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PubMed1996

MR imaging of the rotator cuff mechanism: comparison of spin-echo and turbo spin-echo sequences.

OBJECTIVE: Although well documented in other MR imaging applications, the value of turbo spin-echo sequences in evaluating the shoulder has not been addressed. This study was designed to directly compare matched spin-echo and turbo spin-echo sequences in the MR imaging evaluation of the rotator cuff. MATERIALS AND METHODS: Using otherwise matched double-echo sequences of equal time duration, we performed 123 paired spin-echo (TR/TE, 200/25,75; one excitation) and turbo spin-echo (3500-5000/22,90; two excitations) sequences in the paracoronal and/or parasagittal plane of the shoulders of 76 patients referred to our institution for possible rotator cuff tear. The sequences were retrospectively analyzed for cuff signal and morphology, fluid conspicuity, coracoacromial arch morphology, and bone marrow signal abnormalities. Surgical and nonsurgical clinical results were correlated when available. RESULTS: We found 100% diagnostic correlation between spin-echo and turbo spin-echo sequences for rotator cuff integrity. Surgical data were available for 26 patients, and clinical follow-up for another 37. For complete rotator cuff tear in the surgical subpopulation, sensitivity was 89%, specificity was 94%, and diagnostic accuracy was 24 of 26 (92%). We found no diagnostically significant difference between the two imaging sequences for fluid conspicuity, coracoacromial morphology, or marrow signal. Signal-to-noise ratios were superior in the turbo spin-echo sequences. CONCLUSION: Turbo spin-echo sequences are an accurate and efficient tool in the MR imaging evaluation of the rotator cuff. Potential benefits include time saving, increased spatial resolution, and improved signal-to-noise ratio.

Adolescent↗
PubMed2005

Comparison of fat-suppressed T2-weighted fast spin-echo sequence and modified STIR sequence in the evaluation of the rotator cuff tendon.

OBJECTIVE: This study was performed to determine whether a modified version of the classic STIR sequence provides similar information about the integrity of the rotator cuff tendon as the commonly used fat-suppressed T2-weighted fast spin-echo sequence. SUBJECTS AND METHODS: Sixty-one consecutive MRI examinations of the shoulder in 57 patients were performed using a coronal oblique T1-weighted spin-echo sequence, a modified version of the STIR sequence, and a fat-suppressed T2-weighted fast spin-echo sequence. Three reviewers independently assessed the rotator cuff tendon using the coronal oblique modified inversion recovery sequence and T1-weighted spin-echo sequence. After a minimum of 4 weeks, reviewers assessed the rotator cuff tendon using the fat-suppressed T2-weighted fast spin-echo sequence and T1-weighted spin-echo sequence. The kappa statistic was used to measure the degree of concordance between interpretations when each sequence was used independently. The conditional probability that a full- and a partial-thickness tear would be diagnosed on both sequences was calculated. Image quality was assessed in a side-by-side comparison. RESULTS: The overall weighted kappa score was 0.82, which indicates excellent concordance between the two sequences. If a full-thickness tear of the rotator cuff tendon was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was a 94.1% probability that the same conclusion would be reached using the modified inversion recovery sequence. If a partial-thickness tear was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was an 80.3% probability that the same conclusion would be reached with the modified inversion recovery sequence. Fat suppression in the modified inversion recovery sequence was superior to that in the T2-weighted fast spin-echo sequence in 26-39% of the examinations. CONCLUSION: The modified inversion recovery sequence and fat-suppressed T2-weighted fast spin-echo sequence provide similar information about the integrity of the rotator cuff tendon.

Adult↗
PubMed2001

Arthroscopic rotator cuff interval capsular closure.

Closure of the rotator cuff interval is an important component of open stabilization techniques in shoulder surgery. This study describes a technique in which the deep layer of the capsule within the rotator cuff interval is closed arthroscopically. The effect of closure of this capsule within the rotator cuff interval on glenohumeral motion also is quantified. Sutures were placed from the superior glenohumeral ligament to the middle glenohumeral ligament and tied intra-articularly in fresh-frozen cadaveric shoulders. Closure of the interval capsule resulted in statistically significant limitation of humeral elevation, external rotation, and extension. Arthroscopic closure of the deep layer of the rotator cuff interval capsule produced a visible superior shifting of the middle and inferior glenohumeral ligaments and imbricated the anterosuperior capsule of the shoulder. In addition, this procedure can be performed in conjunction with arthroscopic capsulolabral reconstruction.

