Type Of Rotator Cuff Tear Research Articles

Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears

To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure. Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired t test was used to determine statistical significance (P < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score. A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, P= .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, P= .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, P= .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (P= .033 for ASES score and P=.020 for UCLA score) or U-shaped tears (P= .047 for ASES score and P= .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears. The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears. Level IV, therapeutic case series.

Can coracoacromial ligament degeneration be evaluated with preoperative MRI?

Subacromial impingement syndrome is one of the most common causes of painful shoulder in the middle-aged and elderly population. Coracoacromial ligament (CAL) degeneration is a well-known indicator for subacromial impingement. To examine the relationship between CAL thickness on preoperative magnetic resonance imaging (MRI), arthroscopic CAL degeneration and types of rotator cuff tears. Video records of patients who underwent arthroscopic shoulder surgery between 2015 and 2021 were retrospectively scanned through the hospital information record system. In total, 560 patients were included in this study. Video records of the surgery were used to evaluate the grade of coracoacromial ligament degeneration and the type of cuff tear. Preoperative MRI was used to measure CAL thickness, acromiohumeral distance, critical shoulder angle, acromial index, and acromion angulation. Significant differences were observed between grades of CAL degeneration in terms of CAL thickness (P < 0.001). As CAL degeneration increases, the mean of CAL thickness decreases. According to the results of post-hoc analysis, the mean CAL thickness of normal patients was significantly higher than those of patients with full-thickness tears (P = 0.024) and massive tears (P <0.001). Patients with articular-side, bursal-side, and full-thickness tears had significantly higher CAL thickness averages than patients with massive tears. This study showed that the CAL thickness decreases on MRI as arthroscopic CAL degeneration increases. High-grade CAL degeneration and therefore subacromial impingement syndrome can be predicted by looking at the CAL thickness in MRI, which is a non-invasive method.

Rotator cuff tear patterns: MRI appearance and its surgical relevance.

A new perspective on rotator cuff anatomy has allowed a better understanding of the patterns of the different rotator cuff tears. It is essential for radiologists to be aware of these different patterns of tears and to understand how they might influence treatment and surgical approach. Our objective is to review the arthroscopy correlated magnetic resonance imaging appearance of the different types of rotator cuff tears based on current anatomical concepts.Critical relevance statement Knowledge of the characteristics of rotator cuff tears improves our communication with the surgeon and can also make it easier for the radiologist to prepare a report that guides therapeutic conduct and serves as a prognosis for the patient.Key points• There is no universally accepted classification for RC tears.• New patterns such as delamination or myotendinous junction tears have been defined.• The most difficult feature to assess in full thickness tears on MRI is the pattern.• Fatty infiltration of the RC tendons is crucial in the prognosis and outcome.• The radiological report is an effective way of communication with the surgeon.

Influence of Critical Shoulder Angle and Rotator Cuff Tear Type on Load‐Induced Glenohumeral Biomechanics: A Sawbone Simulator Study

Glenohumeral (GH) biomechanics after rotator cuff (RC) tears are not fully understood. The purpose of our study was to determine if the critical shoulder angle (CSA), type of RC tears, and level of weight bearing increase GH translation, instability based on the instability ratio, muscle forces and joint reaction force (JRF), and shifts the center of force (CoF) superiorly. A GH simulator with muscle‐mimicking cable systems was used to simulate 30° abduction in the scapular plane. A Sawbone humerus and five specimen‐specific scapular anthropometries were used to test six types of RC tears, three weight‐bearing loads, and the native and adjusted (to different CSAs) deltoid origin sites. Linear mixed effects models (CSA, RC tear type, and weight bearing) with random effects (specimen and sex) were used to assess differences in GH biomechanics. With increasing CSA, GH translation increased, JRF decreased, and the CoF position was more inferior. RC tears did not significantly alter GH translation but shifted the CoF position superiorly, close to where glenoid erosion occurs in patients with RC tears with secondary osteoarthritis. Weight bearing significantly increased GH translation and JRF. RC and deltoid muscle forces increased with the presence of RC tears and increased weight bearing. The remaining RC muscles of intact tendons compensated for the torn RC tendons but not for the altered CoF position. GH translation remained comparable to shoulders with intact RC. These findings highlight the importance of early detection, clinical management, and targeted rehabilitation strategies for patients with RC tears.

