Full-thickness Rotator Cuff Research Articles

Plasma poly-unsatured fatty acids profile in children with inattentive ADHD - preliminary results of an efficacy Italian study with omega 3/6

Symptomatic full-thickness rotator cuff (RC) tears are often recommended for surgical repairs. However, some patients decide not to have surgery. The aim of this study was to see if there was any difference in preoperative variables between the two groups.137 consecutive patients recommended for surgery due to symptomatic full-thickness RC tear were evaluated. At mean 58.1 months after surgery-recommendation, the patients were asked whether they had surgery and their clinical outcome was assessed. Variables at the time of surgery-recommendation including demographics, range-of-motion (ROM), tear size, and fatty infiltration on MRI, and clinical score were compared between the two groups.The 59 men and 78 women had a mean age of 64.4 years. Overall, 104 (75.9%) patients were treated with RC repair and 33 (24.1%) were not. The main three reasons for not having surgery were improvement of symptoms or minimal pain (55%), economic burden (12%), and concern for postoperative long rehabilitation (9%). Demography and ROM measured at the time of surgery-recommendation did not differ. All clinical scores at one year and final follow-up survey showed no difference between the two groups. The Constant and UCLA scores at the time of surgery-recommendation were significantly higher and tear size was smaller in the ‘No-surgery’ group. Fatty infiltration of supraspinatus (2.0 versus 1.2, p < 0.001) and global fatty degeneration index (1.4 versus 0.8, p = 0.011) were statistically lower in ‘No-surgery’ group as well.Patients with relatively preserved function and small size tear tend to select non-surgical treatment and lead to relatively good outcome.

Partial and Full-Thickness RCT: Modern Repair Techniques.

The purpose of this article is to review the recent literature concerning modern repair techniques related to partial- and full-thickness rotator cuff tears. The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial- and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseus-equivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

Management of Acute Work-Related Shoulder Injuries by an Early Shoulder Assessment Program: Efficiency of Imaging Investigations.

Purpose: There has been a significant increase in the number of costly investigations of the shoulder joint over the past decade. The purposes of this study were to (1) describe the diagnostic imaging investigations ordered for injured workers seen at an Early Shoulder Physician Assessment (ESPA) program, (2) evaluate the impact of these investigations on final diagnosis and management, and (3) examine how efficient the program was by determining the appropriateness of referrals and whether costly imaging was justified. Methods: This was a retrospective review of the electronic files of injured workers who had been referred to an early assessment program because they had not progressed in their recovery or return-to-work plan within 16 weeks of the injury or reoccurrence. Results: The data of 750 consecutive patients-337 women (45%) and 413 men (55%), mean age 49 (SD 11) years-were reviewed. A total of 183 patients (24%) had been referred for further investigation. Of these, 90 (49%) were considered candidates for surgery (group 1), 58 (32%) had a change in diagnosis or management (group 2), and 17 (9%) had no change in diagnosis or management (group 3); 18 (10%) patients were lost to follow-up. We noticed a pattern in the type of diagnosis and the groups: full-thickness rotator cuff (RC) tear was the predominant diagnosis (Fisher's exact test [FET]=0.001, p<0.0001) for group 1. No statistically significant differences were found among the groups in the prevalence of labral pathology (FET=0.010, p=0.078), impingement syndrome (FET=0.012, p=0.570), partial-thickness RC tear (FET=0.004, p=0.089), or biceps pathology (FET=0.070, p=0.149). Ultrasound investigations were more prevalent in group 2 (FET=0.004, p=0.047). No pattern was found for use of magnetic resonance imaging and group allocation. However, all magnetic resonance arthrogram investigations (FET=0.007, p=0.027) had been ordered for patients who required labral or instability-related surgery. Conclusions: Of the injured workers we studied, 24% had further investigation, and the type and severity of pathology had affected the type of investigation. For the 165 patients who were included in groups 1-3, the ESPA was 90% efficient, with only 10% of patients not having had a change in diagnosis or management.