Aged↗
PubMed2005

Management of irreparable rotator cuff tears and glenohumeral arthritis.

Glenohumeral arthritis with irreparable rotator cuff tears remain a difficult entity to treat. Varied causes include rotator cuff tear arthropathy, osteoarthritis, or rheumatoid arthritis with irreparable cuff tear. Common symptoms are progressive pain and dysfunction. Physical examination may reveal pain, crepitance, rotator cuff weakness, and loss of motion and function. Radiographs may reveal varying degrees of osteophyte formation, sclerotic bone, superior humeral head migration, and bony erosion. Additional imaging modalities may reveal cuff tear size, retraction, atrophy, and fatty infiltration. Failure of nonoperative management may lead to operative intervention. Rotator cuff repair or reconstruction may help prevent progression of tears and future arthritic changes. In patients with moderate to severe glenohumeral arthritis and irreparable rotator cuff tears, hemiarthroplasty is currently the procedure of choice. For patients with severe cuff dysfunction or loss of coracoacromial arch, or for patients who require revision, the reverse shoulder prosthesis may offer a treatment option. Future management continues to be defined with additional study.

Acromion↗
PubMed1999

Partial-thickness tears of the rotator cuff: evaluation and management.

The approach to management of a partial-thickness rotator cuff tear is best made with the understanding that this is not a singular condition. Rather, partial tears represent the common outcome of a variety of insults to the rotator cuff. Degenerative changes due to aging, anatomic impingement, and trauma may all be etiologic agents. Overhead athletes may develop tears due to repetitive microtrauma or internal impingement. Outlet radiographs and magnetic resonance imaging are recommended for routine preoperative evaluation. A nonoperative treatment program for rotator cuff strengthening and stretching is appropriate as initial treatment; modification of activities and anti-inflammatory medication are often used as well. Operative management may be considered when nonoperative treatment fails. Arthroscopic evaluation is required to determine the true extent of the cuff lesion. Arthroscopic subacromial decompression is recommended when outlet impingement is present. Rotator cuff debridement or formal cuff repair is dependent on the size of the cuff defect and the age and activity level of the patient. The importance of recognizing the different causes of partial-thickness rotator cuff tears is emphasized in this review of pathogenesis, clinical diagnosis, imaging, and treatment.

Acromion↗
PubMed1999

[Ultrasonographic evaluation of the rotator cuff after its surgical reconstruction].

The aim of this paper was to evaluate ultrasonographic picture of rotator cuff integrity after surgical reconstruction performed in 34 patients with mean follow-up 17.2 months (range 6-45 months). The lack of rotator cuff echo or hypoechogenic area were the criteria for diagnosis of re-tear. This occurred in 16% of shoulders with isolated supraspinatus tear and in 33.3% of shoulder with 2 tendons involved. Hyperechogenic changes were noted in 35.3% of shoulders, some thinning of the rotator cuff in 23.5%, while both of these changes in 14.7%. The thinning of the rotator cuff was classified as pathologic if there was difference between diameter of rotator cuff measured in 6th to 8th postoperative week and diameter measured at the time of follow-up. Ultrasonographic examination offers critical evaluation of both surgical result and postoperative physical therapy protocol.

Adult↗
PubMed2000

Rotator cuff pathology and subacromial impingement.

Musculoskeletal complaints are one of the most common reasons for primary care office visits, and rotator cuff disorders are the most common source of shoulder pain. Subacromial impingement with subsequent tendinitis and bursitis is frequently found in young adult patients. Rotator cuff tears are a common cause of shoulder pain in patients over age 40. The majority of subacromial impingement and incomplete rotator cuff tears may be successfully managed with conservative treatment. This article discusses anatomic function of the glenohumeral joint and subacromial space, etiology of subacromial impingement and rotator cuff disorders, examination of the shoulder, diagnostic testing, and treatment of subacromial impingement and rotator cuff disorders in the primary care setting.

Adult↗
PubMed2000

Surgical treatment of full thickness rotator cuff tear in patients younger than 40 years.

