Rupture Of Supraspinatus Tendon Research Articles

Acromial Tilt, Lateral Acromial Angle, and Acromiohumeral Interval as Risk Factors for Full-Thickness Supraspinatus Tendon Ruptures

Acromial Tilt, Lateral Acromial Angle, and Acromiohumeral Interval as Risk Factors for Full-Thickness Supraspinatus Tendon Ruptures

Does subscapularis tears combined with supraspinatus tears affect postoperative functional outcomes?

Aims: Roughly 50% of rotator cuff tears includes a tear in the subscapularis tendon. We conducted a comparative analysis of the functional outcomes following arthroscopic repair in patients with a tear in both the supraspinatus and subscapularis tendons, as well as those with a rupture solely in the supraspinatus tendon. Our hypothesis posits that the functional outcomes after surgery for rotator cuff tears, specifically those with tears including subscapularis tendon, are inferior compared to tears that only involve the supraspinatus tendon. Methods: We classified patients who had arthroscopic repair for a rotator cuff tear in our clinic from January 2017 to April 2022 into two groups. The study comprised patients who received arthroscopic surgery for a diagnosed rotator cuff injury. The study excluded individuals who were younger than 18, individuals with large tears that could not be repaired, individuals with paralabral cysts, individuals with glenohumeral arthritis, individuals who had undergone labrum tear repair or slap lesion repair, individuals with concomitant neurovascular damage, and individuals who had a follow-up period of less than 6 months, patients who benefit from physiotherapy and medical treatment for 6 months. Following the application of exclusion criteria, a total of 39 patients were selected to participate in the study. The presence of a rotator cuff injury was verified through arthroscopy after being detected using clinical tests such as Jobe, drop arm test, Neer sign, lift-off and belly-press tests, and radiographic evidence such as magnetic resonance imaging. Patients who received subscapularis repair together with a supraspinatus tear were categorised as Group 1 (n=14), while those who just had supraspinatus surgery without any subscapularis tears were categorized as Group 2 (n=25). We recorded the demographic information. At the last postoperative outpatient clinic follow-up, both groups were compared in terms of mortality, laboratory parameters, radiological findings, visual analogue scale (VAS), Constant-Murley score1, American Shoulder and Elbow Surgeons score (ASES)2, and University of California Los Angeles (UCLA) scores.3 Postoperative satisfaction levels were categorised into four groups: very satisfied, satisfied, undecided, and dissatisfied. Results: The groups did not show any significant differences in terms of age, gender distribution, and follow-up periods (p>0.05). There was no statistically significant disparity observed between the groups in relation to VAS, Constant-Murley score, ASES, and UCLA ratings assessed during the final postoperative outpatient clinic follow-up (p>0.05). There were no instances of re-rupture observed in any patient throughout the postoperative follow-up period. The postoperative satisfaction ratings show no significant difference between the two groups (p>0.05). Conclusion: Our findings indicate that the outcomes of patients who received a surgical repair of rotator cuff tendons including subscapularis were at least as successful as those who underwent surgery for just supraspinatus tendon rupture. There is no basis to believe that arthroscopic repair will have a detrimental impact on the functional outcomes of individuals with rotator cuff tears which includes subscapularis tendon tears.

Methods of analyzing the long head of the biceps tendon in the management of distal supraspinatus tendon ruptures. Part 2: The role and validation of an arthroscopic exploration protocol of the long head of the biceps tendon

