Cuff Tears Research Articles

관절경적 교량형 봉합 술식을 통한 회전근 개 전층 파열의 치료결과

Purpose: To determine clinical results for arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique. Materials and Methods: Between November, 2007 and October, 2008, we evaluated 90 cases of arthroscopic middle, large rotator tear cuff repair. The mean follow-up period was 15 months (range, 12-23 months). Forty-three cases had medium-sized tears; 47 cases had large-sized tears. At the preoperative stage and again at last follow-up, functional results were assessed by the KSS, ASES, UCLA and the PVAS (Pain visual analogue score). Results: Pain score improved from 2.56 preoperatively to 0.96 at final follow-up; movement scores improved from 6.94 to 1.70. At. final follow-up, the average UCLA score improved from 17.08 to 31.17 with 31 excellent (34%), 49 good (54%) and 10 poor results (12%). The final UCLA score was 31.47 in the group less than 60 years of age and 30.69 in the group over 61 years of age (p=0.344). The UCLA score was 31.23 in those with medium-sized tears and 31.11 in those with large-sized tears (p=0.924). The UCLA score was 31.10 in non-trauma patients and 31.23 in trauma patients (p=0.929). Conclusion: Arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique can produce excellent clinical results. These outcomes are not affected by age or trauma history.

Zementfreier Oberflächenersatz bei Dislokationsarthropathie des Schultergelenks

Only a few reports in the literature describe that total shoulder replacement provides better functional results in dislocation arthropathy than hemiarthroplasty. Nevertheless, the risk of aseptic loosening in young and active patients is high after long-term follow-up. We evaluated the results of cementless humeral head resurfacing in this group. We evaluated 29 patients with dislocation arthropathy who had been followed up for a mean of 39 months. The mean age at the time of operation was 43.7±14.7 years. Preoperatively, cuff deficiency was seen in 11 cases. The mean adjusted Constant score improved from 16.8±15.2% to 78.1±21.9%. Negative prognostic factors turned out to be female sex, age, cuff tears especially of the subscapularis tendon, and previous bone block procedures. Revision was performed in five patients, and two developed painful glenoid erosion which required conversion to total shoulder arthroplasty. Cementless humeral head replacement is a viable option in the treatment of dislocation arthropathy. Revision can be performed easily since the bone stock has been preserved. On the basis of our data, humeral head replacement in patients <40 years with dislocation arthropathy offers promising short- to midterm results with an acceptable complication rate.

Infraspinatus scapular retraction test: a reliable and practical method to assess infraspinatus strength in overhead athletes with scapular dyskinesis

BackgroundAlteration of normal scapulohumeral rhythm due to the fatigue of scapular-stabilizing muscles induces decrease of rotator cuff strength. In this study we analyzed the interobserver and intraobserver realibility of the infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT) in 29 overhead athletes with scapular dykinesis, before and after 6 months of scapular musculature rehabilitation.Materials and methodsSubjects with magnetic resonance imaging (MRI) findings of labral injuries (2 cases, 5%) and cuff tears (4 cases, 11%) were excluded. Scapular dyskinesis patterns were evaluated according to Kibler et al. (J Shoulder Elbow Surg 11:550–556, 2002). We found a type I dyskinesis in 24 cases (83%) and a type II in 5 cases (17%). Patients were tested by using IST and ISRT and the maximum infraspinatus strength (kg) was registered by a handheld dynamometer. Changes in shoulder IR were measured by using a standard goniometry. Rehabilitation continued for 6 months and was focused on the restoration of scapular muscular control and balance. We used a paired Student t test for the significance of the force values (alpha = 0.01). Intraclass correlation coefficient (ICC) and standard error (SE) were applied to determine the realibility of repeated values collected within testers and between testers.ResultsValues of ICC close to 1 at baseline and at 6 months indicated a higher interexaminer and intraexaminer realibility. IST force values registered a significant increase at 6 months for both examiners (P < 0.01). The mean difference between IST and ISRT values were not significant at 6 months (P > 0.01). The increase of glenohumeral internal rotation was significant at 6 months (P < 0.01).ConclusionThe good realibility and the easy reproducibility make the ISRT an excellent test to assess patients with infraspinatus weakness due to scapular dyskinesis and address them toward an appropriate program of rehabilitation aimed to restore scapular musculature balance and control.

