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PubMed2005

[Validity of ultrasound examinations of disorders of the shoulder joint].

OBJECTIVES: The objective of the present study was to assess the validity of ultrasound diagnosis of shoulder disorders in relation to examiner experience. METHODS: A total of 239 patients referred to us for shoulder arthroscopy from October 2001 to June 2004 were prospectively studied by ultrasound. The following ultrasound diagnoses were evaluated: total and partial rotator cuff tears, calcific tendinitis, biceps tendon injuries and subacromial bursitis. Examiner A established the ultrasound diagnoses and examiner B performed the surgery during week A, whereas examiner B did the examinations and examiner A operated in week B. The surgeon was blinded to the ultrasound results. Examiner A conducts ultrasound training seminars for DEGUM, the German Society of Ultrasound in Medicine, and has performed over 10,000 ultrasound examinations, with an average of roughly 150 examinations per year. Examiner B completed his ultrasound training some years ago and has performed roughly 1500 examinations (50 per year). The results were analysed in a time-independent and blinded manner by the co-author (H), who neither operated nor examined the patients. RESULTS: Ultrasound correctly identified 103 of 104 complete rotator cuff tears (sensitivity: 0.99--specificity: 0.99--accuracy: 98.7%). Both examiners achieved comparable results. Moreover, 41 of 52 partial rotator cuff tears were detected preoperatively (sensitivity: 0.79--specificity: 0.91--accuracy: 88.7%). Examiner A achieved a sensitivity of 0.92, a specificity of 0.95, and an accuracy of 94.7%. The corresponding rates for examiner B were: sensitivity 0.68, specificity 0.86, and accuracy 81.3%. 16 of 23 injuries of the long biceps tendon were identified correctly (4 of 8 dislocations and 12 of 15 tears: sensitivity 0.53; specificity 0.9; accuracy 95.3%). Examiner A achieved: sensitivity 0.58; specificity 0.99; accuracy 91.7% compared to examiner B: sensitivity 0.33; specificity 0.97; accuracy 95.3%. Both examiners correctly identified all 32 cases of calcific tendinitis (sensitivity 1.0; specificity 0.98; accuracy 98.3 % examiner A: 1.0--1.0--100% examiner B: 1.0--0.96--96.2%). 22 of 28 cases of subacromial bursitis were correctly diagnosed (sensitivity 0.79; specificity 0.98; accuracy 95.8% examiner A: 0.92--0.99--98.5% examiner B: 0.69--0.97--92.5%). CONCLUSIONS: Preoperative ultrasound examination of the shoulder permits a reliable diagnosis of complete rotator cuff tears and calcium deposits (calcific tendinitis). The method is less sensitive but sufficiently reliable for the diagnosis of partial rotator cuff tears and pathology of the long biceps tendon. Examiner experience plays an important role in these special cases. Permanent continuous training in the field of ultrasound diagnosis is a prerequisite for sufficient reliability of ultrasound diagnosis of shoulder disorders.

Arthroscopy↗
PubMed2000

Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis.

OBJECTIVES: To assess the occurrence and persistence of two restrictively defined neck-shoulder disorders among sewing machine operators. To assess factors associated with the development of neck-shoulder disorder and prognostic factors for remaining a case, when disorders were already present. METHODS: In an initial group of 243 sewing machine operators, 178 were followed up for 2 years. At baseline and at 1 and 2 years follow up the participants underwent a clinical examination of the neck and arms and filled in a questionnaire about current musculoskeletal complaints. Clinical criteria for two main neck-shoulder disorders were defined: rotator cuff tendinitis and myofascial pain syndrome. A baseline control group consisted of 357 women with varied non-repetitive work. RESULTS: At baseline the overall prevalence of myofascial pain syndrome and rotator cuff tendinitis was 15.2% and 5.8% among sewing machine operators compared with 9.0% and 2.2%, respectively, among controls. The presence of the disorders was strongly associated with a self perception of poor general health. Although myofascial pain syndrome showed a U shaped association with years as a sewing machine operator, rotator cuff tendinitis was absent among the newest recruits and present among 15% of the women with more than 20 years as a sewing machine operator. Besides years as a sewing machine operator, the risk of having a neck-shoulder disorder at baseline was significantly associated with high stress (prevalence ratio (PR)=2.54; 95% confidence interval (95% CI) 1.28 to 5.05) when adjusted for age, body mass index, smoking, living alone with children, job strain, and social support from colleagues and supervisors. Only one of 13 participants with rotator cuff tendinitis at baseline recovered during follow up. Myofascial pain syndrome showed a much more fluctuating tendency. Low social support (RR 3.72; 95% CI 1.22 to 11.30) and smoking (RR 3.93; 95% CI 1.33 to 11.58) were associated with the development of neck-shoulder disorders, which was also associated with neck-shoulder pain score and living alone with children. CONCLUSION: Rotator cuff tendinitis showed a higher degree of persistence than myofascial pain syndrome. Both disorders highly influenced the perception of general health. Women who lived alone with children, were smokers, or experienced low support from colleagues and supervisors had a higher risk of contracting a neck-shoulder disorder.