IntroductionInter-observer arthroscopic assessments of the Long head of the Biceps tendon (LHB) injuries, in the absence of predefined instructions, are poorly reproducible. There are several types of LHB injuries, of varying severity, which can make its intraoperative analysis subjective. HypothesisThe application of a precise arthroscopic exploration protocol, particularly dynamic, associated with an equally precise analysis of the possible tendon lesions, intrinsic or extrinsic, makes it possible to obtain a reproducible analysis of the lesions of the LHB and aid decision-making around its conservation or its resection, in distal supraspinatus tendon ruptures. Material and methodsThis was a prospective, multicenter study including 371 patients with a stage 1 rupture of the supraspinatus tendon, in accordance with the Patte classification. An exploration protocol with intraoperative video recording of the articular portion of the biceps was systematically performed by the operators. It included static intra-articular and extra-articular observation of the LHB, as well as a dynamic intra-articular hook test with mobilization in internal and external rotation, and in anterior elevation. An analysis of the lesion status of the LHB was then made by the principal operator (Op), after defining the various possible lesions: intrinsic or extrinsic. This initial diagnostic assessment was then compared with the analysis made by two independent observers (Obs1, Obs2) based on a replay of the recorded videos. The reliability of agreement was then measured using Cohen's Kappa coefficient (K) and Fleiss’ kappa. ResultsTwo hundred and fifty-seven videos were analyzable. The level of agreement between the two independent observers was strong (K=0.63) for applying the diagnosis of a healthy or pathological biceps. The agreement between the independent observers and the operator was weaker (respectively K Op-Obs1=0.51 - moderate and K Op-Obs2=0.39 - poor). ConclusionThe application of a precise protocol for the exploration of the LHB, associated with a previously defined lesion classification, makes it possible to obtain a high rate of agreement for the arthroscopic diagnostic analysis of the LHB. However, arthroscopy cannot be used as the only criterion for deciding which procedure to perform on the LHB. Other clinical and para-clinical factors must be taken into consideration. Level of evidenceIII; prospective inter-observer series.

Arthroscopic repair of rotator cuff injury with bioabsorbable suture anchor vs. all-suture anchor: a non-inferiority study

BackgroundCompare all-suture anchors to traditional anchors through clinical and radiological evaluation at pre-established end-points.Materials and methodsWe performed a two-arms non-inferiority study on all-suture anchor (2.3 iconix™, Stryker) device with respect to traditional anchor (5.5 healix Advance™ BR, Depuy/Mitek) device under unpaired samples with size equal to 30 patients per group, all suffering from supraspinatus tendon rupture. We administrated DASH (Disabilities of the Arm, Shoulder and Hand); constant; and SST (Simple Shoulder Test) questionnaires in pre-operative, 3 ± 1 months post-intervention and 8 ± 1 months post-intervention. Questionnaires scores were the primary outcome. We also evaluated RMI at 3 and at 8 months after surgery to assess the presence of oedema or any loosening of the implant.ResultsAll-suture anchor approach has been proven to have non-inferior performances with respect to traditional anchor approach, according to questionnaires scores at the 3-month endpoint. We observed 26 patients with oedema by MRI (18 in control group, 6 in experimental group). In the 8-month endpoint we found persistent edema in 12 patients (all treated with healix), 2 had mobilitazions (healix), 10 had partial retears (8 healix, 2 iconix) and 1 implant failure (healix).ConclusionsAll suture devices have clinical and functional results comparable to traditional devices, while they tend to give fewer complications in terms of bone edema, loosening and retear rate. The effectiveness of all-suture devices should be further investigated in rotator cuff suture arthroscopic revision surgery, given the advantages they offer.