Value of contrast-enhanced percutaneous ultrasound in the diagnosis of rotator cuff tear subtype

To explore characteristics of contrast-enhanced ultrasound (CEUS) images features and diagnostic value of rotator cuff tear subtypes. From January 2019 to March 2022, percutaneous ultrasound-guided subacromial bursography (PUSB) with persutaneous ultrasound-guide tendon lesionography (PUTL) was performed on 114 patients with suspected rotator cuff injury were evaluated, including 54 males and 60 females ranged in age from 35 to 75 years old with an average of (58.8±8.7 ) years old;76 patients on the right side and 38 patients on the left side;the course of disease ranged from 0.13 to 111 months with an average of (10.2±9.8) months. GE LOGIQ E9 color doppler ultrasound diagnostic high frequency(6 to 12 MHz) was used to CEUS Using arthroscopy as gold standard, receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy of US, MRI and CEUS for rotator cuff injury, also sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. The sensitivity of US in diagnosing full-thickness tears was 72.1%, specificity was 93.0%, and accuracy was 85.1%. The sensitivity, specificity and accuracy of MRI diagnosis of full-thickness tear were 90.9%, 92.6% and 92.1% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of full-thickness tear were 100%. The sensitivity, specificity and accuracy of US in the diagnosis of partial tear were 85.7%, 77.2% and 79.8% respectively. The sensitivity, specificity and accuracy of MRI diagnosis of partial tear were 83.7%, 81.7% and 82.5% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of partial tear were 95.7%, 92.6% and 93.9% respectively. There were significant differences in diagnosis results of US, MRI and CEUS for rotator cuff bursa tear (P<0.001). Kapp test showed good consistency between CEUS and arthroscopy in diagnosing rotator cuff tear subtypes (full-thickness and partial tears). Using PUSB/PUTL to observe distribution of contrast media in bursa, tendon and joint cavity to evaluate the type of rotator cuff tear, its diagnostic performance is significantly better than US and MRI. Therefore, percutaneous contrast-enhanced ultrasound can be a reliable method for diagnosing subtypes of rotator cuff tears.

Imaging and histological evaluation of the long head of the biceps tendon in the presence of different types of rotator cuff tears

BackgroundA comparison of changes in the long head of the biceps tendon for different types of rotator cuff tears has not been previously performed. Furthermore, the correlation between the thickening and degeneration of the long head of the biceps tendon and the cause of these changes have not been fully clarified. We evaluated the relationship between degenerative changes in the long head of the biceps tendon and rotator cuff tears in a rat model using imaging and histology.MethodsNinety-six 12-week-old Sprague–Dawley rats were divided into anterior (subscapularis tear), anterosuperior (subscapularis, supraspinatus, and infraspinatus tears), superior (supraspinatus and infraspinatus tears), and control groups. The long head of the biceps tendon was harvested at 4 or 12 weeks postoperatively. The cross-sectional areas of the intra- and extra-capsular components of the tendon were measured using micro-computed tomography, and the affected/normal ratio of the cross-sectional area was calculated. Masson’s trichrome staining and Alcian blue staining were performed for histologic analysis, with degenerative changes described using the modified Bonar scale. The correlation between the affected/normal ratio and Bonar scores was evaluated.ResultsThe affected/normal ratio was higher for the anterior and anterosuperior groups than for the control group at 4 and 12 weeks. The ratio increased for the intra-articular portion in the superior group and for both the intra- and extra-articular portions in the anterior and anterosuperior groups. Degeneration considerably progressed in the anterior and anterosuperior groups compared with the control group from weeks 4 to 12 and was greater in the intra- than in the extra-articular portion. The ratio correlated with extracellular matrix score.ConclusionsSubscapularis tears were associated with progressive thickening and degeneration of the long head of the biceps tendon at 4 and 12 weeks postoperatively, which was more significant in the intra- than in the extra-articular portion. Histologic evaluation indicated that the extracellular matrix likely caused these degenerative changes.

