Management Of Rotator Cuff Tears Research Articles

Delayed diagnosis of concomitant rotator cuff tear and brachial plexopathy in a patient with traumatic brain injury: A case report

Mukand JA, Blackinton DD, VanDyck WR. Delayed diagnosis of concomitant rotator cuff tear and brachial plexopathy in a patient with traumatic brain injury: a case report. Arch Phys Med Rehabil 2001;82:1729-32. Traumatic brain injury (TBI) is often accompanied by additional trauma that can be obscured by cognitive dysfunction or multiple injuries in the same region of the body. This report describes the case of an unhelmeted motorcycle rider who collided with a telephone pole. He sustained a diffuse subarachnoid hemorrhage, bilateral subdural hematomas (right frontal and left temporal), diffuse axonal injury in the subcortical and periventricular white matter, and a left tibial fracture. After medical and surgical stabilization, he was transferred to a subacute rehabilitation facility and then to a rehabilitation center. He was evaluated for pain and limited range of motion in his right shoulder, where both a rotator cuff tear and a brachial plexopathy were diagnosed. This report discusses concomitant injuries that occur with TBI, and the management of rotator cuff tears and brachial plexopathy. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior aspect of the shoulder, localized tenderness of the coracoid process, anterior shoulder pain on horizontal adduction testing, and positive subcoracoid block suggest subcoracoid impingement syndrome. Postoperative subcoracoid impingement syndrome was investigated in 11 of 216 cases with rotator cuff surgery. The average patient age at the time of surgery was 61.2 y (range, 28-78 y). Coracoplasty (partial resection of the posterolateral side of the coracoid process) was performed in 9 shoulders that had not responded to a 6-month regimen of conservative treatment. Complete pain relief was achieved in all cases. Histopathologic findings revealed hypertrophic changes of the fibrocartilage layer at the posterior aspect of the resected coracoid process. We concluded that subcoracoid impingement syndrome was an important factor in unsuccessful rotator cuff surgery and recommend that coracoplasty be performed on patients with symptoms of subcoracoid impingement syndrome after management of the rotator cuff tear. (J Shoulder Elbow Surg 2000;9:275-8.)

A proposal of management of rotator cuff tear

A proposal of management of rotator cuff tear

Diagnosis and treatment of rotator cuff tears in the emergency department

This article will review the diagnosis and management of rotator cuff tears in the emergency departaient. Rotator cuff disease is a common source of shoulder pain. It encompasses a wide range of pathology of the rotator cuff tendons. These lesions can include impingement or tendinitis, and may progress to rupture of the tendons. In considering the emergency department management of cuff tears, it is useful to classify patients by the mechanism of their injury. Proper classification of patients requires a careful history and physical examination. Interpretation of these data is based on an understanding of the entire range of pathology that can affect the tendons of the rotator cuff.

Management of rotator cuff tears: A comparison of arthroscopic debridement and surgical repair

In a prospective study, 87 consecutive patients with 88 chronic, full-thickness tears of the rotator cuff were randomly assigned to either open surgical tendon repair and anterior acromioplasty (50 shoulders) or arthroscopic debridement and subacromial decompression (38 shoulders). All patients were reexamined 2 to 5 years after the operation with the University of California at Los Angeles 35-Point Scale for Pain and Function of the Shoulder. The average ratings were 30.5 (rotator cuff repair) and 25.1 (arthoscopic debridement/decompression) for each group. The open surgical repair group faired significantly better than the arthroscopic debridement group (p = .0028). Thirteen required subsequent procedures, four with tendon repair and nine with decompression. Five in the decompression group experienced cuff tear arthropathy. Surgical repair of full-thickness rotator cuff tears provided results superior to those of arthroscopic debridement and subacromial decompression.

Arthroscopic management of rotator cuff tears with emphasis on the throwing athlete

Traditional open rotator cuff repair techniques are successful and reliable in terms of pain relief; however, the possibility of retum to overhead throwing and racquet sports is uncertain. Our preliminary experience with an arthroscopic-assisted technique of rotator cuff repair indicates that both pain relief and function are as good or better in comparison with open techniques because of the preservation of the deltoid sleeve and limitation of the dissection. The technique also allows inspection of the glenohumeral joint and detection of any concomitant labral pathology. Because arthroscopy is performed with the patient in the beach-chair position, conversion to an open technique is easy if arthroscopic repair cannot be performed.