Shoulder Disorders: The Challenging Issue Among Orthopedic Surgeons

Background: Choose a proper therapeutic approach for various shoulder joint involvements is still a significant challenge. Objectives: The study aimed to assess the knowledge and attitude of orthopedic surgeons in managing patients with shoulder problems. Methods: In a cross-sectional survey, a questionnaire consisted of 2 different parts was directly presented to orthopedic surgeons. Part 1 investigated the experience of shoulder surgeries, and part 2 evaluated their knowledge and attitude toward 4 patients with different scenarios. Results: The surgeons were divided into 2 groups: shoulder surgeons (n=17) and general orthopedic surgeons (n=192). The first scenario is about a 21-year-old male with first anterior shoulder dislocation. In this scenario, shoulder surgeons chose surgical intervention more than general surgeons (88.21% vs 33.54%, P<0.05). The second scenario presents a 55-year-old male with shoulder osteoarthritis and complete and repairable rupture of supraspinatus and rupture of the long head of the biceps tendon. Shoulder surgeons chose total shoulder arthroplasty (43.8%) and arthroscopic rotator cuff repair (37.5%). But, only 21.87% of general orthopedic surgeons choose these two items together. The third scenario is a 65-year-old male with supraspinatus and infraspinatus tendon rupture. Sixteen of 17 shoulder surgeons answered this case, and 100% chose surgical interventions (62.5% arthroscopic and 37.5% open repair). On the other hand, 180 general surgeons of 192 answered this case scenario, and only 41.11% chose surgical treatment. The fourth scenario presents a 52-year-old female with refractor adhesive capsulitis. Arthroscopic capsular release and manipulation was the most frequent answer among shoulder surgeons compared to general surgeons (64.71% vs 31.38%). Conclusion: It seems that an advanced course of shoulder surgeries is necessary to improve the knowledge of general orthopedic surgeons about shoulder diseases and treatment choices

Acute Spontaneous Supraspinatus Tendon Rupture in a Patient with End-stage Renal Disease

Acute Spontaneous Supraspinatus Tendon Rupture in a Patient with End-stage Renal Disease

Magnetic Resonance Imaging Identification of Rotator Cuff Pathology: Inter-rater Realibilty

Background. The shoulder MRI is one of the main methods for the rotator cuff injuries diagnostics and determination of the further treatment tactics. The agreement in the MRI data interpretation among specialists regarding different types of shoulder ruptures is an integral part of diagnostic test validity evaluation. The purpose of this study was to assess the agreement in the MRI data interpretation in the patients with shoulder rotator cuff pathology among trauma surgeons, as well as between trauma surgeons and a radiologist. Materials and Methods. The study was a retrospective analysis of the MRI data and surgical reports regarding 57 patients with various shoulder pathologies undergone the shoulder MRI and arthroscopic shoulder revisions in the period from 2017 to 2019. There were 38 (67%) men and 19 (33%) women among the patients. The average age of the patients was 52.7±13.6 years. The sensitivity and specificity, as well as the shoulder MRI inter-rater reliability were assessed in the course of the study. Results. The rotator cuff pathology was revealed in 52 patients: supraspinatus tendon injury in 98% of cases, supraspinatus and infraspinatus tendon — in 26%, isolated subscapularis tendon injury — in 2%, supraspinatus and subscapularis tendon — in 39%. The maximal concordance in the MRI data interpretation was achieved in the patients with full-thickness supraspinatus tendon rupture, as well as with the supraspinatus tendon calcifications. However, significant disagreement was found between orthopedists with different work experience in determination of the presence and type of infraspinatus and subscapularis tendons pathology and supraspinatus tendon incomplete ruptures and tendinitis. Conclusion. The high agreement in the MRI data interpretation in determining the pathology of the shoulder rotator cuff among trauma surgeons, as well as between trauma surgeons and radiologists, was observed only regarding the supraspinatus tendon, calcifying tendonitis and full-thickness injury. The diagnosis of tendinitis and incomplete tendon rupture remains difficult. Their interpretation results vary greatly. It is also worth noting the heterogeneity of the results of diagnostics of the infraspinatus and subscapularis tendon pathology.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment.

