Rotator Cuff Disorders Research Articles

Epidemiology and risk factors for Rotator cuff tears in Indian population

Introduction: Rotator cuff disorders are a prevalent shoulder problem in clinical settings. The incidence of rotator cuff tears in cadaveric studies ranges from 5% to 40%, with multifactorial etiology. Limited data exists on the epidemiology of rotator cuff tears in the Indian population. This study aims to evaluate risk factors and demographic features associated with symptomatic rotator cuff tears.Materials and Methods: This prospective observational study was conducted at a tertiary care center in Bangalore, India, involving 105 patients with MRI-confirmed full-thickness rotator cuff tears. A one-time evaluation assessed risk factors, demographic characteristics, and physical examination findings, including range of motion, strength, and impingement. Data were analyzed with descriptive statistics and the Chi-square test to explore associations between age, gender, comorbidities, and rotator cuff tears.Results: The age distribution showed 5.48% in 31-40 years, 23.81% in 41-50 years, 40.95% in 51-60 years, 22.86% in 61-70 years, and 6.90% in >70 years. The male-to-female ratio was 1.56:1, with a significant gender difference (p = 0.03). Right shoulder involvement was more common (68.10%), with the dominant shoulder affected in 65 patients. Hypertension (29.5%) and type 2 diabetes (24.8%) were the most common comorbidities.Conclusion: Increasing age is the primary risk factor for rotator cuff tears, with risk rising proportionately with age. Hypertension and diabetes mellitus are common comorbidities associated with rotator cuff disease in the Indian population.

Treatment of Partial-Thickness Rotator Cuff Tears with Bio-Inductive Collagen Implant for Paraplegic Tennis Player: A Case Report

In patient with lower limb disability, rotator cuff disorders are prevalent, with partial thickness tears occurring at nearly twice the rate of full thickness tears. For those with acromion spurs unresponsive to conservative treatment, rotator cuff repair via the take-down method poses a retear risk and requires extensive rehabilitation. Conversely, surgery utilizing bio-inductive collagen implants shows a lower retear risk and enables faster recovery, making it an appealing option for wheelchair athletes. Thus, the authors aim to present favorable outcomes from isolated bio-inductive collagen implant repair in a 45-year-old female wheelchair tennis player with a bursal side partial thickness tear, alongside a literature review.

Value of Strain Elastography in Evaluation of Supraspinatus Tendinopathy in Patients with Chronic Shoulder Pain, A Comparative Study to MRI

Abstract Background Rotator cuff disorders are one of the most important causes of chronic shoulder pain and the clinical differentiation between the different rotator cuff disorders is difficult and imaging is mandatory for diagnosis and proper assessment of rotator cuff abnormalities. The most commonly used imaging modalities are ultrasonography (US) and magnetic resonance imaging (MRI) with MRI is the reference standard for imaging of rotator cuff disorders yet its use is hindered by high cost and MRI contraindications. Aim of the Work to assess role of SEL in the evaluation of supraspinatus tendon abnormalities and to evaluate the relationship between the measured strain ratio and the MRI grade of tendinopathy. Patients and Methods Our study included 40 patients with chronic shoulder pain including 11 patients with no evident tendinopathy on MRI (grade 0) (27.5%) 9 patients with grade I tendinopathy (22.5 %), 10 patients with grade II tendinopathy (25 %) and 10 patients (25 %) with supraspinatus tendon tear (grade III). Results Our study showed that normal supraspinatus tendons appear homogenous and stiff with high strain ratios, whereas pathological ones showed a more heterogenous and reduced stiffness pattern with intratendinous color alterations and lower strain ratios. This is explained by the fact that tendinopathy leads to collagen fiber degeneration and breaking down, resulting into tendon softening and weakness. Our study also showed strong linear association between the MRI grade and the stiffness indicated by the strain ratios (p < 0.05). There was a perfect negative correlation grade of tendinopathy and SEL strain ratio. As tendinopathy increased, tendons became softer which was indicated by the reduced strain ratio values. These findings were in agreement with many previously published studies. Conclusion The application of SEL in musculoskeletal system is not well established, but this study showed that SEL can detect differences between the normal and diseased rotator cuff tendons with good correlation to MRI with other studies showed improved sensitivity, specificity and accuracy in detection of tendon abnormalities. It can also add further important information to conventional shoulder imaging such as tendon quality which considered as a prognostic factor for rotator cuff repair.

