Rotator Cuff Research Articles

The Reduction Of Occupation Ratio Of The Supraspinatus Muscle Following A Simulated Acute Retracted Rotator Cuff Tear

The Reduction Of Occupation Ratio Of The Supraspinatus Muscle Following A Simulated Acute Retracted Rotator Cuff Tear

Do Intact Rotator Cuff Tendons And Soft Tissue Tensioning Affect Stress Shielding In Reverse Total Shoulder Arthroplasty?

Do Intact Rotator Cuff Tendons And Soft Tissue Tensioning Affect Stress Shielding In Reverse Total Shoulder Arthroplasty?

Can Second Step Opioid Analgesics Reduce MMEs While Preserving Adequate Pain Management Following Rotator Cuff Repair?

Can Second Step Opioid Analgesics Reduce MMEs While Preserving Adequate Pain Management Following Rotator Cuff Repair?

Update And Validation Of A Model Predicting Shoulder Function After An Arthroscopic Rotator Cuff Repair In Switzerland

Update And Validation Of A Model Predicting Shoulder Function After An Arthroscopic Rotator Cuff Repair In Switzerland

Changes in Supraspinatus Muscle Volume and Fat Fraction After Arthroscopic Rotator Cuff Repair at Minimum Follow-up of 5 Years

Changes in Supraspinatus Muscle Volume and Fat Fraction After Arthroscopic Rotator Cuff Repair at Minimum Follow-up of 5 Years

Does Prior Rotator Cuff Surgery Influence The Outcomes And Complications After RTSA In Patients With Cuff Tear Insufficiency?

Does Prior Rotator Cuff Surgery Influence The Outcomes And Complications After RTSA In Patients With Cuff Tear Insufficiency?

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.

Comparison of MRI and High-Resolution USG in Evaluating Patients With Rotator Cuff Pathologies

Comparison of MRI and High-Resolution USG in Evaluating Patients With Rotator Cuff Pathologies

Management of Rotator Cuff Injuries: Surgical Repair vs. Conservative Treatment

Rotator cuff injuries are a common cause of shoulder pain and dysfunction, resulting from acute trauma or degenerative changes. These injuries, including partial and full-thickness tears, can significantly impair daily activities and reduce quality of life. Treatment options range from conservative measures, such as physical therapy and NSAIDs, to surgical interventions like arthroscopic repair. The choice of treatment depends on factors such as tear size, patient age, and activity level. This review compares the effectiveness of conservative treatment and surgical repair for rotator cuff injuries, focusing on pain relief, functional recovery, and complication rates. Conservative treatment is typically the first-line approach for partial-thickness tears or patients with lower physical demands. Physical therapy and nonsteroidal anti-inflammatory drugs are common modalities that can improve symptoms, particularly for smaller tears. Corticosteroid injections are also used to provide short-term relief, although their long-term benefits are less clear. For larger or full-thickness tears, surgery is often necessary due to the risk of progressive degeneration and persistent symptoms. Arthroscopic repair is particularly beneficial for younger or more active patients, offering superior long-term outcomes in terms of strength and function. Studies indicate that while conservative treatment and surgery may offer similar short-term outcomes for smaller tears, surgery provides better long-term recovery for more extensive injuries. Ultimately, the decision between conservative and surgical treatment should be individualized, considering tear size, patient age, activity level, and overall health. Surgery is recommended for full-thickness tears or when conservative treatment fails to yield sufficient improvement, while conservative management remains effective for many smaller tears.

Making Sense of Topical Pain Relief Options: Comparing Topical Analgesics in Efficacy and Safety.

In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today. Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used. Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed. Level 2. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome. Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost. Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Research progress on factors of shoulder stiffness after rotator cuff tear repair

Rotator cuff tear is a common shoulder injury in daily work and sports activities. Arthroscopic repair is the most widely used method for rotator cuff tears, and the postoperative prognosis is good. However, there are still a series of postoperative complications that affect the therapeutic effect and patient satisfaction, such as postoperative pain, infection, retear, shoulder stiffness, etc. This paper reviews the occurrence and influencing factors of shoulder stiffness after arthroscopic repair of rotator cuff tear, in order to provide reference for the prevention of postoperative shoulder stiffness and explore the mechanism of postoperative shoulder stiffness.

Outcome of mini open anterolateral rotator cuff repair by suture anchor

Background: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments. Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated. Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p<0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p<0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p<0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients. Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies.