ObjectiveTo evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome.Materials and MethodsThe acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles.ResultsThe glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively.ConclusionInferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Intra-substance steroid injection for full-thickness supraspinatus tendon rupture

BackgroundThe use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. This study aimed to evaluate the effectiveness and safety of this treatment method.MethodsTwelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and 1% xylocaine 1 cc. Twelve patients in Group 2 received an injection with normal saline 1 cc and 1% xylocaine 1 cc. The rupture size was measured by sonography before the injection, 3 months after the injection, and 6 months after the injection. Shoulder Pain and Disability Index (SPADI) score and Pain Visual Analogue Scale (VAS) score were measured and compared between the two groups before the injection, 1 week after the injection, 3 months after the injection, and 6 months after the injection.ResultsPain and function improved more in Group 1 than in Group 2. The therapeutic effect lasted for at least 6 months in both groups. The size of the supraspinatus tendon rupture was not increased after injection in either group.ConclusionsIntra-substance injection into rupture area of supraspinatus tendon with steroid and xylocaine is effective to reduce pain and improve function in patients with full-thickness supraspinatus tendon rupture without increasing the size of the rupture.Trial registrationCurrent Controlled Trials ChiCTR1900026376, data of registration: 2019/10/05 retrospectively registered.

Features of Partial Rotator Cuff Tears Diagnostics

Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.

Supraspinatus Tendons Have Different Mechanical Properties Across Sex.

Sex differences in the mechanical properties of different musculoskeletal tissues and their impact on tendon function and disease are becoming increasingly recognized. Tendon mechanical properties are influenced by the presence or absence of sex hormones and these effects appear to be tendon- or ligament-specific. The objective of this study was to determine how sex and hormone differences in rats affect supraspinatus tendon and muscle properties. We hypothesized that male supraspinatus tendons would have increased cross-sectional area but no differences in tendon material properties or muscle composition when compared to supraspinatus tendons from female or ovariectomized (OVX) female rats. Uninjured supraspinatus tendons and muscles from male, female, and OVX female rats were collected and mechanical and histological properties were determined. Our analysis demonstrated decreased dynamic modulus and increased hysteresis and cross-sectional area in male tendons. We found that male tendons exhibited decreased dynamic modulus (during low strain frequency sweep and high strain fatigue loading), increased hysteresis, and increased cross-sectional area compared to female and OVX female tendons. Despite robust mechanical differences, tendon cell density and shape, and muscle composition remained unchanged between groups. Interestingly, these differences were unique compared to previously reported sex differences in rat Achilles tendons, which further supports the concept that the effect of sex on tendon varies anatomically. These differences may partially provide a mechanistic explanation for the increased rate of acute supraspinatus tendon ruptures seen in young males.

The Temporal Relationship between Supraspinatus Tendon Rupture and Fatty Infiltration of the Supraspinatus Muscle

The Temporal Relationship between Supraspinatus Tendon Rupture and Fatty Infiltration of the Supraspinatus Muscle

Comment on: Comparison of the results of ultraso-nographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture.

