat LHB tendon irreversible structural abnormalities associated with cuff rotator lesions. This technique entails the construction of a biological anchor between the LHB and supraspinatus and/or infraspinatus tendons according to arthroscopic findings. The rationale, although not supported by biomechanical studies is to obtain a triple, biomechanical effect. The first of these biomechanical effects which we try to promote through the procedure of transposition is the elimination of the deviation and oblique angle which occurs as the LHB completes its intra-articular course prior to reaching the bicipital groove. Furthermore, we have found this technique extremely useful in the presence of large ruptures of the rotator cuff with muscle retraction. The most common complication associated to this particular method, observed in less than 3%, is failed biological fixation which manifests as subsidence of the tenodesis and consequent descent of the tendon with evident aesthetic deformity.
Arthroscopy↗
Subacromial space measurement: a reliable method indicating fatty infiltration in patients with rheumatoid arthritis.
Proximal migration of the humeral head is thought to indicate fatty infiltration of the rotator cuff muscles or rotator cuff tears. We sought to evaluate the influence of these rotator cuff abnormalities on the subacromial space. Using anteroposterior radiographs, ultrasound, and computed tomography, we analyzed 54 shoulders in 29 patients with rheumatoid arthritis. The upward migration index was defined as proximal migration of the humeral head relative to its size. The mean muscle density from computed tomography images was used to indicate fatty infiltration. Fatty infiltration of the infraspinatus muscle showed the strongest correlation with proximal migration. After correcting for age, cuff tears, and rheumatoid disease, the partial correlation coefficient between both remained strong. A subdivision in proximal migration is proposed to screen for rotator cuff abnormalities. A large amount of fatty infiltration was indicated by an upward migration index less than 1.25, a medium amount by an upward migration index between 1.25 to 1.35, and a small amount by an upward migration index greater than 1.35. Measurement of proximal migration using the upward migration index provides a reliable screening method indicating fatty infiltration of the rotator cuff.
Acromion↗
[The course of historical development of treatment approaches to rotator cuff-related problems].
Rotator cuff-related issues and problems first appeared in the medical literature in the eighteenth century. A significant amount of knowledge was obtained on diagnosis and treatment over the twentieth century, most of which is the result of pioneering work of Codman and Neer. In this review, a chronological course of development is tracked to better understand future venues.
Europe↗
Attrition sign in impingement syndrome.
Extrinsic compression of the rotator cuff by the coracoacromial arch has been accepted as a major factor in the etiology of bursitis, cuff tendonitis, and rotator cuff tears. Other etiologies for rotator cuff syndrome have also been proposed in various patient populations. These include repetitive microtrauma and underlying instability with tensile overload, particularly in the younger (younger than 35) athletic population. In this evolving field, the arthroscopist must to be able to recognize arthroscopic signs of impingement syndrome. Therefore, this paper discusses evaluating rotator cuff syndromes and reviews the signs of subacromial impingement found at bursoscopy. We also offer several tips to maximize visualization during shoulder bursoscopy.
Arthroscopy↗
Postoperative shoulder rehabilitation.
This article focuses on the rehabilitation considerations for several shoulder surgeries: acromioplasty, rotator cuff repair, rotator cuff debridement, Bankart repair, thermal capsulorrhaphy, superior labral anterior posterior repair, multidirectional instability, proximal humerus fracture, surgical management of the stiff shoulder, arthroplasty,and fusion. General guidelines are presented for discussing and planning rehabilitation for patients, including exercises, timing of progression, patient education, precautions or restrictions, and expectations.
Acromion↗
Hemiarthroplasty in rotator cuff-deficient shoulders.
Between 1974 and 1990 a Neer humeral hemiarthroplasty was used in 20 patients (21 shoulders) with combined glenohumeral arthritis and complete degenerative lesions of the rotator cuff. Patients were monitored for an average of 4 years (range 2 to 6.6 years). The coracoacromial ligament was preserved as a restraint against anterosuperior displacement. The rotator cuff defect was irreparable, and no attempt was made to cover the superior defect. Two patients underwent transfer of the sternocostal portion of the pectoralis major to the lesser tuberosity for subscapularis insufficiency and anterior subluxation. After the operation rehabilitation of the deltoid was aggressively pursued. With limited goals criteria described by Neer, 18 (86%) shoulders achieved satisfactory results. Pain scores improved from a mean of 2.9 (scale of 0 to 3) before operation to 0.6 after operation. All patients had lower pain scores after operation. However, only 12 shoulders had no pain (pain score of 0). Average active flexion improved to 120 degrees after operation from 70 degrees before operation. However, five patients achieved less than 90 degrees of active flexion after operation. Active external rotation improved from a mean of 27 degrees (range 0 degrees to 65 degrees) to a mean of 46 degrees (range 0 degrees to 70 degrees). No instances of postoperative instability occurred. Although the results of hemiprosthetic replacement in this difficult patient population are inferior to results experienced by patients with an intact rotator cuff, the improvement of pain and preservation of function obtained make it an attractive alternative to arthrodesis, resection arthroplasty, or constrained arthroplasty.
