Traumatic Rotator Cuff Tears Research Articles

Similar results comparing early and late surgery in open repair of traumatic rotator cuff tears.

The purpose was to investigate whether surgical repair earlier or later than 3months after injury may result in similar outcomes and patient satisfaction. Seventy-three patients (75 shoulders, 58 males, mean age 59) who had undergone surgical intervention for traumatic rotator cuff tears from 1999 to 2011 were assessed by MRI, clinical examination and Western Ontario Rotator Cuff Index (WORC) as a primary outcome measure and Oxford Shoulder score (OSS), Constant-Murley score (CS) and EQ-5D as secondary. The patients treated less than 3months after injury (n=39) were compared with patients treated more than 3months after injury (n=36). The average follow-up time was 56months (range 14-149), and the average time from injury to repair for all patients was 16weeks (range 3-104). A single senior radiologist performed a blinded evaluation of all the MRIs. Rotator cuff integrity, presence of arthritis, fatty degeneration and muscle atrophy were evaluated. No differences were found for any of the assessed outcomes (WORC, OSS, CS and EQ-5D) between the two groups. The mean WORC% was 77% for both groups. Re-tear frequency was 24%, nine in both groups. Patients with re-tear reported less satisfaction with their outcome. The surgical treatment of symptomatic traumatic rotator cuff tears repairable later than 3months after injury yields a good functional outcome, a high level of subjective patient satisfaction, and at the same level for patients receiving earlier treatment. Based on our findings, surgical repair could be encouraged whenever technically possible. Retrospective Comparative Study, Level III.

The Subscapularis Interlocking Stitch for the Arthroscopic Treatment of Subscapularis Tendon Tears at the Shoulder

Restoration of subscapularis function is essential for long-term maintenance of good clinical results for both traumatic and nontraumatic rotator cuff tears. The anatomic repair of partially and completely torn tendons from the footprint at the lesser tuberosity is the goal of surgical repair. The described technique, with a combination of an interlocking stitch and additional mattress sutures using a double-loaded suture anchor, provides reduction of the retracted tendon, sufficient pullout strength, and compression of the tendon to the footprint to facilitate healing.

Return to Sport After Rotator Cuff Tear Repair

Background: One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play. Purpose: The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears. Study Design: Meta-analysis and systematic review. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level). Results: Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play. Conclusion: Most recreational athletes return to sports at the same level of play as before their injury, but only half of professional and competitive athletes return to an equivalent level of play.

Traumatic Supraspinatus Tears in Patients Younger Than 25 Years.

Traumatic rotator cuff tears in patients younger than 25 years are rare events, with few reports in the literature. When compared with the more mature shoulder, the young, healthy supraspinatus tendon is a robust tendon that is able to absorb a significant amount of energy before tendon failure. Therefore, the diagnosis of a rotator cuff tear can be often overlooked in this population due to the patient's age. This is a report of traumatic supraspinatus repairs in patients younger than 25 years. Nine patients younger than 25 years were identified with a posttraumatic supraspinatus tear as visualized during routine diagnostic shoulder arthroscopy. These 9 patients represented 0.33% of all rotator cuff repairs during a 9-year period. Average patient age was 19.1 years (±3.7 years; range, 13 to 25 years). Magnetic resonance imaging failed to diagnose a rotator cuff tear in 50% of the patients. Mean delay from injury to surgery was 6.6 months. All tears were arthroscopically repaired. Concomitant anterior instability pathology was demonstrated among 66.7% of the patients. No complications were reported. At latest follow-up, all patients reported minimal to no shoulder pain and were tolerating strenuous work, activities, and sports without significant complaints. Even with advanced imaging, the diagnosis of a rotator cuff tear can often be missed in this patient population. Although clinical outcomes can be good, care must be taken to broaden the diagnostic differential in young patients with posttraumatic shoulder pain.

Does presence of anterior greater tuberosity cysts change the function in patients with chronic rotator cuff tear?