BACKGROUND: Full thickness tear of the rotator cuff is a well-known entity in the middle-aged and elderly population and the results of surgical repair are well documented. Rotator cuff tear in patients under the age of 40 years is unusual and the cause and treatment are not well established. The present study reports 12 young patients with full thickness tear of the rotator cuff treated surgically. METHODS: Open anteroinferior acromioplasty and cuff repairs were performed on every patient after failure of nonsurgical treatment. The average follow-up was 59.5 months (range, 36-100 months). RESULTS: The average patient age at the time of surgery was 30.2 years (range, 17-39 years). Symptoms included pain and dysfunction in all patients and weakness in eight patients. The duration of symptoms before surgery ranged from 6 to 60 months (average, 22.8 months). Ten patients were able to return to their preinjury status within an average of 4.5 months (range, 3-9 months) after surgery. Three athletes were able to return to previous levels of competition. Nine patients had excellent functional results with regard to pain, motion, strength, function and satisfaction. Eleven patients were satisfied with the operation and had significant pain reduction compared with their preoperative status. CONCLUSIONS: An acute traumatic event was the etiology of the rotator cuff tears in this study. The results of surgical treatment in this younger group of patients were satisfactory and were comparable to the outcomes reported for surgical treatment of rotator cuff tears in older patients and athletes.

Adolescent↗
PubMed2000

[Arthroscopic rotator cuff repair: a multicentric retrospective study of 87 cases with anatomical assessment].

PURPOSE OF THE STUDY: The aim of this study was to evaluate the anatomical and technical limits of endoscopic rotator cuff repair. Anatomical results were also compared with functional assessment of the shoulder. MATERIAL AND METHODS: A multicentric serie of 87 patients presenting a full thickness rotator cuff tear repaired endoscopically was retrospectively reviewed at 25.4 months (mean) post surgery. Limits of the surgical technique were studied in correlation with functional results and anatomic radiographic evaluation (arthroscans in 93 p. 100). RESULTS: Anatomical repair (normal thickness and no contrast in the subacromial space on arthroscan) was achieved in 83 p. 100 of the rotator cuffs with limited damage to the frontal part of the supra spinatus tendon. This percentage fell to 57.8 p. 100 in case of posterior extension of the tear to the supra spinatus tendon and further dropped to 40.8 p. 100 in case of retraction to the apex of the humeral head. Functional outcome evaluated with the Constant score was strongly related to the radiographic cuff condition (p <0.05). For distal and anterior tears of the supra spinatus tendon, the Constant score at revision was 89.8 points in cases with anatomic repair at revision. This score fell to 75 when the rotator cuff tear was evidenced radiographically (p <0.0001). For tears involving the entire supra spinatus tendon repaired by arthroscopy, the functional difference at revision was 8 points on the Constant scale. Objective and subjective analysis of the surgical procedure identified significant peroperative elements predictive of clinical and anatomical outcome (difficult reduction, p <0.05; subjective degree of solidity, p <0.0001; anatomical aspect of the repaired cuff, p <0.05). DISCUSSION: A comparison of our findings with data on equivalent lesions reported in the literature suggests that endoscopic surgery for rotator cuff tears offers both functional and anatomic results equivalent to those achieved with conventional open surgery. This assumes that the surgical procedure is carried out by surgeons experienced in shoulder arthroscopy who can precisely gauge the posterior/anterior extension of the tears and the limits of the surgical technique.

Adult↗
PubMed2000

Expression of procollagen alpha 1 type III mRNA in rotator cuff tears.

The purpose of this study was to investigate the relationship among expression of procollagen alpha 1 type III mRNA, subacromial adhesion, and limited shoulder elevation in rotator cuff tears. Procollagen alpha 1 type III mRNA was analyzed in the torn supraspinatus tendons and synovial tissue of 42 patients with rotator cuff tears. As a control, four normal supraspinatus tendons of patients who had undergone shoulder surgery other than rotator cuff repair served as controls. Cells stained positively for procollagen alpha 1 type III mRNA were more abundant in the adhesive synovium of the subacromial bursa and in the torn supraspinatus tendons than in controls. Patients with complete-thickness tears who had undergone surgery less than 10 months after trauma were found to have more signal-positive cells than those later than 10 months. We conclude that the adhesive synovium of the subacromial bursa contains abundant cells stained positively for procollagen alpha 1 type III mRNA. We suggest that the production of type III collagen by these cells could contribute to the limitation of shoulder motion in patients with rotator cuff tears, and recommend release and excision of the excess adhesive synovium during rotator cuff surgery.