Adult↗
PubMed1998

Electromyography of the shoulder: an analysis of passive modes of exercise.

Passive shoulder motion is standard early rehabilitation in patients undergoing rotator cuff repair. A number of rehabilitation protocols exist to obtain this goal. This article evaluated different rehabilitation protocols using electromyographic analysis of the rotator cuff muscles to determine if the different protocols promote passive motion. Ten healthy volunteers underwent EMG to investigate the relative activity of the rotator cuff muscles during various exercises used postoperatively following shoulder surgery. The exercises tested were continuous passive motion machine (CPM), pulley, pendulum, self-assisted bar raise using the contralateral arm for power, self-assisted internal and external rotation, therapist-assisted elevation in plane of the scapula, and therapist-assisted internal and external rotation. The relative activity of the supraspinatus, infraspinatus, anterior deltoid, and trapezius muscles were measured and expressed as a percentage of maximal activity. For all muscle groups tested, the pulley exercise showed significantly more activity than the CPM machine. In the supraspinatus muscle, the pulley exercise averaged 17.6% of maximal activity and 8.7% for the self-assisted bar raise using contralateral arm power compared with 5.0% for the CPM machine. In general, therapist-assisted exercises and Codman's pendulum exercises showed activity that was not significantly different from the CPM machine. These results indicate that CPM and therapist-assisted passive range of motion, by being more passive, may increase the safety margin for obtaining early passive range of motion without disrupting the rotator cuff repair.

Adolescent↗
PubMed2000

Internal impingement in the shoulder of the overhand athlete: pathophysiology, diagnosis, and treatment.

The etiology of rotator cuff disease is multifactorial in nature. The process by which the articular surface of the rotator cuff can become diseased secondary to direct abutment against the glenoid rim and labrum has been termed internal impingement. Damage to the undersurface of the rotator cuff can occur from contact at the extremes of shoulder motion and can increase secondary to adaptive changes in bone and soft tissue. Diagnosis is achieved in most instances by a thorough physical examination. Adjunctive tests, particularly magnetic resonance imaging, can increase the accuracy of the diagnosis. If this disease is recognized early, nonoperative intervention may be successful. When nonoperative treatment fails, the use of arthroscopy for the treatment of torn rotator cuff and labral tissue and capsular laxity may be indicated to resolve symptoms and restore the premorbid level of function.

Arthroscopy↗
PubMed1998

MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder.

PURPOSE: To assess the MR arthrographic findings of bicipital tenosynovitis in correlation with arthroscopy. DESIGN AND PATIENTS: The shoulder MR arthrographies of 500 consecutive patients were retrospectively analyzed for signs of bicipital tenosynovitis and associated pathologies. Forty patients (8%) had MR evidence of bicipital tenosynovitis, but only 17 (3%) with arthroscopic confirmation were included in the study. The MR findings in these patients were compared with those of 10 patients with rotator cuff lesions but arthroscopically normal long biceps tendons. MR arthrography was performed with 10-15 ml of a 250 mmol/l gadoterate meglumine (Gd-DOTA) solution injected under fluoroscopic guidance, and transaxial, oblique coronal and sagittal MR sequences were obtained. RESULTS: All 17 patients showed one or more abnormal findings: signal increase in the tendon with or without fusiform distension was seen in 12, surface irregularities in six, adhesions in 11 and noncommunicating effusions of the tendon sheath in six. Associated abnormalities of the rotator cuff were present in 16 while the seventeenth patient had glenohumeral synovitis without rotator cuff pathology. MR arthrograms correlated with arthroscopic findings in the joint but comparison was not possible in the intertubercular groove portion of the biceps tendon. None of the 10 patients with an arthroscopically normal biceps tendon showed any of the MR findings of bicipital tenosynovitis. CONCLUSION: Bicipital tenosynovitis is detectable by MR arthrography. In most cases it is an associated finding of rotator cuff abnormalities and likely to have a similar etiology. When lesions of the anterior rotator cuff are recognized, the biceps tendon should be scrutinized for inflammatory changes.