Aged↗
Morphogenetic effect of rotated skin cuffs on tail regeneration in Plethodon cinereus.
As an epimorphic system, the urodele tail has much in common with the urodele limb, relative to tissue components. In an effort to elucidate potentially similar functions of the skin during regeneration, two procedures which have been shown to be highly disruptive of limb morphogenesis were performed on the tail. In the first, cuffs of tail skin were rotated 180 degrees about the long axis of tails in Plethodon cinereus. Subsequent amputation through the rotated cuffs produced regenerates at a normal rate which were also normal in both internal architecture and skin gland distribution. In a second series, cuffs of tail skin were rotated 90 degrees about the dorso-ventral axis of the tail, such that the dorsal red stripe encircled the tail. Upon amputation through the middle of the cuff, the stump skin presented an exclusively dorsal surface which, nevertheless, had no effect upon the morphogenetic success of the regenerate. These data therefore indicate that a tissue, such as skin, may be inconsistent in its morphogenetic influence among epimorphic fields within the same organism. It is not clear whether these results reflect differences in field behavior or in absolute tissue potential determined by the field of origin. A tissue hierarchy of morphogenetic influence within and among epimorphic fields is suggested as a preliminary framework within which to coordinate such information.
Amputation, Surgical↗
Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings.
Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenoid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery.
Acromion↗
Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome.
BACKGROUND: Several tests for making the diagnosis of rotator cuff disease have been described, but their utility for diagnosing bursitis alone, partial-thickness rotator cuff tears, and full-thickness rotator cuff tears has not been studied. The hypothesis of this study was that the degree of severity of rotator cuff disease affects the diagnostic values of the commonly used clinical tests. METHODS: Eight physical examination tests (the Neer impingement sign, Hawkins-Kennedy impingement sign, painful arc sign, supraspinatus muscle strength test, Speed test, cross-body adduction test, drop-arm sign, and infraspinatus muscle strength test) were evaluated to determine their diagnostic values, including likelihood ratios and post-test probabilities, for three degrees of severity in rotator cuff disease: bursitis, partial-thickness rotator cuff tears, and full-thickness rotator cuff tears. A forward stepwise logistic regression analysis was used to determine the best combination of clinical tests for predicting the various grades of impingement syndrome. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the eight tests varied considerably. The combination of the Hawkins-Kennedy impingement sign, the painful arc sign, and the infraspinatus muscle test yielded the best post-test probability (95%) for any degree of impingement syndrome. The combination of the painful arc sign, drop-arm sign, and infraspinatus muscle test produced the best post-test probability (91%) for full-thickness rotator cuff tears. CONCLUSIONS: The severity of the impingement syndrome affects the diagnostic values of the commonly used clinical tests. The variable accuracy of these tests should be taken into consideration when evaluating patients with symptoms of rotator cuff disease.
Diagnostic Techniques and Procedures↗
The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management.
The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.
Arthritis, Rheumatoid↗
Etiologies of shoulder pain in cervical spinal cord injury.
A protocol including physical examination, plain radiography, and shoulder arthrography was designed to study prospectively the causes of shoulder pain in patients with cervical spinal cord injury. Twenty-four patients (30 shoulders) were studied and subdivided into acute and chronic groups. The causes of shoulder pain in the acute group of 11 patients (15 shoulders) included capsular contracture or capsulitis or both in 6 shoulders; rotator cuff tears in 4; anterior instability in 2; and rotator cuff impingement, osteoarthritis with osteonecrosis, and osteoarthritis in 1 each. Of 13 patients (15 shoulders) assigned to the chronic group, the diagnoses included anterior instability in 5 shoulders; multidirectional instability in 3; capsular contracture or capsulitis or both in 3; and Charcot arthropathy, rotator cuff tear, rotator cuff impingement, and scapular pain in 1 each. To prevent and treat shoulder pain, therapeutic protocols for these patients must be individualized after a correct diagnosis is made.
Adult↗
End range eccentric antagonist/concentric agonist strength ratios: a new perspective in shoulder strength assessment.
