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PubMed1986

Rotator cuff injuries.

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

Arthrography↗
PubMed1983

Serious rotator cuff injuries.

Usually, serious rotator cuff injuries can be operated upon and a high level of performance can be achieved afer surgery. This is not so for the substantial tears seen in baseball pitchers. However, a damaged rotator cuff can be rehabilitated and can recover from the threatened tear without surgery if detected early enough and given the proper treatment.

Adolescent↗
PubMed2000

Rotator cuff injuries.

Different types of rotator cuff injuries frequently present to Accident and Emergency departments and minor injury units but can be difficult to differentiate clinically. This brief case study describes the examination and diagnosis of related shoulder injuries, specifically rotator cuff tears/disruption and calcifying supraspinatus tendinitis. The relevant anatomy and current therapies for these injuries is also discussed to enable the emergency nurse practitioner to have a greater understanding of the theory surrounding their diagnosis and treatments.

Braces↗
PubMed2006

Conservative treatment of rotator cuff injuries.

Across all ages and activity levels, rotator cuff injuries are one of the most common causes of shoulder pain. The anatomy and biomechanics of the shoulder guide the history and physical exam toward the appropriate treatment of rotator cuff injuries. Rotator cuff tears are rare under the age of 40 unless accompanied by acute trauma. Throwing athletes are prone to rotator cuff injury from various causes of impingement (subacromial, internal, or secondary) and flexibility deficits, strength deficits, or both along the kinetic chain. Most rotator cuff injuries may be treated conservatively by using regimens of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and functional rehabilitation therapy. Injury prevention programs are essential for the long-term care of patients with rotator cuff disease, for primary prevention, and for prevention of recurrent injuries, unless a traumatically torn rotator cuff is present. Surgical management is reserved for refractory cases that have exhausted conservative measures.

Adrenal Cortex Hormones↗
PubMed1993

Rehabilitation of the shoulder following rotator cuff injury or surgery.

Rotator cuff problems are encountered frequently and must be rehabilitated precisely. The pace and intensity of the program are regulated by the degree of pathology and the patient's activity requirements. As our ability to understand the biomechanics of shoulder motion improves, we realize that many rotator cuff problems are secondary to instability. This instability can be subtle. The following article details a rehabilitative program for patients with rotator cuff pathology and includes both conservative and postoperative programs for pathology secondary to instability as well as primary impingement.

Adult↗
PubMed2004

Rotator cuff injuries and treatment.

Rotator cuff problems are among the most commonly encountered disorders of the shoulder, and are commonly seen by primary care physicians. Their exact mechanism for susceptibility to injury remains unclear; however, with an understanding of the shoulder's anatomy and biomechanics, we are better able to treat the insults incurred on the cuff. Early recognition, proper treatment, and appropriate follow-up may expedite healing and prevent the occurrence of further injury or complications.

Humans↗
PubMed2006

Rotator cuff injuries in the contact athlete.

Rotator cuff injuries in contact athletes are typically a result of a different mechanism than that seen with older patients or overhead athletes. This unique mechanism along with the extreme demands of these athletes presents special challenges to the surgeon. Special consideration should be given to in-season rehabilitation to allow the athlete to continue to compete if possible. When this is not possible, or for the out-of-season athlete with a rotator cuff injury requiring surgery, special consideration must be given to obtaining the strongest repair possible. The goal in all aspects of treatment is returning the athlete to full participation safely while minimizing recurrent injury or disability during the recovery process.

Arthroscopy↗
PubMed1993

Classification and treatment of rotator cuff injuries in the overhand athlete.

Rotator cuff injury in athletes results from accumulation of microtrauma to both the static and dynamic stabilizers of the shoulder. Our classification of these injuries and treatment protocol is based on knowledge of the pathophysiology of events leading to rotator cuff failure. Rotator cuff disease is attributed to one of five different modes of failure: primary compressive disease, secondary compressive disease, primary tensile overload, secondary tensile overload, and macrotraumatic injuries. Although disease is categorized based on a single failure mode, there is often significant overlap between the mechanisms of injury leading to the disease. Categorization and, consequently, treatment of the injury rely upon proper identification of the primary pathology and an understanding of the causative factors leading to rotator cuff failure. In most cases conservative management is successful, but, in the refractory cases, minimally invasive surgical techniques have also been successful in returning most athletes to a premorbid level of function.

Adult↗
PubMed1997

Diagnosis of tears in rotator-cuff-injuries.