Adult↗
PubMed2001

Management of massive irreparable rotator cuff tears: the role of tendon transfer.

The inability to repair a rotator cuff tear is not uncommon, and in practices devoted to the management of shoulder injuries up to 30% of rotator cuff tears may be irreparable. The anterior and posterior components of the rotator cuff are the most important deficient areas. In the case of an irreparable subscapularis tendon tear, pain relief and stability appear to be reliably achieved by a split pectoralis major transfer; however, functional improvement is less certain because the biomechanics associated with this tendon transfer do not appear to be optimal. In the case of an irreparable posterosuperior rotator cuff tear, a latissimus dorsi tendon transfer reliably restores flexion and relieves pain; however, its use after failure of prior rotator cuff surgery makes the outcome less predictable. Both anterior and posterior reconstructions with tendon transfer require precise surgical technique and patient compliance with postoperative rehabilitation.

Biomechanical Phenomena↗
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↗
PubMed2003

Analysis of rotator cuff muscles in adult human cadaveric specimens.

Management of irreparable massive rotator cuff tears remains a challenging and controversial problem. Defining glenohumeral force relations may allow for the development of treatment strategies based on biomechanical principles. Five fresh-frozen adult human cadaveric shoulder specimens were dissected to determine fiber length, mass, and lever arm of (a) the 3 bellies of the deltoid and (b) the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis). From these data, physiologic cross-sectional areas and moment relations were calculated. These relations provide evidence for a balanced axial force couple between the anterior and posterior rotator cuff. Demonstration of an axial force couple across the glenohumeral joint may have clinical significance for treatment of irreparable massive rotator cuff tears and may explain why many patients with full-thickness rotator cuff tears can regain acceptable shoulder function.

Aged↗
PubMed2003

Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients.

The importance of acromial morphology in the pathogenesis of rotator cuff tears remains controversial. Some surgeons place great emphasis on acromial morphology and others feel that acromial shape is a result of cuff tear pathology rather than the cause. The purpose of this study was to determine if there was an association between acromial morphology, age, and rotator cuff tears found by ultrasound in asymptomatic volunteer subjects with no past history of shoulder symptoms. One hundred eighteen outlet x-rays and ultrasound scans were performed in 59 asymptomatic patients in various age groups. Acromial morphology and the age of the patients were then correlated with the ultrasound findings. Older patients were noted to have a high incidence of type II and type III acromions (93% of those over 70). Full- and partial-thickness tears were more commonly seen in patients with type II or type III acromions compared with type I. Patients over 50 years had a high incidence of full-thickness tears (40%), but the incidence did not increase with increasing age past 50. These findings lend credence to the multifactorial etiology of rotator cuff tears. The patient's age (degeneration) and acromial morphology (impingement) are two of the factors involved in causing rotator cuff tears. The incidence of cuff tears and type III acromions was high in this group of entirely asymptomatic volunteer subjects. Surgeons should interpret radiologically hooked or curved acromions as well as rotator cuff tears diagnosed with ultrasound or other modalities with caution. It may well be that both of these findings should be regarded as part of the natural ageing process.

Acromion↗
PubMed1992

Rotator cuff tears. Results of surgical repair.

A prospective study was done on 73 patients who underwent surgical repair of a rotator cuff tear. The patients were divided into four groups according to the active shoulder flexion and the trophism of the rotator cuff muscles: group A--range of motion > 100 degrees; group B--ROM 60-100 degrees; group C--ROM < 60 degrees; group D--ROM < 100 degrees and significant muscle hypotrophy. The rotator cuff tears were classified into four groups at surgery according to size: grade I measured < 2 cm; grade II measured 2-4 cm, grade III measured > 4 cm but was reparable; and grade IV was irreparable. The results were evaluated after an average follow-up of 2.3 years and correlated to several factors including the preoperative clinical assessment, the size of the lesion, the type of lesion (tear or detachment), and the mechanism of injury (traumatic or atraumatic). Seventy-three percent of the cases had satisfactory results. The preoperative clinical assessment and the size of the tear were the most important indicators of the final outcome. The proportion of satisfactory results underwent a progressive decline from group A (88%) to group D (14%) and from grades I and II (88% and 89%, respectively) to grade III (56%) and grade IV (none). Rotator cuff repair is almost always successful in patients with more than 60 degrees of active arm flexion and either small or medium-size tears. Less than two-thirds of the patients with major tears and less than 60 degrees of motion achieve satisfactory results. Failure is highly probable in irreparable tears and in the presence of significant hypotrophy of the rotator cuff muscles.