Adult↗
PubMed2001

Retrograde fixation of fractures of the neck and shaft of the humerus with the 'Halder humeral nail'.

The Halder humeral nail is a new intramedullary device designed for displaced two part humeral neck and shaft fractures. It is inserted retrograde from the olecranon fossa and a unique trio wire is inserted through the nail to provide good proximal fixation. This avoids the use of proximal screws and damage to the rotator cuff thereby ensuring good rotator cuff function. The results of 100 cases are presented. At 6 weeks, 95 patients could perform the majority of daily tasks. There were four non-unions, one following a deep infection.

Adult↗
PubMed1991

Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value.

The sensitivity, specificity, and predictive value of magnetic resonance imaging in the diagnosis of lesions of the rotator cuff, glenohumeral capsule, and glenoid labrum were evaluated in ninety-one patients and fifteen asymptomatic volunteers. Magnetic resonance imaging demonstrated 100 per cent sensitivity and 95 per cent specificity in the diagnosis of complete tears, and it consistently predicted the size of the tear of the rotator cuff. There was a definite correlation between atrophy of the supraspinatus muscle and the size of a complete, chronic tear of the rotator cuff. The sensitivity and specificity of magnetic resonance imaging in the differentiation of tendinitis from degeneration of the cuff were 82 and 85 per cent, and in the differentiation of a normal tendon from one affected by tendinitis with signs of impingement the sensitivity and specificity were 93 and 87 per cent. The formation of spurs around the acromion and acromiocalvicular joint correlated highly with increased age of the patient and with chronic disease of the rotator cuff. The sensitivity and specificity of magnetic resonance imaging in the diagnosis of labral tears associated with glenohumeral instability were 88 and 93 per cent. The study showed that high-resolution magnetic-resonance imaging is an excellent non-invasive tool in the diagnosis of lesions of the rotator cuff and glenohumeral instability.

Acromioclavicular Joint↗
PubMed2005

Reverse total shoulder arthroplasty for the treatment of defect arthropathy.

OBJECTIVE: Total shoulder replacement for restoration of function and for pain relief of damaged glenohumeral joint accompanied by extensive irreparable cuff defect. INDICATIONS: Any painful shoulder arthropathy with insufficient and irreparable rotator cuff, especially primary defect arthropathy, rheumatoid arthritis with extensive rotator cuff defect, arthropathy after reconstruction of rotator cuff, mutilating rheumatoid arthritis, and crystal-induced arthropathy. Relative: failure of primary shoulder replacement in the presence of an irreparable cuff defect. CONTRAINDICATIONS: Structural or neurogenic lesion of deltoid muscle. Advanced glenoid destruction. Relative: age < 65 years. SURGICAL TECHNIQUE: Anterosuperior or deltopectoral approach. Exposure of glenoid. Resection of humeral head at epi-metaphyseal junction. Complete detachment of anterior, inferior, and posterior capsule from glenoid neck. Preparation of glenoid for cement-free fixation of glenoid base plate (metaglène). Preparation of humeral shaft for implantation of humeral component in 0-10 degrees of retroversion. Screwing of glenosphere to base plate. Insertion of cemented or cement-free modular humeral component. RESULTS: Between 10/1997 and 03/2001, a reverse total shoulder arthroplasty was done in 57 patients (14 men, 43 women; average age 70.1 years). Average follow-up time was 18.2 months. 98% of patients would agree to repeat surgery. Average Constant Score adjusted to age and gender was 94%, 97% for patients not having undergone previous surgery. All patients reported complete or almost complete freedom of pain. On the condition that the deltoid muscle was not damaged during previous surgery, a good improvement of power and function could be obtained. All functional parameters were normal for the patient's age with the exception of a slight limitation of internal rotation (average L5). The power of maintained abduction also corresponded in general to age-specific values. Only grade 1 or 2 inferior glenoid notching was observed but never reaching or surpassing the inferior screw (grade 3 or 4); no glenoid base plate loosening.

Aged↗
PubMed2003

Scoring systems for the functional assessment of the shoulder.