The effects of telemedicine on Rotator cuff-related shoulder function and pain symptoms: a meta-analysis of randomized clinical trials

BackgroundThe effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders.MethodsRandomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger’s test.ResultsTen studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period.ConclusionTelemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings.

Arthroscopic repair of Non Traumatic Small to Medium Sized Full Thickness Rotator Cuff Tears with and without Acromioplasty

Abstract Background The shoulder joint has the greatest range of motion of any other joint. Pain of the shoulder joint is very common and accounts for about 16% of musculoskeletal disorders taking the third place after spine and knee. Rotator cuff disorders including degeneration or tear are most common causes of chronic shoulder pain. Causes of rotator cuff tear (RCT) still unclear and occur as a result of many factors. As degenerative changes of the rotator cuff that occur in old age increase the risk of rotator cuff tear also overhead workers and athletes considered a risk factor. Objective To evaluate the role of acromioplasty in arthroscopic repair of small to medium sized full thickness tear of rotator cuff according to the complication rate, the active range of motion and the function scores of the shoulder to add surgeons in deciding whether acromioplasty must be done routinely during arthroscopic repair of rotator cuff or not. Patients and Methods During the period between February 2019 and May 2022, A Prospective, Randomized Controlled Clinical trial was conducted in Ain Shams University hospital in Cairo. This study was designed to involve 36 cases with symptomatic small to medium sized RC tear, the patients were separated into two groups of 18. Group A comprised those applied with arthroscopic rotator cuff repair, bursectomy and antero- inferior acromioplasty. In Group B, arthroscopic rotator cuff repair was applied with bursectomy only and no acromioplasty. Each patient in this study was carefully assessed clinically by taking a detailed medical history and adequate clinical examination. Results There was a significant difference between the pre-operative and post-operative ASES score, WORC score and ROM but according to postoperative evaluation regarding ASES score, WORC score and ROM there was no statistically significance between the group of acromioplasty and the group of non-acromioplasty. Regarding complications, 3 cases of study population (36) cases were complicated, one case in group A (frozen shoulder) and 2 cases in group B (frozen and revision). With respect of the literature, the results were comparable to that of the literature as regard the functional outcome and complication rate. Conclusion The result of this study showed that there may be no need for routine application of acromioplasty during arthroscopic rotator cuff repair as it has concerns being less cost effective. We acknowledge that the cost was not assessed in our study. However, they are intuitive. Also, more long term follow up studies are required to assess the incidence of retear in rotator cuff repair without-acromioplasty as controversy is still present in the literature.

Assessment of shoulder joint derangements with magnetic resonance imaging in adult Nigerians.

Shoulder pain secondary to various aetiologies is a common musculoskeletal complaint worldwide, and Magnetic Resonance Imaging (MRI) is the most accurate imaging method for evaluating shoulder pain in all age groups. While the patterns of shoulder MRI abnormalities in various demographics have been reported, data on sub-Sahara African populations are still sparse. This study aims to describe the imaging features and spectrum of shoulder joint pathologies on MRI in adult Nigerians. This was a retrospective review of the shoulder MRI of 100 adult Nigerians (with and without trauma) from September 2020 to December 2021. Their clinical data and shoulder MRI findings were extracted and analysed. Statistical significance was set at P ≤ 0.05. There were 64 males and 36 females aged 18-82 years. Right shoulder MRI was done in 53 subjects (53%), while the left shoulder was studied in 47 (47%). Supraspinatus tendinopathy (73%), acromioclavicular joint arthropathy (68%), and subacromial-subdeltoid (SASD) bursitis (64%) were the most frequently detected pathologies. Other demonstrated derangements include glenohumeral joint effusion (24%), long head of biceps tendon sheath effusion (18%), labral abnormalities (16%), subcoracoid bursitis (4%), Hill Sach's deformity (3%), anterior glenohumeral dislocation (2%), fatty degeneration of the supraspinatus/infraspinatus muscles (2%), adhesive capsulitis (1%), and other bony abnormalities (contusion, erosion, subchondral cysts). There was no significant difference in the frequency of shoulder abnormalities between the male and female subjects. Acromioclavicular joint arthropathy, SASD bursitis, and rotator cuff disorders were the dominant pathologies in the participants' shoulders.

