Small Cuff Tears Research Articles

Results of arthroscopic rotator cuff repairs in patients with comorbid disability of other extremities

Objectives: We hypothesized that arthroscopic rotator cuff repair improves functional and clinical outcomes in the patients with comorbid disability in the extremities. Materials and Methods: In a retrospective study, data were collected for eleven patients (six males and five females) from a tertiary care hospital from 2010 to 2018. All the patients underwent arthroscopic rotator cuff repair after confirmed clinical and radiological diagnosis. All the patients were operated on by a single surgeon. UCLS scores and ultrasound imaging were used for pre-operative and post-operative clinical and radiological evaluation, respectively. The mean follow-up was of 3 years. Statistical analysis was carried out using SPSS software and statistical significance was considered at P < 0.05. Results: Out of 11 patients, seven patients had massive cuff tears, two patients had medium cuff tears, and two patients had small cuff tears. Out of 11 patients, three patients were contralateral side amputees, four patients were wheelchair-bound due to post-poliomyelitis muscle weakness, one patient had opposite side hand amputation, and three patients had same side hemiplegia secondary to cerebrovascular stroke. The dominant side was involved in eight patients and the non-dominant side was involved in three patients. Functional range of motion, the visual analog scale for pain, and satisfaction and UCLS scores improved significantly after arthroscopic cuff repairs. Ultrasound evaluation after a mean of 14 ± 3 months revealed complete healing in 88% of cases and partial healing in 12% of cases. Conclusion: Arthroscopic rotator cuff repair improves functional and clinical outcomes in patients with comorbid disability in the extremities. Careful and meticulous clinical acumen, surgical planning, technique, and post-operative rehabilitation program are important for excellent outcomes in arthroscopic cuff repairs, especially in these functionally high-demanding patients.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles.

A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study's purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were measured for full ranges of rotation on 10 independent glenohumeral specimens with the humerus abducted in the scapular plane at 10 and 60 degrees . Supraspinatus and infraspinatus tendons were divided into equal width subregions. Two conditions were tested: tendon divided to the musculotendinous junction, and tendon divided to the insertion on the humerus. Moment arms were determined from tendon excursion via the principle of virtual work. Moment arms for the infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly greater when the tendon was only divided to the musculotendinous junction versus division to the humeral head. Moment arms across subregions of infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly different. A difference in teres minor moment arm was not found for the two cuff tendon conditions. Moment arm differences between muscle subregions and for tendon division conditions have clinical implications. Interaction between cuff regions could explain why some subjects retain strength after a small cuff tear. This finding helps explain why a partial cuff repair may be beneficial when a complete repair is not possible. Data presented here can help differentiate between cuff tear cases that would benefit from cuff repair and cases for which cuff repair might not be as favorable.