A number of instruments have been developed to measure the quality of life in patients with various conditions of the shoulder. Older instruments appear to have been developed at a time when little information was available on the appropriate methodology for instrument development. Much progress has been made in this area, and currently an appropriate instrument exists for each of the main conditions of the shoulder. Investigators planning clinical trials should select modern instruments that have been developed with appropriate patient input for item generation and reduction, and established validity and reliability. Among the other factors discussed in this review, responsiveness of an instrument is an important consideration as it can serve to minimize the sample size for a proposed study. The shoulder instruments reviewed include the Rating Sheet for Bankart Repair (Rowe), ASES Shoulder Evaluation Form, UCLA Shoulder Score, The Constant Score, Disabilities of the Arm, Shoulder and Hand (DASH), the Shoulder Rating Questionnaire, the Simple Shoulder Test (SST), the Western Ontario Osteoarthritis of the Shoulder Index (WOOS), the Western Ontario Rotator Cuff Index (WORC), the Western Ontario Shoulder Instability Index (WOSI), Rotator Cuff Quality of Life (RC-QOL), and the Oxford Shoulder Scores (OSS).

Humans↗
PubMed2005

Corticosteroid injections for painful shoulder: a meta-analysis.

BACKGROUND: There are no systematic reviews of corticosteroids for shoulder pain that calculate the numbers needed to treat. AIM: We wished to determine the effectiveness in terms of improvement of symptoms of intra-articular and subacromial injections of corticosteroid for rotator cuff tendonitis and frozen shoulder. DESIGN OF STUDY: Systematic review and meta-analysis of randomised controlled trials. METHOD: Data sources included the Cochrane Controlled Trials Register, Medline, EMBASE, hand searches and author contacts. The review methods required any randomised controlled trial in which the effectiveness of subacromial or intra-articular steroid injections versus placebo and versus non-steroidal anti-inflammatory medication, could be ascertained. The outcome was improvement of symptoms. The data abstraction was done independently, as was the validity assessment. The data was pooled using Review Manager 4.1. RESULTS: Seven studies were reviewed for corticosteroids versus placebo and three for corticosteroids versus nonsteroidal anti-inflammatory drugs (NSAIDs). The relative risk for improvement for subacromial corticosteroid injection for rotator cuff tendonitis was 3.08 (95% confidence interval [CI] = 1.94 to 4.87). The number needed to treat based on the pooled relative risk was 3.3 (95% CI = 1.8 to 7.7) patients to obtain one improvement. The relative risk for high dose (50 mg of prednisone or more) was 5.9 (95% CI = 2.8 to 12.6). The relative risk for improvement with steroids compared with NSAIDs was 1.43 (95% CI = 0.95 to 2.16). The number needed to treat for corticosteroids versus NSAIDs was 2.5 (95% CI = 1 to 9) for one significant study. The relative risks for intra-articular steroid injection for rotator cuff tendonitis were not statistically significant. CONCLUSION: Subacromial injections of corticosteroids are effective for improvement for rotator cuff tendonitis up to a 9-month period. They are also probably more effective than NSAID medication. Higher doses may be better than lower doses for subacromial corticosteroid injection for rotator cuff tendonitis.

Adrenal Cortex Hormones↗
PubMed1995

Shoulder Injuries in the Throwing Athlete.

The throwing athlete with shoulder pain presents a diagnostic and treatment challenge to the orthopaedic surgeon. Because pitching a baseball requires the arm to accelerate at 7,000 degrees per second, tremendous forces are experienced at the shoulder joint. Electromyographic studies have shown that the larger scapular and trunk muscles are primarily responsible for arm acceleration. The smaller and more fragile rotator cuff muscles play a significant role in decelerating the arm. During the entire throwing mechanism, the rotator cuff and the capsulolabral complex act to stabilize the humeral head on the glenoid fossa. As a result, the labrum, the capsule, and the rotator cuff are frequently the site of shoulder injury in throwers. The diagnosis of injury to these structures is based on the findings from the history, physical examination, and imaging studies. The majority of throwing injuries respond well to a carefully designed rehabilitation program. Athletes who do not improve within 6 months are candidates for surgical repair. The procedure is planned so as to minimize the amount of surgical trauma and thereby to facilitate an early return to sport. Arthroscopy is a valuable first step to confirm the pathologic diagnosis. The arthroscope alone is used to perform subacromial debridement, labral repair, or debridement of undersurface partial-thickness rotator cuff tears. If the athlete has clinical evidence of shoulder instability and arthroscopic evidence of capsular stretch, an open stabilization procedure is performed.