Surgeon Factors and Trends Associated With the Use of Subacromial Decompression at the Time of Rotator Cuff Repair

Subacromial decompression (SAD) has historically been described as an essential part of the surgical treatment of rotator cuff disorders. However, investigations throughout the 21st century have increasingly questioned the need for routine SAD during rotator cuff repair (RCR). Our purpose was to assess for changes in the incidence of SAD performed during RCR over a 12-year period. In addition, we aimed to characterize surgeon and practice factors associated with SAD use. Records from two large tertiary referral systems in the United States from 2010 to 2021 were reviewed. All cases of RCR with and without SAD were identified. The outcome of interest was the proportion of SAD performed during RCR across years and by surgeon. Surgeon-specific characteristics included institution, fellowship training, surgical volume, academic practice, and years in practice. Yearly trends were assessed using binomial logistic regression modeling, with a random effect accounting for surgeon-specific variability. During the study period, 37,165 RCR surgeries were performed by 104 surgeons. Of these cases, 71% underwent SAD during RCR. SAD use decreased by 11%. The multivariable model found that surgeons in academic practice, those with lower surgical volume, and those with increasing years in practice were significantly associated with increased odds of performing SAD. Surgeons with fellowship training were significantly more likely to use SAD over time, with the greatest odds of SAD noted for sports medicine surgeons (odds ratio= 3.04). Although SAD use during RCR appears to be decreasing, multiple surgeon and practice factors (years in practice, fellowship training, volume, and academic practice) are associated with a change in SAD use. These data suggest that early-career surgeons entering practice are likely driving the trend of declining SAD. Despite evidence suggesting limited clinical benefits, SAD remains commonly performed; future studies should endeavor to determine factors associated with practice changes among surgeons.

Management of rotator cuff injuries using allogenic platelet-rich plasma

Rotator cuff injuries are a major cause of shoulder pain, affecting the quality of life and producing a significant burden on healthcare systems. Conservative management modalities are prioritized, resorting to surgery only when required. The field of regenerative medicine involving the use of biologics, such as platelet-rich plasma (PRP), has evolved and shown potential for managing rotator cuff injuries. Nonetheless, limitations including subpar outcomes have led clinicians to question the efficacy of autologous PRP. To circumvent this, the possibility of utilizing a standardized and well-characterized allogenic PRP for RCI has been explored. In this manuscript, we qualitatively present the evidence from in vitro, pre-clinical, clinical and ongoing studies investigating the applications of allogenic PRP in the context of rotator cuff disorders. Administration of allogenic PRP is safe and potentially efficacious to manage rotator cuff injuries, though more adequately powered randomized controlled trials with longer follow-ups are warranted to further establish the efficacy of allogenic PRP and justify its routine clinical use.

Rotator cuff disorders: An updated survey of current (2023) UK physiotherapy practice.

Clinical guidelines recommend treatment by a physiotherapist for people with shoulder pain due to rotator cuff disorder. Despite this recommendation, research evidence supporting the effectiveness of treatment by a physiotherapist is uncertain. While developing a randomised controlled trial to test the effectiveness of treatment by a physiotherapist for people with shoulder pain due to rotator cuff disorders, we first aimed to understand current practice as a basis for defining usual care. An online survey was developed based on a clinical vignette used in a previous survey exploring physiotherapy practice for people with shoulder pain due to rotator cuff disorder. UK-based physiotherapists were invited to complete the survey via X and email across professional networks. One Hundred Seventy complete responses were received. 167 (98%) respondents would offer advice/education to patients with shoulder rotator cuff disorders; 146 (86%) would use isotonic exercise (including concentric/eccentric strengthening); 20 (12%) would offer a corticosteroid injection; 7 (4%) would use joint mobilisation. 168/169 (99%) would offer in-person assessment; 115 (68%) expect to deliver treatment over three to four sessions. Fifty percent agreed there is uncertainty about the effectiveness of physiotherapy treatment for patients with shoulder rotator cuff disorders. Seventy six percent agreed that patients with this condition can recover without physiotherapy intervention. Exercise and advice remain the most common treatments offered by physiotherapists for people with shoulder pain due to rotator cuff disorder. Corticosteroid injections are infrequently considered. Uncertainty about the effectiveness of treatment by a physiotherapist for shoulder pain due to rotator cuff disorder is evident.