This study aims to compare rotator cuff muscle atrophy with fatty degeneration, tear size, range of motion, shoulder muscle strength, pain and upper extremity function in patients with chronic rotator cuff tear, and with or without anterior greater tuberosity cyst. A total of 101 patients (32 males, 69 females; mean age 51 ± 12.9 years; range 17 to 76 years) were evaluated in this study. Fifty-eight patients were excluded due to traumatic or acute rotator cuff tears and neck pain. Forty-three patients of chronic rotator cuff tear were divided into two groups as patients with (n=15) and without (n=28) an anterior greater tuberosity cyst. Patients were evaluated for range of motion, shoulder muscle strength, pain and upper extremity function, and radiologically. Statistical differences were investigated between two groups. The number of patients with tears larger than 1 cm and the number of patients who had muscle atrophy were higher in the group of patients with a cyst. Also, upper extremity function was reduced in the group of patients with a cyst (Western Ontario Rotator Cuff Index, p=0.03, Nine-Hole Peg Test, p=0.02). Our findings demonstrated that decreased function, larger cuff tears and muscle atrophy can be observed patients with anterior greater tuberosity cysts. Anterior greater tuberosity cysts can be detected by plain X-rays. The presence of these cysts should warn the physician regarding the possibility of decreased shoulder function, muscle atrophy and larger cuff tear before ordering a magnetic resonance imaging.

Temporal outcomes of shoulder arthroplasty

Introduction: Rotator cuff tears can occur insidiously without a specific initiating event (non-traumatic), or from acute shoulder trauma (traumatic). The aim of this study was to determine if repairs of traumatic rotator cuff tears had better outcomes than repairs of non-traumatic rotator cuff tears. Methods: In this retrospective comparative study, the cohort consisted of 1300 consecutive patients who completed a preoperative questionnaire regarding their shoulder injury, had a systematic evaluation of shoulder range of motion and strength, a primary arthroscopic rotator cuff repair performed by a single surgeon, had anultrasound scan and the same subjective and objectivemeasurements made of their shoulder six months post-surgery. Post-hoc, this cohort was separated into two groups; those who reported no history of trauma (N=489) and those with a history of traumatic injury (N=811). Multiple logistic regression analyses were used to determine factors that affected rotator cuff integrity at six months. Results: Patients with traumatic rotator cuff tears were slightly younger (3 years), had larger tears by 0.6 cm2, stiffer shoulders (3–11∞) and came to surgery earlier (7 months) than those who could not recall a specific initiating event. Both groups had improved outcomes at sixmonthswith re-tear rates of 14% and12% in the traumatic and non-traumatic groups respectively (NS). In the both groups, larger intraoperative tear sizes predicted re-tears at six months (p<0.001). Those patients with shoulder trauma who waited longer than 24 months, had higher re-tear rates (20%) at six months compared to those who had their surgery earlier (13%) (p<0.05). Discussion:Recollectionof a traumatic initiatingeventhad little effect on the outcome of arthroscopic rotator cuff repair. Re-tears were predominantly predicted by intraoperative tear size. Previous studies that have used smaller sample sizes, foundno differences in postoperative re-tear rates based on time to surgery. In this study, duration of preoperative symptoms was important in predicting re-tears if patients recalled a specific initiating event, but not in patients who did not recall any specific initiating event. Patients with a history of trauma should therefore be encouraged to have their rotator cuff tears repaired within two years of their trauma. Limitations of this study include the retrospective design, and a relatively short follow-up time of six months.