Journal Article↗
PubMed2006

Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis.

PURPOSE: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. TYPE OF STUDY: Case series. METHODS: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean follow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. RESULTS: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145 degrees to 160 degrees but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45 degrees (range, 0 degrees to 90 degrees) to 60 degrees (range, 0 degrees to 100 degrees). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. CONCLUSIONS: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series, no control group.

Arthritis, Rheumatoid↗
PubMed1993

Postsurgical shoulder strength in the older patient.

Following surgery, a goal of rehabilitation is to return the surgical extremity to its original strength. However, for the older rotator cuff repair patient, we are unsure if this is a realistic goal. The purpose of this study was to determine the quality of shoulder strength in older males who had undergone rotator cuff repair and acromioplasty surgery and to determine if test position and test velocity effects for rotation at the shoulder existed. Nine patients (mean age = 60.8 years) were tested bilaterally on the Cybex II isokinetic dynamometer for two movements (internal/external rotation), two velocities (60 degrees/sec, 120 degrees/sec), and two positions (neutral, 90 degrees abduction) to determine the peak torques for the shoulders. Following a three-way analysis of variance (ANOVA) with repeated measures, results indicated that the surgical shoulder had torque values approximating the nonsurgical shoulder and that test position had no significant effect on the internal or external rotation torques produced. As seen with nonshoulder-impaired younger subjects, peak torque decreased with increased test velocities. It was concluded that the older rotator cuff repair patient may be expected to attain a level of strength in the surgical shoulder similar to or exceeding the nonsurgical shoulder and that either test position recommended by Cybex for testing of the shoulder rotators was acceptable. Clinically, a full functional recovery similar to the nonsurgical shoulder should be expected in the older patient with postsurgical rotator cuff repair and acromioplasty.

Acromion↗
PubMed2006

Characteristics of the rat supraspinatus tendon during tendon-to-bone healing after acute injury.

Rotator cuff repair is known to have a high failure rate. Little is known about the natural healing process of the rotator cuff repair site, hence little can be done to improve the tendon's ability to heal. The purpose of this study was to investigate the collagen formation at the early repair site and to localize TGFbeta-1 and 3 during early healing and compare their levels to cell proliferation and histological changes. Bilateral supraspinatus tendons were transected and repaired in 60 rats. Specimens were harvested and evaluated at 0, 1, 3, 7, 10, 28, and 56 days. Histological sections were evaluated for cell morphology. Immunohistochemistry and in situ hybridization was performed to localize protein and mRNA for collagen types I and III and TGFbeta-1 and 3. Proliferating cell nuclear antigen (PCNA) assay was performed to measure cell proliferation, and cells were counted to determine cell density. Biomechanical properties were evaluated. Repair tissue demonstrated an initial inflammatory response with multinucleated cells present at 1 and 3 days, and lymphocytes and plasma cells presents at 7 and 10 days. Capillary proliferation began at 3 days and peaked at 10 days. Ultimate force increased significantly over the time period studied. Collagen I protein and mRNA significantly increased at 10 days, and reached a plateau by 28 and 56 days. Collagen III showed a similar trend, with an early increase, and remained high until 56 days. TGFbeta-1 was localized to the forming scar tissue and showed a distinct peak at 10 days. TGFbeta-3 was not seen at the healing insertion site. Cell proliferation and density followed the same trend as TGFbeta-1. A wound healing response does occur at the healing rotator cuff insertion site, however, the characteristics of the tendon after healing differ significantly from the uninjured tendon insertion site at the longest time-point studied. A distinctive collagen remodeling process occurred with an initial increase in the formation of collagen types I and III followed by a decrease toward baseline levels seen at time 0. Growth factor TGFbeta-1 was localized to repair tissue and coincided with a peak in cell proliferation and cellularity. Repair sites remained unorganized histologically and biomechanically inferior in comparison to previously described uninjured insertion sites.

Acute Disease↗
PubMed2006

Strain on the repaired supraspinatus tendon during manual traction and translational glide mobilization on the glenohumeral joint: a cadaveric biomechanics study.