Quantitative evaluation of adhesion severity around subscapularis and its relationship with shoulder range of motion in frozen shoulder and rotator cuff disorder: an observational study using dynamic ultrasonography

BackgroundThis study aimed to evaluate the severity of adhesion between muscles in the shoulder joint using dynamic ultrasonography and to confirm whether adhesions cause range of motion (ROM) restrictions. MethodsTwenty-four shoulders from fifteen frozen shoulder (FS) patients and Twenty-four shoulders from eighteen rotator cuff disorder (RCD) patients were enrolled. We obtained ultrasound video sequences of the subscapularis and deltoid muscles during shoulder external rotation. The mean stretching velocities of the deltoid (VDelt) and subscapularis (VSSC) were subsequently analyzed using a PC. If adhesions occurred between both muscles, the deltoid was stretched more vigorously, and we calculated VDelt/VSSC as adhesion severity. The coracohumeral ligament (CHL) thickness was measured using the same images. Shoulder ROM was measured by using a universal goniometer. ResultsThe intraclass correlation coefficients (1.1) and (2.1) of the adhesion severity measurements were 0.85 and 0.91, respectively. Multiple linear regression analysis revealed that the adhesion severity is a significant predictor for external rotation ROM in the RCD group (R2 = 0.44, F = 10.1, p < 0.01, t = -2.9), while CHL thickness predicts ROM in the FS group (R2 = 0.28, F = 5.5, p = 0.01, t = -3.0). ConclusionThe proposed method is reliable. Muscle adhesion causes ROM restriction of the shoulder joint. The primary cause of shoulder ROM restriction differed between the diagnostic groups.

ROTATOR CUFF DISORDERS: A SURVEY OF CURRENT PHYSIOTHERAPY PRACTICE IN TURKIYE

Purpose: One of the most important factors guiding the physiotherapy program for rotator cuff disorders (RCD) is the clinical preferences of the physiotherapist in light of the evidence. However, the management parameters are remarkably variable between physiotherapists. It was aimed to describe the current physiotherapy practice of Turkish physiotherapists for the management of RCD and to explore its parallelism with the research evidence, and with the clinical perspective in European countries. Methods: A cross-sectional online survey based on a clinical scenario that describes a typical patient with symptoms of RCD was conducted during July/August 2020. Descriptive responses of 104 physiotherapists were reported and analyzed by grouping physiotherapists with special interest (SI) who have further clinical experience or specialized training on RCD and no special interest (NSI). Results: The most preferred approaches were mobilization (82), scapular stabilization exercises (82), advice/education (71), and taping (62). The preference rate of cold therapy (χ2=4.303, p=0.038) and isometric exercises (χ2=4.248, p=0.039) were significantly higher for physiotherapists with SI rather than NSI group. Conclusions: The most preferred management strategies of mobilization, exercise, and advice/education have been aligned with the preferences of physiotherapists from European countries and the current research evidence. However, passive modalities were also highly preferred. The management strategies differ between the physiotherapists who have SI and NSI. The high degree of practice variability and passive treatment preference of physiotherapists for the patients with RCD might be due to a lack of following the current literature evidence regularly.