Rotator Cuff Tear Shape Characterization

Objectives:Proper surgical planning requires accurate and reliable pre-operative patient information. The more comprehensive the data, the more the surgeon can tailor a general surgical technique to an individual patient’s unique anatomy. A previous retrospective study demonstrated that three-dimensional magnetic resonance imaging more accurately characterized rotator cuff tears compared to two-dimensional images when checked against intra-operative pictures. The purpose of this study was to determine if three-dimensional MRI imaging would continue to be more accurate than two-dimensional imaging in a prospective study.Methods:Patients were prospectively included if they had a full-thickness primary rotator cuff tear on pre-operative MRI. Intra-op videos were taken from the posterior and lateral portals, with a grasper fully mobilizing the torn tendon in each view. 7 surgeons then reviewed the videos and independently characterized the shape of the tears into crescent, U-shaped tears, L-shaped tears, or massive tears. This was considered the gold-standard. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear’s retraction and size 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and fleiss’s kappa.Results:37 patients were enrolled in the study. Among the 7 surgeons, agreement on cuff tear was 93% ( =.87). The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 73.4% for reader 1 and 71.2% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 92% for reader 1 and 94% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 83%. The overall accuracy of 3D MRI was 91%, significantly different (P=.07) from 2D MRI accuracy (70.4).Conclusion:Our study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing rotator cuff tear shapes compared with current 2D MRI-based techniques.

MRI evaluation of arthroscopic full-thickness postero-superior rotator cuff repair using double row versus suture bridge fixation. A prospective, randomized study

MRI evaluation of arthroscopic full-thickness postero-superior rotator cuff repair using double row versus suture bridge fixation. A prospective, randomized study

Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum.

Synopsis The hallmark characteristics of rotator cuff (RC) tendinopathy are pain and weakness, experienced most commonly during shoulder external rotation and elevation. Assessment is complicated by nonspecific clinical tests and the poor correlation between structural failure and symptoms. As such, diagnosis is best reached by exclusion of other potential sources of symptoms. Symptomatic incidence and prevalence data currently cannot be determined with confidence, primarily as a consequence of a lack of diagnostic accuracy, as well as the uncertainty as to the location of symptoms. People with symptoms of RC tendinopathy should derive considerable comfort from research that consistently demonstrates improvement in symptoms with a well-structured and graduated exercise program. This improvement is equivalent to outcomes reported in surgical trials, with the additional generalized benefits of exercise, less sick leave, a faster return to work, and reduced costs to the health care system. This evidence covers the spectrum of conditions that include symptomatic RC tendinopathy and atraumatic partial- and full-thickness RC tears. The principles guiding exercise treatment for RC tendinopathy include relative rest, modification of painful activities, an exercise strategy that initially does not exacerbate pain, controlled reloading, and gradual progression from simple to complex shoulder movements. Evidence also exists for a specific exercise program being beneficial for people with massive inoperable tears of the RC. Education is an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) may enhance outcomes. Outcomes may also be enhanced by subgrouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation and the patient's response to shoulder symptom modification procedures outlined herein. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. J Orthop Sports Phys Ther 2015;45(11):923-937. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5941.

Impact of cardiovascular risk factor on the prevalence and severity of symptomatic full-thickness rotator cuff tears

IntroductionThe natural history of rotator cuff (RC) tears is likely multifactorial. Two theories have been put forward to explain them: extrinsic and intrinsic. Cardiovascular (CV) risk factors may be important in the context of the intrinsic theory. ObjectivesThe objectives of this study were to demonstrate the influence of CV risk factors and their cumulative effect on the prevalence of symptomatic full-thickness RC tears and on the severity of these lesions. Material and methodsA prospective observational case-control study was carried out with 206 consecutive patients undergoing arthroscopic rotator cuff repair. The control population consisted of 100 consecutive patients of the same age who had asymptomatic unoperated shoulders and were being operated in the orthopedics unit. The full-thickness RC tears were classified intraoperatively using the Southern California Orthopaedic Institute (SCOI) classification described by Snyder. CV risk factors were rated as either present or absent: smoking, high blood pressure (HBP), diabetes, alcoholism, dyslipidemia, obesity and CV history. ResultsUsing a multivariate analysis, two factors were identified as having a significant influence on the prevalence of RC tears: smoking (OR=8.715, 95%CI=4.192–18.118, P<0.0001) and dyslipidemia (OR=4.920, 95%CI=2.046–11.834, P=0.0004). The following factors had a significant effect on the severity of RC tears: smoking (OR=1.98, P=0.0341, 95%CI=1.05–3.74), HBP (OR=3.215, P=0.0005, 95%CI=1.67–6.19) and history of CV disease (OR=6.17, P<0.0001, 95%CI=2.5–14.78). The case patients had an average of 2.09 CV risk factors while the control patients had an average of 0.74 (OR=3.56, 95%CI=2.18–6.33, P=0.0012). The average number of CV risk factors increased as the severity of the tear increased: 0.19 for stage 1, 1.75 for stage 2, 2.75 for stage 3 and 2.90 for stage 4. DiscussionModification of the vascular background appears to influence the severity and prevalence of tears. This corroborates anatomical studies in which a hypovascular area was identified in the tendon, 10–15mm from the lesser trochanter attachment. Smoking, high blood pressure and obesity have been identified in other published studies as risks factors for the severity and prevalence of RC tears. However, it will be important to dissociate prevalence issues from that of RC healing in patients with compromised vascularity. ConclusionCardiovascular risk factors have a significant role in the pathology of RC tears. The prevalence of RC tears is greater in patients who smoke or have dyslipidemia. Their severity is greater in patients who smoke, have high blood pressure or have experienced at least one CV event. The next step will be to study how these factors affect tendon healing, as this information could change our indications for cuff repair. Level of evidenceProspective cohort study level 2.

Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings

Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre- and postoperative clinical findings. Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears.

Arthroscopic Distal Clavicle Resection in Symptomatic Acromioclavicular Joint Arthritis Combined With Rotator Cuff Tear

Background: The treatment of symptomatic acromioclavicular joint (ACJ) injury in the rotator cuff (RC) tear has not been well clarified. Purpose: To compare the clinical results between patients who had distal clavicle resection (DCR) and those who did not during RC repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From August 2008 to December 2009, a total of 56 consecutive patients (58 shoulders) were included. All patients had either a full-thickness or high-grade (>50%) RC tear, ACJ tenderness, arthritic change visible on plain radiographs, and a positive ACJ lidocaine injection test the day before surgery. Patients were randomized into 2 groups: DCR and RC repair (DCR+RCR group) and RC repair only (isolated RCR). Evaluation was performed preoperatively, at 6 months postoperatively, and at a final follow-up a minimum of 24 months postoperatively using the American Shoulder and Elbow Surgeons (ASES) score, the Constant shoulder score, range of motion examination, and pain visual analog scale (VAS). Results: After simple randomization, 26 shoulders were allocated in the DCR+RCR group, and 32 were placed in the isolated RCR group. Five shoulders in the DCR+RCR group and 6 in the isolated RCR group were excluded from analysis due to loss of follow-up. Therefore, the evaluation was performed for 21 shoulders in the DCR+RCR group and 26 shoulders in the isolated RCR group. The mean follow-up period was 44.2 months in the DCR+RCR group and 44.0 months in the isolated RCR group. There were no differences in age, sex, symptom duration, RC tear size, or preoperative ASES, Constant, and VAS scores between the 2 groups (P > .05). At final follow-up, the ASES, Constant, and VAS scores were significantly improved in both groups (P < .001). There were no differences in ASES, Constant, and VAS scores between the 2 groups at final follow-up (P > .05), and there was no difference in residual ACJ tenderness (7 in the DCR+RCR group and 5 in the isolated RCR group) between the 2 groups (P = .270). Conclusion: There was no difference in the clinical evaluations between the combined arthroscopic DCR and RCR group and the isolated RCR group at a minimum 24-month follow-up. Arthroscopic DCR should be carefully considered in patients who have symptomatic ACJ arthritis with RC tears.

Functional and Imaging Outcomes of Arthroscopic Simultaneous Rotator Cuff Repair and Bankart Repair After Shoulder Dislocations

Background: Previous studies have investigated outcomes of simultaneous rotator cuff (RC) repair and superior labral injury repair; however, there is limited information in the literature on outcomes of simultaneous RC repair and Bankart lesion repair after acute shoulder dislocations. Purpose: To determine functional and imaging outcomes of simultaneous arthroscopic RC repair and Bankart repair after acute shoulder dislocations and to compare functional outcomes to contralateral, asymptomatic shoulders. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients who underwent arthroscopic simultaneous RC repair and Bankart repair with a minimum of 2 years’ follow-up were recruited. All patients had suffered an acute shoulder dislocation. The American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Short Form (SF)–36 scores were obtained. The affected shoulder also underwent ultrasound imaging to assess the integrity of the RC. Results: Thirteen patients (mean age, 58.8 ± 11.2 years; mean follow-up, 38.5 ± 12.3 months) were recruited. In a comparison of the affected versus unaffected shoulder, there were no significant differences in the mean ASES score (89.7 ± 12.6 vs 95.0 ± 6.7, respectively), mean Constant score (80.5 ± 18.9 vs 86.8 ± 7.9, respectively), or mean abduction strength (15.4 ± 6.4 lb vs 15.4 ± 5.2 lb, respectively) (P > .05). The mean SF-36 physical component summary was 48.4. According to ultrasound imaging, there were persistent/recurrent full-thickness tears in 4 patients, and 1 patient had a new full-thickness tear. At follow-up, patients with full-thickness RC tears in the affected shoulder compared with their unaffected shoulder showed similar mean ASES scores (90.9 ± 11.8 vs 97.6 ± 4.3, respectively), mean Constant scores (77.8 ± 20.3 vs 84.8 ± 7.2, respectively), and mean abduction strength (11.5 ± 5.3 lb vs 12.6 ± 4.5 lb, respectively) (P > .05). Conclusion: After simultaneous arthroscopic repair of the RC and a Bankart lesion in patients after shoulder dislocations, the affected extremity had similar functional outcomes compared to the noninjured, asymptomatic side at a mean of 3 years after surgery. Persistent or recurrent RC tears involving the operative extremity were common, but they did not significantly affect functional outcomes in this small study.