commentsComment on: Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture Michel Kandel Michel Kandel Correspondence: Dr. Michel Kandel, Physiotherapie, Michel Kandel, Physiotherapy, Staatsstrasse 46, 9463 Oberriet, SG, Switzerland, T: +41787073533, E-mail Address: [email protected] Search for more papers by this author Published Online::6 Apr 2017https://doi.org/10.5144/0256-4947.2017.170SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionWith respect to the following article published in 2014 in Annals of Saudi Medicine:Görmeli C, and others, “Comparison of the Results of Ultrasonographic Evaluation and Arthroscopy in Patients Scheduled for Surgery of the Supraspinatus Tendon Rupture” Ann Saudi Medicine, 34.6 (2014), 522–6 < http://dx.doi.org/10.5144/0256-4947.2014.522>.By recalculating the data of the ultrasonographic results compared to the arthroscopic diagnosis (the usual means of diagnosis, i.e., the gold standard), represented in Table 1 in the original article, a statistical failure was found. The sensitivity and specificity of the tendinosis, full, and partial thickness tears were mixed up, as seen in the 2×2 tables and calculations at the right. The calculation of the humeral degeneration in Table 2 in the original article was correctly calculated.The corrected calculation of the sensitivity and specificity of tendinosis, full, and partial thickness tears are shown in the tables at the right. The corrections do not affect the conclusions and the high validity of the ultrasonographic findings for supraspinatus pathology can be confirmed. The specificity, however, is higher than the sensitivity for these findings. These findings correlate with other studies, which compared ultrasonography findings with a gold standard in supraspinatus disorders.1,2UltrasonographyArthroscopyTotalTendinosisNo tendinosisTendinosis516No tendinosis24244Total74350Sensitivity: 5/7=71%; Specificity: 42/43=98%.UltrasonographyArthroscopyTotalPartial thickness tearNo partial thickness tearPartial thickness tear18422No partial thickness tear42428Total222850Sensitivity: 18/22=82%; Specificity: 24/28=86%UltrasonographyArthroscopyTotalFull thickness tearNo full thickness tearFull thickness tear15318No full thickness tear23032Total173350Sensitivity: 15/17=88%; Specificity: 30/33=91%Görmeli and colleagues declined to respond.ARTICLE REFERENCES:1. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. "Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered" . Cochrane database Syst Rev. 2013; 9(9):CD009020 doi: 10.1002/14651858.CD009020.pub2. Google Scholar2. Vlychou M, Dailiana Z, Fotiadou A, Papanagiotou M, Fezoulidis IV, Malizos KN. "Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation" . Acta radiol. 2009; 50(1):101-105 doi: 10.1080/02841850802600764. Google Scholar Previous article FiguresReferencesRelatedDetails Volume 37, Issue 2March-April 2017 Metrics History Published online6 April 2017 InformationCopyright © 2017, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download

Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair?

Background: The exact role of platelet-rich plasma (PRP) in rotator cuff tendon reconstruction remains unclear. Purpose/Hypothesis: This study investigated whether an intraoperative pure PRP injection, compared with a local anesthetic injection, improves patient-reported outcomes at 3 and 6 months after arthroscopic rotator cuff repair. The hypothesis was that pure PRP improves patient-reported outcomes (Oxford Shoulder Score [OSS]) at 3 and 6 months after surgery and has the same pain-reducing effect compared with a postoperative subacromial local anesthetic (ropivacaine) injection. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between January 2011 and November 2012, a total of 120 patients who underwent arthroscopic double-row repair of a supraspinatus tendon rupture were randomized to receive either pure PRP by an injection at the footprint (PRP group; n = 60) or ropivacaine injected in the subacromial region (control group; n = 60). Seventy-eight percent of patients had other concomitant tears. All patients, surgeons, and follow-up investigators were blinded. Clinical parameters and various outcome scores (Constant-Murley shoulder score; OSS; patient American Shoulder and Elbow Surgeons score; quick Disabilities of the Arm, Shoulder and Hand score; EuroQol 5 dimensions) were documented preoperatively and at 3, 6, and 24 months postoperatively. The repair integrity was assessed by magnetic resonance imaging or ultrasound at 24 months. Furthermore, a pain diary was completed within the first 10 postoperative days, and adverse events were recorded. Group outcome differences were analyzed using t tests, Fisher exact tests, and mixed models. Results: The final follow-up rate was 91%. An associated tear of the subscapularis tendon was diagnosed in 23% of PRP-treated patients and 36% of control patients. Three months after surgery, the mean (±SD) OSS was 32.9 ± 8.6 in PRP-treated patients and 30.7 ± 10.0 in control patients (P = .221). No significant differences were noted for other outcome parameters as well as at 6 and 24 months postoperatively. Smoking was a significant effect modifier. Pain for both groups decreased from postoperative day 1 to 10 without any significant group difference (P = .864). Six (12.2%) and 11 (20.8%) patients were diagnosed with a recurrent supraspinatus tendon defect in the PRP and control groups, respectively (P = .295). Twenty-two (40.7%) and 18 (30.5%) PRP-treated and control patients, respectively, experienced a local adverse event within 24 months (P = .325). Conclusion: Patients treated with pure PRP showed no significantly improved function at 3, 6, and 24 months after arthroscopic repair compared with control patients receiving ropivacaine; however, a similar pain reduction was documented in both groups. The negative influence of smoking on the effect of pure PRP requires further investigation. Registration: NCT01266226 (ClinicalTrials.gov).

Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture.

BACKGROUND AND OBJECTIVESThis study aims to compare the findings of the shoulder ultrasonography (US) of patients with a supraspinatus (SS) tendon rupture with those of the shoulder arthroscopy, to determine the reliability and diagnostic performance of the shoulder US in the algorithm of the SS tendon pathologic lesions and their secondary ultrasonographic findings.DESIGN AND SETTINGSA prospective study conducted with patients scheduled for arthroscopy of the shoulder due to an SS tendon rupture in Yildirım Beyazit Education and Research Center and Gazi University, Ankara, Turkey.MATERIALS AND METHODSFifty patients scheduled for an arthroscopy of the shoulder due to an SS tendon rupture were evaluated by shoulder US 1 week before the surgery. SS tendon pathologic lesions (tendinosis, partial tears, and full-thickness tears) and humeral degeneration were recorded, and the results of shoulder US were compared with those of arthroscopy.RESULTSWith reference to the arthroscopic data, the sensitivity of the ultrasonographic evaluation for the diagnosis of a full-thickness SS tendon rupture was 91%, with a specificity of 88%; the sensitivity for the diagnosis of a partial-thickness rupture was 86%, with a specificity of 82%; and the sensitivity for the diagnosis of a tendinosis was 98%, with a specificity of 71%. With reference to the arthroscopic data, the sensitivity of US for the diagnosis of humeral degeneration was 93%, with a specificity of 91%.CONCLUSIONThe high sensitivity and specificity rates of US in detecting SS tendon rupture and its secondary imaging findings make it an efficient and reliable diagnostic modality, which should be preferred to other more expensive and more invasive methods in the algorithm.

Comparison of 3D turbo spin-echo SPACE sequences with conventional 2D MRI sequences to assess the shoulder joint

PurposeTo determine the accuracy and reliability of three-dimensional (3D) T1- and proton density (PD)-weighted turbo spin-echo (TSE) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) compared with conventional 2D sequences in assessment of the shoulder-joint. Materials and methodsNinety-three subjects were examined on a 3-T MRI system with both conventional 2D-TSE sequences in T1-, T2- and PD-weighting and 3D SPACE sequences in T1- and PD-weighting. All examinations were assessed independently by two reviewers for common pathologies of the shoulder-joint. Agreement between 2D- and 3D-sequences and inter-observer-agreement was evaluated using kappa-statistics. ResultsUsing conventional 2D TSE sequences as standard of reference, sensitivity, specificity, and accuracy values of 3D SPACE were 81.8%, 95.1%, and 93.5% for injuries of the supraspinatus-tendon (SSP), 81.3%, 93.5%, and 91.4% for the cartilage layer and 82.4%, 98.5%, and 97.5% for the long biceps tendon. Concordance between 2D and 3D was almost perfect for tendinopathies of the SSP (κ=0.85), osteoarthritis (κ=1), luxation of the biceps tendon (κ=1) and adjacent bone marrow (κ=0.92). Inter-observer-agreement was generally higher for conventional 2D TSE sequences (κ, 0.23–1.0), when compared to 3D SPACE sequences (κ, −0.33 to 1.0) except for disorders of the long biceps tendon and supraspinatus tendon rupture. ConclusionBecause of substantial and almost perfect concordance with conventional 2D TSE sequences for common shoulder pathologies, MRI examination-time can be reduced by nearly 40% (up to 11min) using 3D-SPACE without loss of information.

