Atraumatic Rotator Cuff Tears Research Articles

Characteristics and Clinical Outcomes in Overhead Sports Athletes after Rotator Cuff Repair.

Rotator cuff tears in young overhead sports athletes are rare. The pathomechanism causing rotator cuff tears in young overhead athletes is different from that in aged patients. The purpose of this study was to investigate rotator cuff tear characteristics in young overhead sports athletes to reveal the pathomechanism causing these injuries. This study included 25 overhead sports athletes less than 30 years old with atraumatic rotator cuff tears necessitating repair. Rotator cuff tear characteristics were evaluated intraoperatively, including rotator cuff tear shape and injured rotator cuff tendon. Clinical outcome measures were assessed before surgery and at the final follow-up. In this study, 22 patients reported minimal to no shoulder pain and returned to sports without significant complaints at last follow-up. The isolated infraspinatus tendon was most often injured; the incidence rate of the tear at this site was 32% (8 cases). In the deceleration phase of overhead motion, the eccentric contraction force of the ISP (infraspinatus) tendon peaks and the increased load leads to injury at the ISP tendon. The pathomechanism of rotator cuff injuries in young overhead athletes might be not only internal or subacromial impingement, but also these mechanisms.

Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome after Rotator Cuff Repair?

Objectives:Variations in scapular morphology have been associated with the development of atraumatic rotator cuff tears (RCT). Current theories suggest a morphologic predisposition for altered shoulder biomechanics favoring the development of RCTs. The critical shoulder angle (CSA) is a radiographic measure that accounts for both glenoid inclination and lateral extension of the acromion, and angles >35 degrees are reported to be correlated with the development of degenerative RCTs. The impact of the CSA on outcomes following rotator cuff repair (RCR) has not previously been investigated. The purpose of this study was to investigate the relationship between the CSA and clinical outcomes after rotator cuff repair.Methods:As part of a prospective observational cohort study we obtained CSA measurements for 144 patients with documented full-thickness RCTs who were followed up for a minimum of 48 weeks. Patients were then stratified based on RCT etiology and treatment. Demographic data as well as The Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score and Visual Analog Scale (VAS) for pain were collected at baseline, four, eight, 16, 32 and 48 weeks. The CSA for all of the patients was measured retrospectively, with all assessors being blinded to the data and we calculated interclass correlation coefficients (ICC) to measure agreement. The statistical analysis included longitudinal multilevel regression modeling to investigate the association of the CSA and the WORC, ASES and VAS for pain.Results:Controlling for demographic and clinical characteristics, patients with CSAs less than 38 degrees reported better outcome scores over time compared to those with CSAs greater than 38 degrees (WORC: B=-106.6, p=0.025, ASES: B=4.83, p=0.0001, VAS: B=-12.99, p=0.0001). Interobserver and intraobserver reliability for CSA measurements resulted in an ICC of 0.969 and 0.982 respectively, indicating excellent agreement.Conclusion:We found that a CSA less than 38 degrees was associated with better outcomes in patients following surgical repair of atraumatic full-thickness rotator cuff tears. This is the first study to examine the relationship between the CSA and outcomes following RCR. These findings suggest that individual scapular morphology may influence both disease development and surgical outcomes of rotator cuff tears. This association warrants further investigation.

Effects of Sleeping Positions on the Rotator Cuff Pathology

Abstract The rotator cuff tear etiology is still unclear. Especially for atraumatic ruptures, degenerative processes come into prominence. This study aims to correlate between four most commonly-seen sleeping positions and patients with rotator cuff pathology. 87 patients who applied to the institute for suffering from shoulder pain for more than 6 months without a trauma and 93 voluntary people (as control group) above the age of 50 who applied to the institution for reasons other than shoulder pain included in the study. Rotator cuff ruptures and acromion types of the patients are diagnosed via magnetic resonance imaging. In face-to-face interviews, all the patients are asked to show their favorite sleeping positions on the visual cards and also questioned about their smoking habits and overhead activities. There are not any statistically substantive parameters between the patients and the control group in terms of age and sex. 83.9% of the patients with rotator cuff rupture have stated preferring lateral decubitus position while this rate is 61.3% among the control group (p=0.003). Atraumatic rotator cuff tears are increase with age. The increase pressure in the subacromial space can lead distribution in microvascular circulation of rotator cuff. Decrease in the microvascular circulation also affects the regeneration potential of rotator cuff. Laboratory studies demonstrated that lateral decubitus position has the most prominent increase in the subacromial pressure over all sleeping positions. We consider that sleeping in the lateral decubitus position causes long-term high subacromial pressure, leading to a microcirculatory disorder in the rotator cuff, which is a risk factor for the rotator cuff etiology. Keywords: Rotator cuff, risk factors, tendinopathy, sleeping position, subacromial pressure, etiology

Shoulder Activity Level Is Not Associated With the Severity of Symptomatic, Atraumatic Rotator Cuff Tears in Patients Electing Nonoperative Treatment