Adult↗
PubMed2003

Arthroscopic rotator cuff tear repair.

Rotator cuff injuries or disease can be particularly troubling to patients by causing them pain, weakness, and dysfunction of the shoulder. Surgery of the shoulder and, in particular, of the rotator cuff, has evolved over the years from open surgery to include arthroscopic treatment for many conditions. Although technically demanding, arthroscopic repair of full- and partial-thickness rotator cuff tears has been shown to produce satisfactory results. Along with the advantages of the arthroscopic technique, smaller skin incisions, access to the glenohumeral joint for inspection and treatment of intra-articular lesions, no detachment of the deltoid, and less soft-tissue dissection, patients' results are comparable with those obtained with the open method of repair. The three phases of shoulder rehabilitation for patients who have undergone surgical treatment of rotator cuff disease are described: Phase 1, the immediate postoperative, or protective, phase; phase 2, the progressive strengthening phase; and phase 3, the advanced conditioning and return-to-sport phase. The postoperative rehabilitation programs for the arthroscopic and mini-open rotator cuff repair are essentially the same.

Arthroscopy↗
PubMed2004

Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases.

BACKGROUND: Although many investigators have evaluated the accuracy of ultrasonography and magnetic resonance imaging for the detection of full and partial-thickness rotator cuff tears, few have directly compared the two tests. The purpose of our study was to compare the accuracy of the two tests for detection and measurement of the size of rotator cuff tears, with arthroscopic findings used as the standard. METHODS: One hundred and twenty-four consecutive patients with shoulder pain were prospectively studied with ultrasonography and magnetic resonance imaging. Seventy-one had subsequent arthroscopy, and they formed the study group. The arthroscopic diagnosis was a full-thickness tear in forty-six patients, a partial-thickness tear in nineteen, and no tear in six. The presence or absence of a full or partial-thickness tear and the tear size as demonstrated by each imaging test and at the time of arthroscopy were recorded. The findings of the imaging tests and arthroscopy were then compared for each parameter. RESULTS: Ultrasonography correctly identified forty-five of the forty-six full-thickness tears and magnetic resonance imaging, all forty-six. Ultrasonography correctly identified thirteen of the nineteen partial-thickness rotator cuff tears and magnetic resonance imaging, twelve of the nineteen. The overall accuracy for both imaging tests was 87%. Ultrasonography correctly predicted the degree of retraction of 73% of the full-thickness tears and the length of 85% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the retraction and length of 63% and 75%, respectively. Ultrasonography correctly predicted the width of 87% of the full-thickness tears and 54% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the width of 80% and 75%, respectively. No significant differences between ultrasonography and magnetic resonance imaging were demonstrated (p > 0.05). CONCLUSIONS: Ultrasonography and magnetic resonance imaging had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. When an investigator has comparable experience with both imaging tests, the decision regarding which test to perform for rotator cuff assessment does not need to be based on accuracy concerns. The choice can be based on other factors, such as the importance of ancillary clinical information (regarding lesions of the glenoid labrum, joint capsule, or surrounding muscle or bone), the presence of an implanted device, patient tolerance, and cost.

Adult↗
PubMed2003

[Rotator cuff rupture].

The rotator cuff is the complex of four muscles that arise from the scapula; supscapularis, supraspinatus, infraspinatus and teres minor. The long head of the biceps tendon may be considered a functional part of the rotator cuff. The rotator cuff is key structure of the shoulder which gives dynamic stability and movements. Rotator cuff tears my occur as consequence of impingement syndrome or degenerative changes. Most tears occur in the supraspinatus tendon. The patients are usually older than 40 years. On clinical examination there is weakness of abducation and external rotation of the arm. Open or arthroscopic repair should be performed in active individuals.

Humans↗