Classifications in Brief: The Ellman and Snyder Classifications of Partial-thickness Rotator Cuff Tears

Classifications in Brief: The Ellman and Snyder Classifications of Partial-thickness Rotator Cuff Tears

The Critical Shoulder Angle as a Highly Specific Predictor of a Full-Thickness Rotator Cuff Tear: A Case-Control Study.

The critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs. The purpose of this study was to define the relationship between full-thickness RCTs and the CSA. It was hypothesized that patients with full-thickness RCTs would have an increased CSA compared with matched controls. Cross-sectional study; Level of evidence, 3. This retrospective case-control study identified patients with magnetic resonance imaging scans showing full-thickness RCTs between 2009 and 2019. A 1 to 1 propensity score match was performed to identify a control group with normal rotator cuffs while controlling for baseline participant characteristics-including age, sex, body mass index, and tobacco use. A total cohort of 532 was identified, with 266 cases and 266 controls. Two independent observers measured CSAs on true anteroposterior shoulder radiographs. There was no difference in baseline participant characteristics between the RCT and the non-RCT groups (P > .05). The mean CSA for the entire cohort was 33.6°± 4.2°. The CSA did not significantly vary by sex (P = .088) or tobacco usage (P = .16). The mean CSA for the RCT case group, 36.2°± 3.3°, was significantly different from the mean CSA for the control group, 30.9°± 3.3° (P < .0001). The receiver operating characteristic curve analysis produced an area under the curve of 0.88 (P < .0001). At CSAs ≥35°, there was a 67.7% sensitivity and 89.4% specificity for having a full-thickness RCT. Last, each degree of increase in the CSA increased the risk of having an associated RCT by 1.7 times (OR, 1.7 [95% CI, 1.551-1.852]; P < .0001). Patients with RCTs had significantly higher CSAs compared with matched controls. Increased CSA was an independent risk factor for RCTs, with an odds ratio of 1.7 per degree. The CSA is an accurate test (area under the curve, 0.88) with good sensitivity (67.7%) and specificity (89.4%) at values ≥35°. The CSA is a simple, reproducible measurement that can assist in clinical decision-making regarding full-thickness RCTs.

Mechanical strength of the rotator cuff and cable interface: a complete histological and biomechanical study.

This study sought to evaluate the biomechanical properties of the interface between the rotator cuff and the semicircular humeral ligament or rotator cable (RCa) using histological and biomechanical techniques. Out of 13 eligible cadaver specimens, 5 cadaver shoulders with an intact rotator cuff were included, 8 were excluded due to an injured rotator cuff. The histological study enables us to describe the capsule-tendon interface between the infraspinatus tendon (IST) or supraspinatus tendon (SST) and RCa, and to detect loose connective tissue layers to determine their precise location and measure their length along the interface. The biomechanical study sought to characterize and compare the mechanical strength of the IST-RCa versus SST-RCa interfaces. The average thickness of the RCa was 1.44 ± 0.20mm. The histological study revealed a loose connective tissue layer at the IST-RCa interface, a finding not observed at the SST-RCa interface. The biomechanical study showed that the rigidity of the SST-RCa interface (72.10-2N/mm) was 4.5 times higher than for the IST-RCa interface (16.10-2 N/mm) and the average maximum forces reached were 19.0N and 10.6N for the SST-RCa and IST- RCa interfaces, respectively. The IST-RCa interface consists of a loose connective tissue layer contrary to the SST-RCa interface. In parallel, two different groups in terms of the mechanical response were identified: the IST-RCa interface group had less rigidity and ruptured more quickly than the SST-RCa interface, therefore emerging as the most vulnerable interface and explaining a potential extension of rotator cuff tears.

Single-nucleus transcriptomics reveals subsets of degenerative myonuclei after rotator cuff tear-induced muscle atrophy.

Rotator cuff tear (RCT) is the primary cause of shoulder pain and disability and frequently trigger muscle degeneration characterised by muscle atrophy, fatty infiltration and fibrosis. Single-nucleus RNA sequencing (snRNA-seq) was used to reveal the transcriptional changes in the supraspinatus muscle after RCT. Supraspinatus muscles were obtained from patients with habitual shoulder dislocation (n = 3) and RCT (n = 3). In response to the RCT, trajectory analysis showed progression from normal myonuclei to ANKRD1+ myonuclei, which captured atrophy-and fatty infiltration-related regulons (KLF5, KLF10, FOSL1 and BHLHE40). Transcriptomic alterations in fibro/adipogenic progenitors (FAPs) and muscle satellite cells (MuSCs) have also been studied. By predicting cell-cell interactions, we observed communication alterations between myofibers and muscle-resident cells following RCT. Our findings reveal the plasticity of muscle cells in response to RCT and offer valuable insights into the molecular mechanisms and potential therapeutic targets of RCT.