The acromial index is not predictive for failed rotator cuff repair

The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39-74) and follow-up was 30.81 months (12-72). True anterior-posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. Eighteen cases with recurrent tears (17.4%) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711 ± 0.065 and for patients without recurrent tears 0.710 ± 0.064 (p < 0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63 ± 5.9 years; group without recurrent tears 58.8 ± 7.5 years) (r = -0.216; p = 0.029). We did not find an association between size of the primary tear and recurrent tears (r = -0.075; p < 0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r = -0.073; p < 0.05). We observed that 38.9% of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation. In this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair.

A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears

This pilot study evaluates the outcome after occupational therapy, compared to home-based exercises in the conservative treatment of patients with full thickness rotator cuff tears. Forty-three adult subjects (range, 18-75 years), who had a full thickness rupture of the rotator cuff which was verified by magnetic imaging tomography, with clinical signs of a chronic rotator cuff impingement, and who were available for follow-up, were randomized to occupational therapy or to independent home-based exercises using a booklet. After drop-out, 38 patients were available for full examination at follow-up. Before therapy and after 2 months of conservative treatment, pain intensity, the Constant-Murley score, isokinetic strength testing in abduction and external rotation, functional limitation, clinical shoulder tests and health-related quality of life (EQ-5D) were evaluated. Two-thirds of the patients improved in clinical shoulder tests, regardless of the therapy group. There were no significant differences between the groups with reference to pain, range of motion, maximum peak force (abduction, external rotation), the Constant-Murley score, and the EQ-5D index. The only significant difference observed was the improvement in the self-assessed health- related quality of life (EQ-5D VAS) favoring home-based exercises. Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment.

Systematic review of rotator cuff tears in workers' compensation patients

The burden imposed by workplace rotator cuff (RC) injuries has been reasonably defined. However, literature associated with the demographic characteristics and 'best practices' to manage such injuries among workers' compensation (WC) patients is scant. To consolidate the existing literature on full-thickness RC tears among WC patients. Subject, shoulder and injury characteristics were examined to determine if and how WC recipients may differ from their non-compensable counterparts. A systematic search (databases, clinical practice guideline web resources, conference proceedings and reference lists) revealed 450 abstracts. Two blinded reviewers independently assessed abstracts for inclusion. Sixty abstracts were subsequently included in a blinded full manuscript review. Seventeen of these manuscripts (3.8% of sample; 11 intervention and 6 determinant) were included in the present review. Previous studies demonstrate that operative interventions are appropriate for full-thickness RC tears as substantial gains in range of motion, strength and quality of life were witnessed within the first post-operative year. Non-operative interventions, including workplace-based work hardening, physical therapy and the use of an early referral system, were shown to improve outcomes. Conflicting results exist with respect to determinants such as age and sex. Importantly, WC patients had consistently poorer outcomes than non-WC patients. Our results show that although WC patients experience substantial benefits from various treatments for full-thickness RC tears, disparities exist between them and their non-WC counterparts. The lack of WC-specific literature limited our results. Larger studies, particularly ones comparing WC patients with their non-compensable counterparts, are crucial to allow for future evidence-based recommendations.