Posttraumatische Rotatorenmanschettenläsionen

BackgroundThe increasing incidence of rotator cuff tears with increasing age indicates that rotator cuff lesions are naturally correlated with ageing and often present without clinical symptoms. Rotator cuff tears from extrinsic causes, i.e., repetitive microtrauma or even macrotrauma, are different entities. Because of the strong and stiff tendon tissue, direct injury mechanisms may not lead to a rotator cuff tear. Excentric mechanisms of tensioned tendons or shearing forces during dislocation may, on the other hand, result in traumatic rotator cuff tears. EvaluationFor the decision from a legal point of view of whether it is a traumatic or degenerative rotator cuff tear, an individual- and patient-related analysis of all circumstances and information including radiographs or MRI is necessary. TherapyReconstruction of the tear is indicated especially in younger patients as well with a history of relevant trauma or of dislocation. The operation should be performed early, if associated with concomitant neurologic lesions. Good to very good results are achieved using open or arthroscopic techniques in the short and long-term follow-up.

An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears

The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears. An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data. Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77. Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair. Level IV, systematic review Levels III and IV studies.

Rotator Cuff Tears in Polytrauma - A Hidden Lesion

A rotator cuff tear in a polytraumatized patient can be a devastating injury if not identified early. Traumatic rotator cuff tears are often massive, and generally retract within a short period of time. If the tear is missed, the consequences are profound especially if the tear becomes irreparable and especially in the younger, more active population. These consequences include pseudoparalysis, persistent pain, and rotator cuff tear arthropathy. Specific examination of the polytraumatized patient with shoulder pain on secondary/tertiary survey should include a detailed assessment of the rotator cuff. Ultrasound has been advocated as a potential adjunct to MRI but most surgeons would agree that MRI is imaging study of choice for evaluation of the rotator cuff. The treatment of acute or acute on chronic traumatic rotator cuff tear in the polytraumatized patient should be early rotator cuff repair when the patient’smedical status allows.

외상성 급성 회전근개 파열 환자의 한방치료 1례

Objectives: There is no report on treatment of acute traumatic rotator cuff tear in Traditional Korean Medicine. We reported Traditional Korean Treatment for pain relief and better movement of acute traumatic rotator cuff tear. Methods: Shoulder MRI was used to confirm the diagnosis of tear of rotator cuff. The patient was treated with Traditional Korean Methods (Acupuncture, Herbal medicine, Pharmacopuncture) for 6 months. We evaluated the patient through VAS (Visual Analogue Scale), UCLA shoulder scale, ROM (Range of motion) and Shoulder MRI.

The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears

Background and purpose Few authors have considered the outcome after acute traumatic rotator cuff tears in previously asymptomatic patients. We investigated whether delay of surgery, age at repair, and the number of cuff tendons involved affect the structural and clinical outcome.Patients and methods 42 patients with pseudoparalysis after trauma and no previous history of shoulder symptoms were included. A full-thickness tear in at least 1 of the rotator cuff tendons was diagnosed in all patients. Mean time to surgery was 38 (6–91) days. Follow-up at a mean of 39 (12–108) months after surgery included ultrasound, plain radiographs, Constant-Murley score, DASH score, and western Ontario rotator cuff (WORC) score.Results At follow-up, 4 patients had a full-thickness tear and 9 had a partial-thickness tear in the repaired shoulder. No correlation between the structural or clinical outcome and the time to repair within 3 months was found. The patients with a tendon defect at follow-up had a statistically significantly lower Constant-Murley score and WORC index in the injured shoulder and were significantly older than those with intact tendons. The outcomes were similar irrespective of the number of tendons repaired.Interpretation A delay of 3 months to repair had no effect on outcome. The patients with cuff defects at follow-up were older and they had a worse clinical outcome. Multi-tendon injury did not generate worse outcomes than single-tendon tears at follow-up.