The validity of ultrasound and shear wave elastography to assess the quality of the rotator cuff

ObjectivesUS with shear wave elastography (SWE) could reduce the burden and costs of the diagnostic process for patients with rotator cuff disorders. The aim of this study is to investigate the validity of US and SWE in preoperative assessment of fatty infiltration (FI) and muscle atrophy of the supraspinatus (SSP) and infraspinatus (ISP) muscles.MethodsPatients with a rotator cuff disorder and a recent shoulder CT or MRI scan were eligible to participate. Goutallier and Warner stages of the SSP and ISP muscle were measured on the scan, for assessment of FI and muscle atrophy, respectively. These findings were compared with shear wave velocities (SWVs) assessed on US. Visual assessment of FI on US was compared with the Goutallier stage. To quantify the amount of muscle atrophy, the occupation ratio between SSP fossa and muscle was measured on MRI and US.ResultsSeventy-eight shoulders were included in the analysis. The correlation found between the occupation ratio on US and Warner and Goutallier stage and ratio on MRI ranged between r = − 0.550 to 0.589. The Goutallier stage of ISP and SSP muscle assessed on US showed a fair correlation with the Goutallier stage on a scan of r = 0.574 and r = 0.582, respectively. There was a poor correlation between the SWVs and scan results (r = − 0.116 to 0.07).ConclusionSWE is not a valid method to measure the amount of FI or muscle atrophy in the SSP muscle. Therefore, SWE is not a suitable alternative for MRI in standard preoperative diagnostics in rotator cuff pathologies.Clinical relevance statementShear wave elastography should not be used in the diagnostics of rotator cuff pathologies.Key Points• There is a fair correlation between the Goutallier stage of the supraspinatus and infraspinatus muscle assessed on MRI and CT and visual assessment of fatty infiltration achieved on US.• Shear wave elastography is not a valid tool for the determination of the amount of fatty infiltration or muscle atrophy.• Shear wave elastography should not be used as a cheaper and less burdensome alternative for diagnostics in rotator cuff pathologies.

Case Study: Successful Rehabilitation of a Torn Rotator Cuff through Physical Therapy for Positive Functional Recovery

Older adults often suffer from shoulder pain. Rotator cuff problems are typically responsible for shoulder pain. The majority of rotator cuff disorders can be treated conservatively. Shoulder issues are rather common. More than 30% of people have shoulder pain at some time in their lives. Shoulder discomfort is one of the most frequent musculoskeletal problems in people over the age of 65. The rotator cuffs are four muscles that connect the top arm bone (humerus) to the upper shoulder blade (scapula). If the rotator cuff is injured, every motion on the affected shoulder, including flexion, extension, abduction, adduction, and internal and external rotation, may be difficult. Having a rotator cuff tear restricts movement of the shoulder, which makes it difficult for the patient to do everyday tasks such as getting dressed or washing their hair. They may also find it difficult to remove something from their back pockets. patient was completely immobile when injured. Treatment was provided for up to three months, and almost 30 rehabilitation sessions were conducted during this time. In each rehabilitation session, patients were treated with electrotherapeutic modalities, dry cupping, and manual therapy exercises. The rehabilitation session lasted up to an hour. After one month of rehabilitation, the shoulder pain was noticeably reduced and nearly gone. Following the treatment, she achieved the most improvement in her functional capacity. For instance, she is now able to put on clothes without any assistance. Now she can comb her hair on her own. It was proven that exercise treatment significantly reduced pain and improved function in individuals with fully ruptured or torn supraspinatus and infraspinatus tendons. Keywords: Rotator cuff, full thickness tear, disability, surgery, shoulder pain, physical therapy.

Evaluating the content validity of the Single Assessment Numeric Evaluation (SANE) in shoulder pathologies

BackgroundThe Single Assessment Numeric Evaluation (SANE) is a single item patient reported outcome measure (PROM) of function, in where patients rate how normal they feel in relation to a specific joint or problem. Although validated for some orthopedic conditions, it is not yet validated for a population with shoulder pathologies; nor have other studies explored the content validity. This study aims to understand how 1) patients with shoulder conditions interpret and calibrate responses to the SANE and 2) how they define normal. MethodsThis study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated the SANE. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework for classification of interpretation variances. ResultsOverall, the single-item SANE was well received by all participants. Through the interviews, the themes of: Comprehension (20% of participants), Reference Point (20% of participants), Relevance (10% of participants), and Perspective Modifiers (50% of participants) emerged as potential sources of interpretation variances. Clinicians indicated this tool facilitates discussion when trying to create realistic recovery expectations for patients post-operatively. The word “normal” was defined by the themes of: 1) levels of current pain compared to pre-injury, 2) personal expectations of recovery and 3) pre-injury activity levels. ConclusionsOverall, respondents found the SANE to be cognitively simple, but it was clear that the interpretation of the question and what factors calibrated their responses were highly variable between respondents. The SANE is perceived favorable by patients and clinicians, while providing a low response burden. However, the construct being measured may vary between patients.