The Cause and the Effect to the Clinical Result of Deterioration of Osteoarthritic Change with Cuff Tear

The Cause and the Effect to the Clinical Result of Deterioration of Osteoarthritic Change with Cuff Tear

Die Korrelation von Degeneration des AC-Gelenkes und Rupturen der Rotatorenmanschette

During the past various factors were quoted to be causative of a degeneration of the rotator cuff. In this study 122 shoulder specimen, aged 58-95 years, were dissected. A high correlation between severe degeneration of the ac-joint and rupture of the rotator cuff was found. The correlation was even higher between distally pointing osteophytes and cuff ruptures. The results demand to clearly define the degeneration of the ac-joint and the rotator cuff in patients suffering from shoulder pain. A simultaneous occurrence has to be considered. If conservative treatment fails in patients with cuff tear and ac-joint degeneration, surgical revision is recommended. This should comprise: 1. suture of the cuff-rupture 2. excision of the coraco-acromial ligament 3. anterior acromioplasty according to Neer 4. excision of the outer end of the clavicle

Stiffness and Rotator Cuff Tears: Incidence, Arthroscopic Findings, and Treatment Results

Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0 degrees to 20 degrees TROMD. Group 2 consisted of 24 patients with 25 degrees to 70 degrees TROMD, and group 3 included 6 patients with a TROMD greater than 70 degrees. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10 degrees to 4 degrees in group 1, from 36 degrees to 12 degrees in group 2, and from 89 degrees to 31 degrees in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35 degrees in this subgroup. Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70 degrees or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. Level IV, case series.

Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears

Background The intraarticular portion of the long head of the biceps tendon is often widened in shoulders with cuff tears. It is unclear whether this is a local phenomen or is caused by muscle hypertrophy.Methods We investigated morphological changes of the biceps brachii in 14 embalmed shoulders: 7 with intact rotator cuff and 7 with rotator cuff tears.We measured the cross-sectional area (CSA) of the tendon of the long head of the biceps (LHB) at 9 levels between the glenoid origin and the musculotendinous junction. The muscle volume and the muscle fiber length of the long and short heads of the biceps were measured to calculate the physiological CSA (PCSA) by dividing the volume by the fiber length.Results The CSA of the LHB tendon at the entrance to the bicipital groove was greater in cuff tear shoulders than in normal shoulders. The PCSA of the biceps was similar in normal and cuff tear shoulders.Interpretation Hypertrophy of the LHB tendon appears to be a localized morphological change near the entrance to the bicipital groove.

The biceps tendon footprint

Background By arthroscopy, we observed a phenomenon that, according to our knowledge not previously described, we call the "biceps tendon footprint" (BTF)-an area of chondromalacia beside the bicipital groove.Patients and methods We studied 118 shoulder arthroscopies prospectively. We documented whether a BTF could be observed and what the main pathology associated with it was. We used 3 grades of cartilage wear to describe BTF, and we analyzed pathological changes in associated structures (subscapularis, biceps tendon and humeral head).Results We found a BTF in 16% of the cases. Associated diagnoses were cuff tears and instabilities, most often multidirectional. We observed all 3 grades of cartilage wear, grade 3 being the commonest. Biceps synovitis occurred more often in the BTF group.Interpretation BTF is not a rare phenomenon. Mal-traction of the intraarticular biceps tendon in MDI and cuff tears in addition with biceps synovitis appear to cause BTF.