Background: Patient activity level may be an important prognostic variable relating to outcomes in patients with shoulder disorders. Little is known about the predictors of activity level in patients with shoulder disorders. Hypothesis: Tear size and patient variables would be predictive of shoulder activity level in a cohort of patients who have selected initial nonoperative treatment for a symptomatic, atraumatic rotator cuff tear on magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with an atraumatic rotator cuff tear on MRI were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) shoulder study of nonoperative treatment. As part of routine data collection, these patients were asked to complete a previously validated shoulder activity scale. A regression analysis was performed to assess the association of shoulder activity level to rotator cuff tear characteristics, including tendon involvement and retraction, and patient factors such as age, sex, smoking, and occupation. Results: A total of 434 patients (220 male, 214 female) with a mean age of 62.7 years (range, 31-90 years) completed the activity scale. Shoulder activity was not associated with severity of the rotator cuff tear, but it was negatively associated with age (P = .0001) and female sex (P = .001). The only other factor associated with shoulder activity level in this cohort was occupation (P = .0006). Conclusion: Shoulder activity level in patients with an atraumatic rotator cuff tear confirmed on MRI is not associated with severity of the tear but is affected by age, sex, and occupation.

Predictors of Pain and Function in Patients With Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears

Background: Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined. Purpose: To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores. Results: A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P < .001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant. Conclusion: Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore, physical therapy for patients with symptomatic rotator cuff tears should target these modifiable factors associated with pain and loss of function.

Rotator Cuff Tear in a 12-Year-Old Baseball Pitcher: A Case Report

Rotator cuff injury is common among baseball pitchers. The tremendous forces and torques repetitively generated at the shoulder during the throwing motion place it at risk for injury [1]. Adolescent baseball players commonly experience shoulder pain owing to issues not seen in the adult population. In the skeletally immature thrower, the physis is the weakest structural link in the kinetic chain and poorly tolerates the biomechanical stress of throwing [2]. Thus, injuries to the physis, such as Little League shoulder (or proximal humeral epiphysiolysis), occur frequently in young throwers. Rotator cuff injuries, however, are seen much less frequently in the adolescent athlete. Rotator cuff tears, in particular, are extremely uncommon in the pediatric population. A review of the literature yielded only 1 case of an atraumatic rotator cuff tear in anyone younger than 18 years; that case described a partial thickness tear in a 13-year-old baseball player [3]. A case of a near full-thickness tear of the supraspinatus tendon in a 12-year-old baseball pitcher is presented. CASE REPORT A right-handed 12-year-old starting baseball pitcher presented with 3-day history of acute superior and posterior shoulder pain in his dominant shoulder. He reported that he had injured it after pitching 2 ½ innings of Little League. At the time of injury, he denied hearing an audible snap or crack, or having local trauma. After the onset of pain he was unable to continue throwing and experienced swelling along the lateral aspect of his shoulder. Pain was exacerbated with overhead activity and range of motion. On further questioning it was revealed that he was participating in 2 Little Leagues simultaneously and pitching close to the maximum allowed innings in both leagues. He denied pitching curveballs. Neither league was informed that he was participating in another league. He denied a history of any trauma. Physical examination 3 days after injury revealed point tenderness just lateral to the acromion and along the upper trapezius. Range of motion of the shoulder was full; however, scapular dyskinesis was seen with shoulder abduction. He demonstrated normal strength in internal and external rotation, but had diminished strength in abduction as determined with the empty can test about the affected shoulder compared with the opposite extremity. Impingement signs including both Hawkins’ [4] and Neer’s [5] were negative, drop arm test was negative, Scarf test was negative, and anterior apprehension/relocation test was negative for signs of instability. The patient was advised to avoid all physical activities including overhead throwing until diagnostic workup was completed and he was seen for follow-up. Bilateral anteroposterior (AP) and lateral shoulder radiographs were obtained, which showed no bony pathology or widening of the physis. Because of the severity of his symptoms, a magnetic resonance image (MRI) was obtained (Figure 1) demonstrating a near full-thickness tear of the supraspinatus tendon. The patient was sent for consultation to an orthopedic specialist, who recommended confirming the MRI findings with a magnetic resonance (MR) arthrogram as it was thought unlikely that the patient had a rotator cuff tear considering his young age. The MR arthrogram demonstrated a partial-thickness tear of the supraspinatus tendon, and the orthopedic surgeon recommended nonoperative treatment considering the patient’s young age. The patient was treated nonoperatively with a physical therapy program that included core strengthening, scapular stabilization, and range of motion exercises. After completion of 4 weeks of physical therapy, the patient returned to playing recreational basketball without pain or limitation. On his return visit at 5 weeks, his physical examination was essentially normal with full and symmetric range of motion and

Rotator cuff tearing and inferior subluxation of the humeral head: Report of two cases

We encountered two patients with atraumatic rotator cuff tears who exhibited inferior subluxation of the humeral head. In both patients shoulder motion was limited by pain. Repair of the rotator cuff tear relieved the pain and restored glenohumeral joint motion. Although the cause of this unusual complication of rotator cuff damage remains unclear, the inferior subluxation was associated with reflex muscle hypotonia, which would have reduced the pressure in the subacromial space and thus would have decreased the pain caused by the cuff lesion. No similar case seems to have been documented in the literature.