There has been no report on the mechanical effects of joint mobilization on rotator cuffs. The purpose of this study was to determine whether it is safe to use grade 3 joint mobilization techniques after rotator cuff repair. Nine fresh frozen cadaveric shoulders were used in this study. The strains on the artificially repaired supraspinatus tendon during joint mobilization were measured at 0 degrees and 30 degrees of shoulder abduction and were compared with those at the maximal stretching position and relaxing position. Additionally, gap distances were measured during this experiment. The strain at 30 degrees of abduction of the repaired tendon during each joint mobilization was significantly smaller than that at 0 degrees abduction (P<0.05). At 30 degrees of abduction, the strain during joint mobilization was not statistically different from that of the shoulder in the relaxing position, except during the inferior glide technique. Gap distances were 0mm at 30 degrees , while the distances were 1.06-1.46 mm at 0 degrees. Our findings suggest that joint mobilization techniques, except inferior glide, can be performed safely without significantly straining the repaired tendon at 30 degrees of abduction, if rotator cuff repair is performed at 0 degrees of abduction.

Aged↗
PubMed2006

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles.

A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study's purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were measured for full ranges of rotation on 10 independent glenohumeral specimens with the humerus abducted in the scapular plane at 10 and 60 degrees . Supraspinatus and infraspinatus tendons were divided into equal width subregions. Two conditions were tested: tendon divided to the musculotendinous junction, and tendon divided to the insertion on the humerus. Moment arms were determined from tendon excursion via the principle of virtual work. Moment arms for the infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly greater when the tendon was only divided to the musculotendinous junction versus division to the humeral head. Moment arms across subregions of infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly different. A difference in teres minor moment arm was not found for the two cuff tendon conditions. Moment arm differences between muscle subregions and for tendon division conditions have clinical implications. Interaction between cuff regions could explain why some subjects retain strength after a small cuff tear. This finding helps explain why a partial cuff repair may be beneficial when a complete repair is not possible. Data presented here can help differentiate between cuff tear cases that would benefit from cuff repair and cases for which cuff repair might not be as favorable.

Biomechanical Phenomena↗
PubMed1997

Surgical treatment of postoperative deltoid origin disruption.

Although it is well recognized that deltoid disruption after shoulder surgery is associated with poor function, little information is available regarding results of surgical treatment for this problem. Twenty-four patients underwent direct repair or rotational deltoidplasty reconstruction of a detached muscle origin after shoulder surgery. The original surgical procedure was rotator cuff repair in 12, acromioplasty in four, and lateral acromionectomy with or without rotator cuff repair in eight. The average duration of symptoms before deltoid reconstruction was 17 months. The mean followup was 39 months (range, 13-84 months). Twelve patients reported moderate to severe pain, whereas 12 had minimal pain. Two patients required a shoulder fusion for intractable pain. Overall, one (4%) excellent, seven (29%) good, and 16 (67%) unsatisfactory results were observed. A poor outcome was associated with a prior lateral acromionectomy, involvement of the middle deltoid, a massive rotator cuff tear with weakness in external rotation, and a residual postoperative defect larger than 2 cm. In select cases, repair or deltoidplasty can improve function and pain.

Acromion↗
PubMedDate not supplied

The influence of cuff pathology on shoulder function after arthroscopic subacromial decompression: a 3- and 6-year follow-up study.

In the literature operative management of rotator cuff ruptures in the shoulder varies, from tendon repair to debridement of the cuff lesion combined with subacromial decompression. This study was made to evaluate whether patients with intact rotator cuff differed from patients with rotator cuff ruptures regarding functional outcome after arthroscopic subacromial decompression. We performed a clinical review of 39 patients with subacromial impingement who all underwent arthroscopic subacromial decompression; no other surgery was performed. There were 13 patients with intact cuff, 13 patients with partial-thickness supraspinatus ruptures, and 13 patients with full-thickness supraspinatus ruptures < 2 cm. Selection was based solely on the status of the supraspinatus tendon. Patients with other pathologic conditions were excluded. Follow-up was performed after 3 and 6 years. The clinical evaluation was performed with the Constant score and the visual analog pain score. The 3- and 6-year follow-up (100% follow-up rate) revealed no significant difference between the groups regarding the Constant scores and the visual analog scale values. Also, no significant difference was seen among the 3 groups in active range of motion or strength, and the patients had no appreciable pain. We conclude that the functional outcome 6 years after arthroscopic subacromial decompression is not obviously related to the preoperative degree of cuff pathology, even if a total rupture of small size is present.

Adult↗