Avoiding complications in arthroscopic subacromial space and instability surgery

Complications during shoulder arthroscopy are very uncommon. Advanced techniques such as labral stabilization and cuff repair, however, have associated high learning curves and recognized pitfalls. Common complications are either procedure specific, such as recurrent instability or cuff tear, or unrelated to the particular procedure, including bleeding, fluid extravasation, implant problem, or iatrogenic articular injury. Most complications can be avoided through careful preoperative planning, judicious patient selection, thorough understanding of normal and variational arthroscopic anatomy, attention to surgical detail, and commitment to development of arthroscopic motor skills.

Five year results of rotator cuff repair.

In thirty nine patients with either an acute rotator cuff rupture or a chronic impingement syndrome plus a cuff tear, a standard acromioplasty was performed along with a cuff repair...

けん板断裂例における肩峰の形態と画像所見の対比

In 1986, Bigliani studied the relationship between the shape of the acromion and rotator cufftears. He reported that a higher incidence of rotator cuff tears results in a hooked type acromion. The aim of this study is to investigate the relationship between the morphology of the acromion obtained at surgery with that of the pre-operative MR image and Scapular Y view.56 patients with an average age of 56 years were operated on, pre-operating MR imaging was carried out in 47 cases and Scapular Y view was in 43 cases. The acromion was obtained at surgery by lateral acromioplasty. The acromion was sliced into a thickness of 100μ and it was classified as flat (type 1), smoothly curved (type 2), or hooked (type 3) according to Bigliani's classification. Scapular Y view was taken with a X-ray fluoroscopy so that the undersurface of the acromion could be observed and classified into three groups. The acrominal shape of MRI imaging was classified from the sagital oblique gradient echo images, and Scapular Y view were obtained and classified into the same classification.Specimens type 1, type 2 and type 3 were 19.6%, 48.2% and 32.1% respectively. The accurancy of MRI image and Scapular Y view were 51.1% and 37.2%. In this study, no higher incidence of rotator cufftears was found in hooked type acromion, but there was a difference between the acrominal type in MRI imaging, Scapular Y view and that of specimens.

Anterior dislocation of the shoulder in elderly patients.

Of 545 consecutive patients with anterior shoulder dislocations, 108 (20%) were aged 60 years or more at the time of injury. We reviewed and radiographed 95 of these elderly patients after a mean follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108 patients, but all recovered completely in 3 to 12 months. There were single or multiple recurrences of dislocation in 21 patients (22.1%), but within this group age had no influence on the tendency to redislocate. Tears of the rotator-cuff were diagnosed by imaging studies or clinically in 58 patients (61%), including all who had redislocations. Sixteen patients required surgery. Eight with a single dislocation and a cuff tear had only repair of the torn cuff. Of the eight patients with multiple dislocations requiring operation, five also had a torn cuff and needed either a stabilising procedure and a cuff repair or repair of the cuff only. All patients who were operated on had a satisfactory result, with the exception of those with multiple redislocations and a cuff tear who had repair of the cuff only. Anterior shoulder dislocation in elderly subjects is more common than is generally believed; 20% suffer redislocation and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to stabilise the shoulder. Patients with multiple redislocations will probably require both procedures.

ANTERIOR DISLOCATION OF THE SHOULDER IN ELDERLY PATIENTS

Of 545 consecutive patients with anterior shoulder dislocations, 108 (20%) were aged 60 years or more at the time of injury. We reviewed and radiographed 95 of these elderly patients after a mean follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108 patients, but all recovered completely in 3 to 12 months. There were single or multiple recurrences of dislocation in 21 patients (22.1%), but within this group age had no influence on the tendency to redislocate. Tears of the rotator-cuff were diagnosed by imaging studies or clinically in 58 patients (61%), including all who had redislocations. Sixteen patients required surgery. Eight with a single dislocation and a cuff tear had only repair of the torn cuff. Of the eight patients with multiple dislocations requiring operation, five also had a torn cuff and needed either a stabilising procedure and a cuff repair or repair of the cuff only. All patients who were operated on had a satisfactory result, with the exception of those with multiple redislocations and a cuff tear who had repair of the cuff only. Anterior shoulder dislocation in elderly subjects is more common than is generally believed; 20% suffer redislocation and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to stabilise the shoulder. Patients with multiple redislocations will probably require both procedures.