How repaired rotator cuff function influences Constant scoring

The function level influence of an intact rotator cuff on the unweighted Constant score and its corresponding items is unknown. The aim of this study was to evaluate this contribution. The hypothesis was that the shoulder muscles other than the rotator cuff ones ensure a "basic" shoulder function level that is improved by the rotator cuff depending on its fatty degeneration index (FDI) MATERIAL AND METHODS: This study was based on a continuous series of 29 non-osteoarthritic shoulders whose sutured rotator cuff tears remained intact after 9 years of follow-up. The preoperative FDI was 0.9 (0-2) and 1.26 (0.2-2.2) at the final follow-up. The Constant score was 76.85 at the final follow-up (range 42-93). There was a strong negative correlation between preoperative and follow-up FDI's and all the Constant scores at the final follow-up. Linear regression analysis was performed. The two linear regression lines were superimposed. For a given FDI value, all Constant scores were lower when linear regression was based on preoperative FDI scores that included postoperative deterioration of the FDI. The two linear regression lines converged as the FDI increased and intersected at an FDI of 2.25. Thus, the impact of intact repaired rotator cuff function was null when the FDI was above 2.25, leaving other shoulder muscles (including the deltoid), to ensure "basic" shoulder function at a Constant score of approximately 62 points. The "basic" shoulder function found in this study is supported by the similar Constant scores found in reverse shoulder prostheses, and in painless shoulders with full thickness rotator cuff tears. The deltoid and the shoulder muscles other than the rotator cuff seem to be responsible for "basic" shoulder function and represent 60% of the unweighted Constant score. The lower the FDI, the more the function of an intact repaired cuff improves this "basic" function level. Level IV.

Enabling Coupled Quantitative Genomics and Proteomics Analyses from Rat Spinal Cord Samples

Translational research is progressing toward combined genomics and proteomics analyses of small and precious samples. In our analyses of spinal cord material, we systematically evaluated disruption and extraction techniques to determine an optimum process for the coupled analysis of RNA and protein from a single 5-mm segment of tissue. Analyses of these distinct molecular species were performed using microarrays and high resolution two-dimensional gels, respectively. Comparison of standard homogenization with automated frozen disruption (AFD) identified negligible differences in the relative abundance of genes (44) with all genes identified by either process. Analysis on either the Affymetrix or Applied Biosystems Inc. gene array platforms provided good correlations between the extraction techniques. In contrast, the AFD technique enabled identification of more unique proteins from spinal cord tissue than did standard homogenization. Furthermore use of an optimized CHAPS/urea extraction provided better protein recovery, as shown by quantitative two-dimensional gel analyses, than did solvent precipitation during TRIzol-based RNA extraction. Thus, AFD of tissue samples followed by protein and RNA isolation from separate aliquots of the frozen powdered sample is the most effective route to ensure full, quantitative analyses of both molecular entities.

Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff.

The purpose of this study was to investigate the validity of the supraspinatus test as a screening test for detecting torn rotator cuff and to determine what its valuable positive signs were. Both the empty-can test and full-can test were performed on 200 shoulders diagnosed by magnetic resonance imaging (MRI)-and in some cases, surgical findings-to have full-thickness or partial-thickness torn rotator cuff s, or no tear in the rotator cuff . During the maneuver, the presence of pain or weakness or both pain and weakness were recorded as positive signs, and the distribution of these signs were analyzed according to the degree of tear. The predictive values were calculated in 2 ways by considering (1) only full-thickness tears as tears and (2) both full- and partial-thickness tears as tears. The 2 tests and the 2 ways of considering partial-thickness tears were compared. Pain and weakness were severity-dependent, and the empty-can test had a higher incidence of pain. The sensitivities of the 2 supraspinatus tests in all positive signs were higher when including partial-thickness tears in the tear group ; however, their specificities were higher when excluding partial-thickness tears. Both pain and weakness were interpretive for the supraspinatus test, and both tests were sensitive to full- and partial- thickness tears and specific for full-thickness tears.

Inflammatory Cytokine Expressions of the Subacromial Bursitis and Glenohumeral Joint Synovitis in the Patients with Full Thickness Rotator Cuff Tear

PURPOSE: The purpose of this study was to compare expression patterns of inflammatory cytokines between subacromial bursitis and glenohumeral (GH) joint synovitis in full thickness rotator cuff (RC) tear patients with severe pain.MATERIALS AND METHODS: We were able to obtain enough tissue from nine subacromial bursitis and GH synovitis patients at the same time during surgery and evaluate them. We compared mRNA expression of inflammatory cytokines between the two groups using Reverse Transcription-Polymerase Chain Reaction (RT-PCR).RESULTS: Relative mean mRNA expression of IL-1beta, IL-6, TNF-alpha, COX-1, COX-2 and SDF-1 in the tissues of subacromial bursitis and GH synovitis patients did not show significant differences.CONCLUSION: GH synovitis may be another source of shoulder pain with subacromial bursitis in full thickness RC tear patients with severe pain.