Comparison of arthroscopic-assisted mini open and all arthroscopic repair methods in small to large size rotator cuff tears

Aim: This study aimed to compare the functional and clinical results of all arthroscopic (AA) and arthroscopic-assisted mini open (AAMO) rotator cuff tear (RCT) repair methods with a minimum 2 years follow-up. Methods: In this retrospective study, patients who operated with the AA repair method were included in group 1 and patients who operated with AAMO RCT repair method were included in group 2. Between January 2018 and June 2021. All patients were evaluated with shoulder range of motion (ROM), the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS) and visual analog scale (VAS) pain score preoperatively and postoperatively. Postoperative evaluation was made on the 3rd, 6th, 12th, and 24th months. In addition, the length of hospital stay, and surgery time were evaluated. Results: Eighty patients (48 female, 32 male) were included in group 1, who were treated with the AA technique. Sixty-seven patients (28 male, 39 female) were included in group 2, who were treated with the AAMO technique. The average follow-up time was 29,36 ±3,48 months for group 1, 28,12±2,87 months for group 2. No significant difference was detected between group 1 and group 2 for length of hospital stay and follow-up time (p&gt;0,05). At the postoperative 3rd-month follow-up measurements, a statistically significant difference was determined between group 1 and group 2 for abduction, flexion measurements, VAS score, and DASH score (p=0,03, p=0,04, p=0,02, p=0,01 respectively). At the 24th month postoperative follow-up, statistically no significant difference was determined between groups 1 and 2 in terms of ROM, VAS, and functional scores. Conclusion: In the early recovery period, AA repair provides better ROM, DASH, and VAS scores. However, in long-term follow-up, no significant difference was detected in AA and AAMO repair in terms of functional results, ROM, and VAS scores.

Quantitative ultrasound assessment of fatty infiltration of the rotator cuff muscles using backscatter coefficient

BackgroundTo prospectively evaluate ultrasound backscatter coefficients (BSCs) of the supraspinatus and infraspinatus muscles and compare with Goutallier classification on magnetic resonance imaging (MRI).MethodsFifty-six participants had shoulder MRI exams and ultrasound exams of the supraspinatus and infraspinatus muscles. Goutallier MRI grades were determined and BSCs were measured. Group means were compared and the strength of relationships between the measures were determined. Using binarized Goutallier groups (0–2 versus 3–4), areas under the receiver operating characteristic curves (AUROCs) were calculated. The nearest integer cutoff value was determined using Youden’s index.ResultsBSC values were significantly different among most Goutallier grades for the supraspinatus and infraspinatus muscles (both p < 0.001). Strong correlations were found between the BSC values and Goutallier grades for the supraspinatus (τb = 0.72, p < 0.001) and infraspinatus (τb = 0.79, p < 0.001) muscles. BSC showed excellent performance for classification of the binarized groups (0–2 versus 3–4) for both supraspinatus (AUROC = 0.98, p < 0.0001) and infraspinatus (AUROC = 0.98, p < 0.0001) muscles. Using a cutoff BSC value of −17 dB, sensitivity, specificity, and accuracy for severe fatty infiltration were 87.0%, 90.0%, and 87.5% for the supraspinatus muscle, and 93.6%, 87.5%, and 92.7% for the infraspinatus muscle.ConclusionBSC can be applied to the rotator cuff muscles for assessment of fatty infiltration. For both the supraspinatus and infraspinatus muscles, BSC values significantly increased with higher Goutallier grades and showed strong performance in distinguishing low versus high Goutallier grades.Relevance statementFatty infiltration of the rotator cuff muscles can be quantified using BSC values, which are higher with increasing Goutallier grades.Key PointsUltrasound BSC measurements are reliable for the quantification of muscle fatty infiltration.BCS values increased with higher Goutallier MRI grades.BCS values demonstrated high performance for distinguishing muscle fatty infiltration groups.Graphical

CORR Insights®: Tissue-engineered Bicipital Autologous Tendon Patch Enhances Massive Rotator Cuff Defects Repair in a Rabbit Infraspinatus Tendon Defect Model.

CORR Insights®: Tissue-engineered Bicipital Autologous Tendon Patch Enhances Massive Rotator Cuff Defects Repair in a Rabbit Infraspinatus Tendon Defect Model.

Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report.

Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient's feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.