Varmam Therapy for Common Shoulder Joint Pathological Conditions- A Review

Varmam- a discrete medical science and a great contribution of Siddhars to Tamil Nadu. It encompases Varma martial arts, Varma therapy, internal and external medicines. Varma therapy and medicines effectively treat neuro musculoskeletal conditions which is admirable. Shoulder pain is most common orthopaedic condition. It is the third common cause of musculoskeletal consultations in primary care. Approximately 1% of adult develops new shoulder pain annually. Common pathological conditions of shoulder like rotator cuff disorders and adhesive capsulitis etc exhibits similar clinical features like pain and stiffness of shoulder joint and restricted movements. Varma therapy rearranges and regulates the “Vaasi” and consequently helps to maintain the equilibrium of trihumours (Vatham, Pitham, Kapham). This review article explicates the Varma points for the treatment of shoulder pathological conditions, the exact anatomical location of Varma points and the appropriate method of its manipulation, certainly a key to further research articles.

Validity, Reliability and Responsiveness of the Malay Shoulder Pain and Disability Index (M-SPADI) for Patients with Shoulder Pain.

The purpose of this study is to determine the validity, reliability, and responsiveness of the Malay Shoulder Pain and Disability Index (M-SPADI) in Malay speakers suffering from shoulder pain. The M-SPADI, the Numerical Rating Scale (NRS), and measurements of shoulder active range of motion (AROM) were completed by 140 patients with shoulder pain (68 with rotator cuff pathology and 72 with other shoulder pathology). Thirty-four patients were retested for test-retest reliability with M-SPADI after an average of 9.2 days. M-SPADI was performed on twenty-one individuals three months after completing treatment for rotator cuff disorders to assess response. The results of exploratory factor analysis revealed a bidimensional structure for M-SPADI. M-SPADI disability score was significantly greater in patients with rotator cuff pathologies (median = 31.87, IQR 82.50) than in patients with other shoulder pathologies (median = 20.00, IQR 23.84). In multi-group factor analysis, measurement invariance revealed no significant difference between the two groups (p>0.05). There was a significant positive correlation between M-SPADI and NRS (Pain = 0.86, Disability = 0.75, Total = 0.82, p=0.005), and a significant negative correlation between M-SPADI and shoulder AROM (Pain = -0.34 to -0.67, Disability =-0.44 to -0.73, Total =0.43 to -0.72, p=0.005). M-SPADI had a high degree of internal consistency (Cronbach's 0.92 for pain and 0.95 for disability). Test-retest reliability was moderate to excellent (ICC Pain = 0.84, ICC Disability = 0.78, ICC Total = 0.81, p=0.001), and the smallest detectable change ranges (Pain = 8.74, Disability = 3.21, Total = 3.83) were less than the minimal detectable change ranges (Pain = 21.57, Disability = 6.82, Total = 8.79). The area under the receiver operating characteristic curve (AUC) for M-SPADI was greater than 0.90 (Pain = 0.99, Disability = 0.94, Total = 0.96). The M-SPADI has established construct validity, internal consistency, test-retest reliability, and responsiveness. The M-SPADI is a reliable and valid instrument for evaluating shoulder pain among Malay-speaking individuals. In addition, the M-SPADI disability subscale may be useful for monitoring functional score changes in patients with rotator cuff pathology.

Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review.

Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological improvements and advanced diagnostic modalities, there has been much progress as to improved understanding of the pathology. Similarly, with advanced implant designs and instrumentation, operative techniques have evolved. Furthermore, refinements in postoperative rehabilitation protocols have improved patient outcomes. In this scoping review, we aim to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight recent advances in its management.

Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis.