Pathology of the rotator cuff is the cause of most common problems at the shoulder joint. Acute injuries are not as frequent as chronic cuff disease, but often they aggravate inflammatory or degenerative tendon alterations, even if they are of minor severity. Traumatic rotator cuff tears predominantly affect the supraspinatus tendon or the rotator interval. The subscapularis tendon is involved in anterior dislocations of the glenohumeral joint or in direct trauma. Plain film radiography still remains the base of all further imaging studies. If only full-thickness tears must be ruled out, double-contrast arthrography and ultrasound are acceptable imaging modalities. However, the former has a drawback in being invasive and does not detect partial tears at the bursal site of the cuff or rotator cuff tendinopathy, whereas the latter heavily depends on the experience of the radiologist and is restricted to the rotator cuff. Nowadays the most comprehensive imaging method is magnetic resonance (MR) imaging. MR imaging enables the detection or exclusion of complete rotator cuff tears with a reasonable accuracy and is also suitable to diagnose further pathologies of the shoulder joint. MR arthrography is valuable in the detection of subtle anatomic details and further improves the differentiation of rotator cuff diseases. Although in comparison MR imaging is still the most expensive imaging method, its high negative predictive value for the diagnosis of complete rotator cuff tears and its reliability evaluating different shoulder joint pathologies make it the preferred imaging modality.

Humans↗
PubMedDate not supplied

Rotator cuff injury in contact athletes.

The causes and incidence of rotator cuff injuries in patients under the age of 40 has not been clearly established. The present study focuses on a group of 10 male contact athletes with rotator cuff injuries related to trauma sustained during football (ages from 24 to 36 years). Symptoms included pain and dysfunction in all 10 patients and a positive shrug sign in 8 of 10. The diagnoses for these patients were two isolated contusions, five partial-thickness tears, and three full-thickness tears. Surgery was performed on all patients after nonoperative treatment failed. Three partial-thickness tears were arthroscopically debrided. One full-thickness and two partial-thickness tears were repaired using the arthroscopically assisted miniarthrotomy technique. An open repair was performed in two patients. Two isolated rotator cuff contusions were arthroscopically debrided. The average followup was 21 months. Nine of 10 athletes returned to active participation in football, 7 of these at their preinjury levels. The diagnosis of rotator cuff injury should be considered in a contact athlete who has persistent shoulder pain, impingement signs, weakness, and a positive shrug sign. Arthroscopic debridement of the subacromial space followed by debridement or repair of rotator cuff tears, as clinically indicated, resulted in a marked improvement in function and rapid return to sport for these patients.

Acromion↗
PubMed1988

Rotator cuff injuries in the throwing athlete.

Injuries to the rotator cuff have often been attributed to a progressive, degenerative process seen in the older patient. Traditionally, impingement has been implicated as the major etiologic factor. This paper will review the recent literature regarding rotator cuff injuries in the throwing athlete and examine the current thoughts on etiology and treatment.

Athletic Injuries↗
PubMed2004

Return to play for rotator cuff injuries and superior labrum anterior posterior (SLAP) lesions.

The shoulder is a frequently injured joint in athletes, and the most common injuries in active patients include instability, rotator cuff injuries, and superior labrum lesions. These three types of injuries often involve different mechanisms of injury, variable methods of surgical repair, and different considerations in rehabilitation and return to play. This article focuses upon rotator cuff injuries and superior labrum lesions, treated nonoperatively and operatively. Return to play with these injuries depends upon many factors including upon the age of the patient, the severity of the pathology,the type of treatment rendered, and the expectations of the patient.

Athletic Injuries↗
PubMed2003

Chronic rotator cuff injury and repair model in sheep.

BACKGROUND: Most rotator cuff surgery is performed on chronic tears. As there is no animal model in which to examine the physiology of muscle and tendon injury and repair in this setting, we developed a chronic rotator cuff injury model in sheep. METHODS: The infraspinatus tendon was released in thirty-six female sheep. Biopsy specimens were obtained from the muscle and were analyzed for fat content. The force generated by the muscle with supramaximal stimulation was recorded intraoperatively. A control group (twelve sheep) underwent an immediate tendon repair. In the remaining twenty-four sheep, the tendon was wrapped in a dura substitute to prevent scarring and was repaired at six weeks (eight sheep) and eighteen weeks (sixteen sheep) after release. In the immediate repair group, four animals were killed at six weeks; four, at twelve weeks; and four, at twenty weeks. In the six-week delayed repair group, four animals were killed at twelve weeks and four were killed at twenty weeks after the repair. In the eighteen-week delayed repair group, eight animals were killed at twelve weeks; four, at twenty weeks; and four, at thirty weeks after the repair. Muscle biopsies and testing were repeated prior to killing of the animals. RESULTS: The average force of muscle contraction decreased 3.6 lb (1.6 kg) by six weeks after the injury and 3.9 lb (1.8 kg) by eighteen weeks after the injury. After the repair, the force of contraction in the six-week group improved by 0.8 lb (0.4 kg) at twelve weeks postoperatively and by 1.3 lb (0.6 kg) at twenty weeks postoperatively. In contrast, no improvement occurred in the eighteen-week group until thirty weeks after the repair, at which time a 0.9-lb (0.4-kg) improvement was noted. There was a twelvefold increase in intramuscular fat concentration; this lipid infiltration was partially reversed after the tendon repair. Isolated tendon samples demonstrated an increase in the modulus of elasticity after chronic detachment that partially corrected after the tendon repair in the earlier (six-week) repair group. CONCLUSIONS: We found that earlier repair of the tendon results in a more rapid recovery of both muscle function and tendon elasticity compared with a more delayed repair. We concluded that there may be a "point of no return" in rotator cuff injury after which the elasticity of the muscle-tendon unit does not return to normal.