Rotator Cuff Injury: Addressing Overhead Overuse

Rotator cuff injuries in sports are usually a result of microtrauma from repetitive movements. Classic, or primary, impingement results directly from overhead motions, and secondary impingement is related to underlying shoulder instability. A variety of physical maneuvers are used to assess pain, muscle weakness, and shoulder stability. The workup also includes plain x-rays, supplemented by other imaging tests if a cuff tear is suspected. Nonoperative treatment, which may include steroid injections, is often effective for an inflamed rotator cuff tendon. Surgery is indicated if the patient has no improvement after at least 6 weeks of physical therapy.

Rotator Cuff Injury

Rotator cuff injuries in sports brief are usually a result of microtrauma from repetitive movements. Classic, or primary, impingement results directly from overhead motions, and secondary impingement is related to underlying shoulder instability. A variety of physical maneuvers are used to assess pain, muscle weakness, and shoulder stability. The workup also includes plain x-rays, supplemented by other imaging tests if a cuff tear is suspected. Nonoperative treatment, which may include steroid injections, is often effective for an inflamed rotator cuff tendon. Surgery is indicated if the patient has no improvement after at least 6 weeks of physical therapy.

Tracheal Injury

Tracheal Injury

OVERUSE SYNDROMES IN ADULT ATHLETES

Approximately 50% of all sports participants will be injured at some point, and at least half of these injuries will be attributed to overuse. This article provides an in-depth review of the presentation, diagnosis, and treatment of the most common overuse injuries encountered in the adult population: epicondylitis, shoulder impingement/rotator cuff tears, patello-femoral dysfunction, and Achilles tendinitis. Stress fractures, the "ultimate" overuse injuries, are also discussed.

Detection of Soft-Tissue Hyperemia: Value of Power Doppler Sonography

Power Doppler sonography is a new technique that offers extended dynamic range over that provided by conventional color Doppler imaging, thereby facilitating measurement of tissue perfusion. We evaluated the efficacy of power Doppler sonography in depicting soft-tissue hyperemia in musculoskeletal inflammatory conditions.Twenty-three patients with predominantly unifocal musculoskeletal symptoms were evaluated with conventional gray-scale imaging and power Doppler sonography. The shoulder was evaluated in 14 patients, the elbow in three, and various other sites in six. For comparison purposes, the contralateral asymptomatic joint or site was examined in 17 cases. Fluid collections were aspirated in seven patients.Soft-tissue hyperemia was seen on power Doppler sonograms at the symptomatic site(s) in 22 of 23 cases studied, with an appearance ranging from frank tissue blush to large, isolated peritendinous/peribursal vessels. Findings associated with hyperemia included rotator cuff tendinitis and/or tear, b...

Assessment of the rotator cuff on sagittal MR image between shoulders with and without cuff tears

Assessment of the rotator cuff on sagittal MR image between shoulders with and without cuff tears

Magnetic Resonance Pathology of the Rotator Cuff

This article reviews the current issues in imaging of the rotator cuff with magnetic resonance imaging (MRI). Important technical issues are discussed, including some of the newer pulse sequences, surface coils, and MR arthrography. Debate continues over what constitutes the normal appearance of the rotator cuff. Issues regarding studies of asymptomatic volunteers, pitfalls in imaging, and MR artifacts such as magic angle effects are discussed. The article also reviews the basic concepts of MR interpretation of pathologic lesions of the cuff, including tendinopathy, partial and complete tears, and the relationships to rotator cuff impingement.