To assess whether the use of Platelet-rich plasma (PRP) produces a clinical benefit in patients with rotator cuff disorders, treated either conservatively or surgically. A systematic review was performed according to PRISMA guidelines on three databases (PubMed, Cochrane Library, Web of Science) to identify randomised controlled trials (RCTs) on the use of PRP in patients with rotator cuff disorders, treated either conservatively or surgically. A meta-analysis was performed on articles reporting results for Constant, UCLA, VAS, SST scores and retear rate. The RoB 2.0 and the modified Coleman Methodology Score were used to assess methodological quality. A total of 36 RCTs (20 surgical, 16 conservative) were included, for a total of 2,443 patients. Conservative treatment showed high heterogeneity and no clear consensus in favour of PRP. The meta-analysis of the studies with surgical treatment showed no benefit in using PRP in any of the clinical outcomes, either at the short or medium/long-term follow-up. However, the retear rate was lower with PRP augmentation (p < 0.001). The overall quality of the studies was moderate to high, with the surgical studies presenting a lower risk of bias than the conservative studies. The use of PRP as augmentation in rotator cuff surgical repair significantly reduces the retear rate. However, no benefits were documented in terms of clinical outcomes. PRP application through injection in patients treated conservatively also failed to present any clear advantage. While there are many studies in the literature with several RCTs of moderate to high quality, the high heterogeneity of products and studies remains a significant limitation to fully understanding PRP potential in this field. Level I.

Dextrose Prolotherapy for Supraspinatus Partial Tear: A Case Report

Introduction: Rotator cuff (RC) tears account for about 20% of RC disorders and presents with severe shoulder pain that can significantly impact activities of daily life. Case report: A 34-year-old male with a history of chronic right shoulder pain presents with tenderness at the lateral shoulder, positive subacromial impingement tests, painful end range of motion and pain score of 6. Ultrasound shows a partial supraspinatus tear at the bursal side. The patient was treated with 15% dextrose to the supraspinatus tendon intrasubstance 3 times, for 4 weeks. Result: Significant pain improvement after the first treatment (VAS 1), with pain-free full range of motion until 4 weeks after treatment and sonographic evidence of supraspinatus tendon healing. Discussion: Dextrose concentrations higher than 12.5% produce an osmotic gradient which stimulates the accumulation of growth factors and inflammatory cells, which in turn can initiate the wound healing process. In this case we can find that the healing process translates to good clinical outcome by ultrasound imaging. Conclusion: Dextrose prolotherapy can be used as an option for supraspinatus tendon partial tear with good results.

Clinical and MRI outcomes of subacromial impingement syndrome with conservative treatment: a 21-month prospective study.

Information is lacking on the natural history of early stages of degenerative rotator cuff disease. Such information can be obtained by using clinical and imaging assessment after conservative treatment in affected patients. Subacromial impingement syndrome is a clinical presentation that can be associated with early stages of the disease. We aimed to describe the natural history of degenerative rotator cuff disease from the early stages by studying clinical and imaging outcomes in non-operated patients with subacromial impingement syndrome. Patients with subacromial impingement syndrome were prospectively included. They had conservative treatment and were assessed before treatment and during at least 12-month follow-up. Assessment included clinical evaluation on a 0- to 100-point Constant scale and subscales as well as MRI of the rotator cuff. Clinical results were compared to baseline MRI findings and according to lesional progression. We included 26 patients with mean age 59.1 (SD 9.6), mean pain duration 23.1 (31.3) months; mean total Constant score 39.1 (12.1). Overall, 9 patients had no tear, 9 had a partial tear and 8 had a full-thickness tear. Mean follow-up was 21 (SD 10) months. Total Constant score and subscores improved at follow-up in the overall sample. Patients without tear and those with partial or full-thickness tear at baseline showed clinical improvement. MRI of the rotator cuff at follow-up indicated lesional worsening in 7 patients. However, clinical improvement did not differ by lesional progression or not. We report on 21-month clinical and MRI assessments of degenerative rotator cuff disorders including early stages of the disease. Clinical improvement was not related to MRI changes over time. Further investigations are needed to verify our findings in larger study populations.