A comparison of early versus delayed repair of traumatic rotator cuff tears

The purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) results between early and delayed operative treatment in patients with traumatic rotator cuff tears (RCT). Thirty-five patients with a traumatic RCT who have been treated surgically during a 4-year period were included in the study. The results of early versus delayed repair of traumatic rotator RCT were assessed using the Constant and UCLA scores. In addition, all patients underwent a postoperative MRI to evaluate repair integrity. Early repair (within 3weeks) was performed in 15 patients (group I) and delayed repair (after 3weeks) in the rest 20 patients (group II). The time interval between injury and operation was 12 and 131days on average for group I and II, respectively. Follow-up time was 34 and 38months for group I and II, respectively. Postoperatively, the UCLA score was 31 and 26 (P<0.05) for group I and II, respectively. The Constant score was 82 and 70 (P<0.05) for group I and II, respectively. Range of motion was significantly better in group I. According to MRI, 5 patients (33%) in the group I and 7 patients (35%) in the group II had a retear. Early repair of a traumatic RCT provides better results in terms of shoulder function in comparison with a delayed repair. A delayed diagnosis of a traumatic RCT leads to difficulties in surgery and less good results. Level III, therapeutic, retrospective, comparative study.

The timing of rotator cuff repair for the restoration of function

This study was developed to test the hypothesis that there is a period in which a painful, traumatic rotator cuff tear, with associated weakness and the inability to abduct above shoulder level, should be repaired to allow for improvement in function. Forty-two consecutive, prospectively followed patients met the criteria for entrance into this study. Of those, 36 patients were available for a minimum 9 months follow-up (average, 31 months; range, 9-71) by office visit. Patient outcomes were measured using the UCLA End-Result and ASES scoring systems. Patient variables, including time from injury to repair, tear size, degree of preoperative fat infiltration, patient satisfaction, and improvement in pain, were evaluated for their association with surgical outcome using independent t testing. Time to repair was evaluated at 0-2 months, 2-4 months, and greater than 4 months. Pain scores improved from 7 to 1.4 (P < .01) and active elevation improved from 55° to 133° (P< .01). UCLA/ASES scores improved from 8/30 to 26/79, respectively (P < .01, P < .01). All but 2 of the 36 patients were satisfied with their result. Preoperative fatty atrophy did not correlate with postoperative function. Rotator cuff tear size had no influence on patient outcome if repaired before 4 months. Massive tears repaired after 4 months had the worst outcome. Our results emphasize that the treatment outcome for traumatic rotator cuff tears of all sizes, with associated weakness, is not compromised up to 4 months after their injury.

Arthroscopic Repair of a Traumatic Massive Posterior Rotator Cuff Tear in a 14-year-old Teenager

Rotator cuff tears in adolescents are extremely rare, with no reported cases of arthroscopic repair being available in the literature thus far. A 14-year-old boy sustained a traumatic tear of his supraspinatus and infraspinatus muscles of the rotator cuff during a fall off his motorcycle during a motocross race. He also sustained a contralateral mid-shaft clavicle fracture. The rotator cuff was repaired arthroscopically with two rows of double loaded suture anchors. The clavicle was fixed with an elastic intramedullary nail. This was followed by intensive physiotherapy, and the patient returned to full pre-injury function in his shoulder by 6 months postoperatively.

Rating Distal Clavicle Resection per the Guides, Sixth Edition

Rating Distal Clavicle Resection per the Guides, Sixth Edition

Sleep Impairment

Abstract In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.