The dynamic muscle stabilizers of the shoulder are critical to high performance in the overhead athlete. Previous evaluations of shoulder strength have focused on the concentric strength of the rotator cuff. Functionally, the rotator cuff muscles interact in an eccentric/concentric fashion. This is the first study to evaluate the end range eccentric antagonist/concentric agonist ratios of the shoulder rotators. Seventy-five asymptomatic college-level males were tested through a range of 20 degrees of lateral rotation to 90 degrees of medial rotation using the Kin-Com computer-assisted, hydraulic-resisted, isokinetic dynamometer at a speed of 90 degrees/sec. The end range (60-90 degrees) ratios for the medial rotators functioning eccentrically and lateral rotators functioning concentrically were 2.39:1 and 2.15:1 for the dominant and nondominant shoulders, respectively. End range (10 degrees of lateral rotation-20 degrees of medial rotation) ratios for lateral rotators functioning eccentrically and medial rotators functioning concentrically were 1.08:1 and 1.05:1 for the dominant and nondominant shoulders, respectively. The application of this functional assessment of strength testing results may provide important information in the evaluation of the injured shoulder in the overhead athlete, for prescreening, and to gauge return to sports after injury or surgery.
Adolescent↗
Effectiveness of an AI-based home exercise app for rehabilitation of rotator cuff-related shoulder pain: A randomized controlled trial.
BACKGROUND: Rotator cuff-related shoulder pain contributes to disability and healthcare use. Although therapeutic exercise is first-line treatment, limited supervision and adherence may reduce its effectiveness; digital rehabilitation with real-time feedback may address these limitations. OBJECTIVES: To evaluate the effectiveness of adding a digital rehabilitation program to standard physiotherapy on pain, function, fear-avoidance beliefs, and healthcare utilization. DESIGN: Single-center, assessor-blinded, randomized controlled trial with two parallel groups. METHOD: Forty-six adults (mean age 59 years) with rotator cuff-related shoulder pain were randomized to 12 weeks of conventional physiotherapy or physiotherapy plus an AI-based digital rehabilitation program using computer vision for real-time feedback and performance monitoring. Outcomes were assessed at baseline and at 2, 4, and 12 weeks. Pain intensity (NPRS) was primary outcome; secondary outcomes included upper limb function (QuickDASH), fear-avoidance beliefs (FABQ), and post-intervention healthcare utilization. Analyses followed an intention-to-treat approach. RESULTS: Pain reduction exceeded the MCID (1.3) at 4 and 12 weeks. Between-group differences favoured the intervention at Weeks 2 and 4 (MD -0.7; 95% CI -1.13 to -0.14 and MD -1.01; 95% CI -1.8 to -0.2, respectively). Upper limb function improved more at Week 4 (MD -7.3; 95% CI -12.3 to -2.2). FABQ scores decreased more at Week 12 (MD -7.6; 95% CI -14 to -0.5). Fewer participants in the experimental group required post-intervention healthcare (3 vs 10; p = 0.02). CONCLUSION: Adding AI-based home exercise app to conventional treatment improve pain and may improve function and reduce healthcare utilization in rotator cuff-related shoulder pain.
Humans↗
Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.
The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.
Adolescent↗
[Medial luxation of the long head of the brachial biceps. Magnetic resonance imaging].
The medial intraarticular dislocation of the biceps tendon of the shoulder is a rare pathologic condition and its diagnosis before surgery is very important to properly repair the tears of rotator cuff tendons, the rotator cuff being nearly always involved. We report our experience in 8 patients (1.8%) with biceps tendon dislocation observed in a series of 432 patients submitted to MR studies to address several diagnostic issues. The MR patterns of biceps tendon dislocation and the related physiopathologic mechanisms are discussed. The MR images were retrospectively reviewed by two of the authors and dislocations were diagnosed in a subgroup of 34 patients (7.8%), associated with full-thickness tears of the tendon of supraspinatus muscle; all patients also presented a full-thickness tear of the subscapularis tendon. A dislocated biceps tendon can follow a variety of courses depending on the pattern of subscapularis tendon tear. We always found a complete dislocation of the biceps tendon; other dislocation patterns reported in the literature, and particularly oblique and superficial dislocations, were never observed in our series. Dislocation is visible on axial images, where the tendon appears completely displaced from the bicipital groove, but also sagittal and coronal images can depict the more medial position of the tendon. In our patients this abnormality was correctly identified in 4 patients during the first observation and in the extant patients during the retrospective review. The dislocation of the biceps tendon of the shoulder was frequently associated with a complete tear of the supraspinatus tendon (23.5%). All patients exhibited severe joint effusion and in two patients the dislodged tendon was also inflamed.
Adult↗