Fracture of Proximal Humerus in the Lateral Anchor Site after Suture Bridge Repair: A Case Report

To report the fracture of proximal humerus in the lateral anchor site after suture bridge repair. A 57-year-old female patient with shoulder pain on the right-side was admitted through the emergency room following a car accident. Seven weeks before the accident, the patient had undergone surgery at a different hospital for the repair of supraspinatus tendon rupture on the right-side via suture bridge technique. Humerus surgical neck fracture was confirmed by X-ray, and proximal humerus fracture at the anchor site was confirmed by magnetic resonance imaging. Following 7 months of conservative treatment resulted in satisfactory bone union and motion of the shoulder joint. We report the need of close observation during and after the arthroscopic repair of the rotator cuff in patients with osteoporosis.

Retraction of Supraspinatus Muscle and Tendon as Predictors of Success of Rotator Cuff Repair

Background: The structural failure rate of rotator cuff repair can exceed 50%. Important predictors for repair failure are preoperative fatty muscle infiltration and myotendinous retraction. Purpose: To quantitatively assess the prognostic value of preoperative retraction of both the supraspinatus muscle and tendon for the outcome of supraspinatus repair. Study Design: Cohort study; Level of evidence, 3. Methods: In 33 shoulders with complete supraspinatus tendon ruptures subjected to arthroscopic repair, magnetic resonance imaging (MRI) scans taken preoperatively and after a mean follow-up of 24 months were studied. The exact position of the lateral extension of the supraspinatus muscle and of the tendon end was evaluated and correlated with the preoperative stage of fatty infiltration (Goutallier) and the failure rate of tendon repair. Results: The mean lengthening of the muscle and tendon end was −3 mm and 4 mm in the failed repairs (n = 19) and 14 mm and 8 mm in the successful repairs (n = 14). If the supraspinatus had preoperative Goutallier stages 2 to 3 and a tendon length of less than 15 mm, the failure rate was 92%, but if the tendon length was greater than 15 mm, the failure rate was only 33%. With Goutallier stages 0 to 1, the corresponding failure rates were 57% and 25%, respectively. Conclusion: Rotator cuff repair lengthens the tendon, even if the repair fails. The possibility to lengthen the myotendinous unit is related to the preoperative length of the tendon. The combination of Goutallier grading and preoperative tendon length appears to be a more powerful predictor for the reparability of a tendon tear than Goutallier grading alone.

Work-related lesions of the supraspinatus tendon: a case–control study

To examine the dose-response relationship between cumulative duration of work with highly elevated arms (work above shoulder level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case-control study. In 14 radiologic practices, we recruited 483 male patients aged 25-65 with radiographically confirmed partial (n=385) or total (n=98) supraspinatus tears associated with shoulder pain. A total of 300 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of lifting/carrying of heavy loads (>20kg) as well as the duration of work with highly elevated arms was added up over the entire working life. The results of our study support a dose-response relationship between cumulative duration of work with highly elevated arms and symptomatic supraspinatus tendon tears. For a cumulative duration of >3,195h work above shoulder level, the risk of a supraspinatus tendon rupture is elevated to 2.0 (95% CI 1.1-3.5), adjusted for age, region, lifting/carrying of heavy loads, handheld vibration, apparatus gymnastics/shot put/javelin/hammer throwing/wrestling, and tennis. The cumulative duration of carrying/lifting of heavy loads also yields a positive dose-response relation with disease (independent from work above shoulder level and from handheld vibration), with an adjusted odds ratio of 1.8 (95% CI 1.0-3.2) in the highest exposure category (>77h). We find an increased risk for subjects exposed to handheld vibration with an adjusted OR of 3.2 (95% CI 1.7-5.9) in the highest exposure category (16years or more in the job with exposure), but a clear dose-response relationship is lacking. This study points to a potential etiologic role of long-term cumulative effects of work with highly elevated arms and heavy lifting/carrying on shoulder tendon disorders.

Supraspinatus tendon rupture in lupus: a rarity

Supraspinatus tendon rupture in lupus: a rarity