Animals↗
PubMed2003

Association of shoulder sonographic findings with subsequent surgical treatment for rotator cuff injury.

OBJECTIVE: To identify any clinical and radiologic findings of rotator cuff injury that predict whether patients will undergo shoulder surgery. METHODS: We retrospectively studied all shoulder sonograms obtained at a single institution over 12 months. Possible predictors of surgical treatment were documented, including patient age and sex, duration and types of symptoms, and the location and severity of tendon damage on sonography. One hundred twenty-eight patients underwent shoulder sonography; 34 patients eventually underwent shoulder surgery. Multivariate logistic regression was performed to identify clinical and sonographic factors associated with the use of surgical therapy. RESULTS: The only statistically significant predictor of surgical intervention was the finding of full-thickness tears (with or without tendon retraction) on sonography (P = .03). Patients with full-thickness tears were 4.3 times more likely to undergo surgery than those with no tears (odds ratio, 4.3). CONCLUSIONS: The sonographic diagnosis of full-thickness rotator cuff tears is the only finding statistically associated with the use of surgical treatment. No single clinical variable was consistently associated with subsequent surgery. Partial-thickness tears on sonography also do not show any statistical association with the eventual use of surgery for rotator cuff symptoms.

Female↗
PubMed1988

Rotator cuff injuries in baseball. Prevention and rehabilitation.

Rotator cuff and ligamentous capsule injuries are common in the young baseball player. In order to understand these injuries, it is important to first appreciate the delicate balance between shoulder mobility and stability as well as the biomechanics of throwing. This background information makes it easy to see how shoulder injuries are really part of a progressive continuum beginning with instability leading to subluxation, and later impingement which can result in a rotator cuff tear. A detailed and precise history and physical is crucial in determining where a patient might be on the continuum. An accurate evaluation will also help appropriately place a patient in one of the following 4 groups: pure impingement, anterior instability due to trauma with secondary impingement, anterior stability due to a hyperelasticity with secondary impingement, and pure anterior instability. A kinesiological repair is the initial treatment of choice. It is the best preventative or early treatment available, and consists of a specific strengthening programme. If this fails (as in only 5 to 10% of the cases), an anatomical repair is instituted. There are 4 basic guidelines when doing this surgery: (a) maintain muscle attachments and proprioceptive fibres; (b) do not shorten the capsule significantly; (c) build up the anterior labrum; and (d) regain full range of motion quickly through abduction splinting and rehabilitation. A postoperative rehabilitation programme is then diligently adhered to, as it is at least as important as the surgery itself.

Adolescent↗
PubMedDate not supplied

MR imaging of rotator cuff injury: what the clinician needs to know.

The rotator cuff muscles generate torque forces to move the humerus while acting in concord to produce balanced compressive forces to stabilize the glenohumeral joint. Thus, rotator cuff tears are often associated with loss of shoulder strength and stability, which are crucial for optimal shoulder function. The dimensions and extent of rotator cuff tears, the condition of the involved tendon, tear morphologic features, involvement of the subscapularis and infraspinatus tendons or of contiguous structures (eg, rotator interval, long head of the biceps brachii tendon, specific cuff tendons), and evidence of muscle atrophy may all have implications for rotator cuff treatment and prognosis. Magnetic resonance imaging can demonstrate the extent and configuration of rotator cuff abnormalities, suggest mechanical imbalance within the cuff, and document abnormalities of the cuff muscles and adjacent structures. A thorough understanding of the anatomy and function of the rotator cuff and of the consequences of rotator cuff disorders is essential for optimal treatment planning and prognostic accuracy. Identifying the disorder, understanding the potential clinical consequences, and reporting all relevant findings at rotator cuff imaging are also essential.

Health Knowledge, Attitudes, Practice↗