Traumatic Anterosuperior Rotator Cuff Tears: The Outcome of Open Surgical Repair

Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than posterosuperior tears and are rarely discussed in the literature. The purpose of this study was to identify the unique features of this injury and to assess the outcome of operative treatment. Thirty consecutive patients, with a mean age of fifty-seven years (range, forty-three to seventy-three years), had an open repair of a traumatic anterosuperior rotator cuff tear. Twenty-four patients (80%) were male. Sixteen patients (53%) had involvement of the dominant shoulder, twenty-three (77%) had a biceps tendon disorder, and sixteen (53%) had a positive lift-off maneuver prior to surgery. Surgical approaches included an isolated superior deltoid-splitting approach in twenty patients, an isolated deltopectoral approach in five patients, and a combined approach in five patients. Open repair was performed at a mean of 4.5 months after the injury or the onset of symptoms. The final outcomes were determined with a physical examination and patient self-assessed outcome tools. At a mean follow-up of fifty-six months, twenty-one of the thirty patients were satisfied with their symptoms, and twenty-nine would have the surgery again. The mean pain score on the visual analog scale improved from 6.2 to 1.2 (p < 0.001). The mean score on the Disabilities of the Arm, Shoulder and Hand questionnaire improved from 41.7 to 12.2 (p < 0.001). The mean percentage of functions that patients were able to perform on the Simple Shoulder Test improved from 36.4% to 82.8% (p < 0.001). The mean age and sex-adjusted Constant score was 93.4 postoperatively. The mean elevation, external rotation, and internal rotation of the involved shoulders were 97%, 109%, and 97%, respectively, of those of the contralateral side. The mean strength of elevation, external rotation, and internal rotation were 85%, 93%, and 101%, respectively, of those of the contralateral side. Infraspinatus involvement (p = 0.04), the extent of the supraspinatus tear (p = 0.03), and a Workers' Compensation claim (p = 0.03) were associated with worse outcomes and decreased satisfaction. Patients with a traumatic anterosuperior rotator cuff tear present with internal rotation weakness, and they usually have a biceps tendon disorder. While larger tears involving greater portions of the supraspinatus and extending into the infraspinatus are associated with poorer outcomes, early recognition of this injury and open repair can reliably restore shoulder function to near normal levels.

상완골 간부 골절과 동반된 외상성 회전근 개 전층 파열 - 증례 보고 -

Full-thickness rotator cuff tears are relatively uncommon in the young adults. One of the pathogenesis of such tear is thought to be closely related to the specific trauma event. Favorable outcome is expected in young patient rotator cuff tears when it is diagnosed early following prompt surgical repair. However, early detection is sometimes difficult when the acute rotator cuff tear is combined with other injuries especially around the shoulder joints such as ipsilateral humerus fractures. Authors report an uncommon case of acute traumatic rotator cuff tear accompanied by the midhumerus shaft fracture in young adult.

Glenohumeral interposition of a torn rotator cuff in a young motorcyclist

This report describes the rare case of a traumatic rotator cuff tear in a young patient which led to a pseudo-paralyzed shoulder by interposition of the tendon stump into the glenohumeral joint. The patient underwent an open rotator cuff repair and regained an almost normal shoulder function after 12 weeks. A review of the literature is presented.

Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears.

The objective of this study was to compare the postoperative range of motion (ROM) and patient satisfaction after surgical reconstruction of traumatic and non-traumatic rotator cuff tears. The cases of 46 consecutive patients who underwent the same standardised surgical reconstruction and postoperative rehabilitation protocol between 1993 and 1998 were reviewed. Traumatic (group I, n=20, average age 34.2 years, range 15-49 years) and non-traumatic tears (group II, n=26, average age 54.1 years, range 50-68 years) formed the two study groups. Mean follow-up lasted 47.1 months (range 13-105 months) in group I and 41.4 months (range 11-94 months) in group II. Assessment included postoperative shoulder function with Constant and Murley's score and visual analogue scale (VAS). Significantly ( p=0.0019) better results were observed in group I with an average of 94.1 points for Constant's score, compared with 75.3 points in group II. Postoperative shoulder function was not affected regarding full-thickness or partial tears ( p=0.239) in group I. VAS revealed an excellent or good result in all patients of group I ( n=20) and 50% of group II ( n=13/26). Quantitative comparison of postoperative ROM demonstrated significantly better results in forward flexion ( p=0.013), abduction ( p=0.0019) and external rotation ( p=0.0042) for group I. The remaining postoperative external rotation deficit for group II with a loss of 31% compared with group I (38.9 degrees vs 56.6 degrees ) was statistically and clinically relevant. The results demonstrate that surgical reconstruction of traumatic and non-traumatic rotator cuff tears is a successful procedure. Comparison of both groups revealed significantly better postoperative results in the younger, traumatic collective.