Influence of rotator cuff integrity on loading and kinematics before and after reverse shoulder arthroplasty

Reverse Shoulder Arthroplasty has become a very common procedure for shoulder joint replacement, even for scenarios where an anatomical reconstruction would traditionally be used. Our hypothesis is that implanting a reverse prosthesis with a functional rotator cuff may lead to higher joint reaction force (JRF) and have a negative impact on the prosthesis. Available motion capture data during anterior flexion was input to a finite-element musculoskeletal shoulder model, and muscle activations were computed using inverse dynamics. Simulations were carried out for the intact joint as well as for various types of rotator cuff tears: superior (supraspinatus), superior-anterior (supraspinatus and subscapularis), and superior-posterior (supraspinatus, infraspinatus and teres minor). Each rotator cuff tear condition was repeated after shifting the humerus and the glenohumeral joint center of rotation to represent the effect of a reverse prosthesis. Changes in compressive, shear, and total JRF were analyzed. The model compared favorably to in vivo JRF measurements, and existing clinical and biomechanical knowledge. Implanting a reverse prosthesis with a functional rotator cuff or with an isolated supraspinatus tear led to more than 2 times higher compressive JRF than with massive rotator cuff tears (superior-anterior or superior-posterior), while the shear force remained comparable. The total JRF increased more than 1.5 times. While a lower shear to compressive ratio may reduce the risk of glenosphere loosening, higher JRF might increase the risk for other failure modes such as fracture or polyethylene wear of the reverse prosthesis.

Pseudoparalysis and pseudoparesis of the shoulder

Abstract Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction &lt;45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (&gt;50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (&lt;45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

Protocol for a multi-site pilot and feasibility randomised controlled trial: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff (the SPeEDy study)

BackgroundClinically, a distinction is made between types of rotator cuff tear, traumatic and non-traumatic, and this sub-classification currently informs the treatment pathway. It is currently recommended that patients with traumatic rotator cuff tears are fast tracked for surgical opinion. However, there is uncertainty about the most clinically and cost-effective intervention for patients with traumatic rotator cuff tears and further research is required.SPeEDy will assess the feasibility of a fully powered, multi-centre randomised controlled trial (RCT) to test the hypothesis that, compared to surgical repair (and usual post-operative rehabilitation), a programme of physiotherapist-led exercise is not clinically inferior, but is more cost-effective for patients with traumatic rotator cuff tears.MethodsSPeEDy is a two-arm, multi-centre pilot and feasibility RCT with integrated Quintet Recruitment Intervention (QRI) and further qualitative investigation of patient experience. A total of 76 patients with traumatic rotator cuff tears will be recruited from approximately eight UK NHS hospitals and randomly allocated to either surgical repair and usual post-operative rehabilitation or a programme of physiotherapist-led exercise. The QRI is a mixed-methods approach that includes data collection and analysis of screening logs, audio recordings of recruitment consultations, interviews with patients and clinicians involved in recruitment, and review of study documentation as a basis for developing action plans to address identified difficulties whilst recruitment to the RCT is underway. A further sample of patient participants will be purposively sampled from both intervention groups and interviewed to explore reasons for initial participation, treatment acceptability, reasons for non-completion of treatment, where relevant, and any reasons for treatment crossover.DiscussionResearch to date suggests that there is uncertainty regarding the most clinically and cost-effective interventions for patients with traumatic rotator cuff tears. There is a clear need for a high-quality, fully powered, RCT to better inform clinical practice. Prior to this, we first need to undertake a pilot and feasibility RCT to address current uncertainties about recruitment, retention and number of and reasons for treatment crossover.Trial registrationClinicalTrials.gov (NCT04027205) – Registered on 19 July 2019. Available via

Association between type of rotator cuff tear and functional outcomes in patients with massive and irreparable rotator cuff tear: A pre-post intervention study

The aim of this study was to analyze: (1) the differences in the pre-post change in functional outcomes after a physical therapy program by the type of massive and irreparable rotator cuff tear (MIRCT) controlling for potential confounders, and(2) the influence of lifestyle behaviors and demographic and tear tendon characteristics on function in patients over 60 years of age with conservatively treated MIRCT. In this pre-post intervention study, 92 patients were prospectively recruited at the Clinical Hospital San Borja Arriaran, with atraumatic MIRCT, between 60 and 75 years of age (mean: 67.9 ± 4.5 years), and the mean of length of symptoms was 16.5 months (±5.7 months). Patients received a physical therapy program consisting of manual therapy and a specific exercise program of 2 sessions per week for 12 weeks. The imaging findings were performed by 2 medical radiologists who classified the rotator cuff tear according to the criteria proposed by Collins. Shoulder function, upper limb function, and pain intensity were assessed with the Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and visual analog scale (VAS), respectively. Analysis of covariancemodels were estimated to assess differences in MIRCT categories between functional outcomes. Multiple regression model analysis was used for the association between the change in functional outcomes and lifestyle behaviors, and demographic and tear tendon characteristics. The results showed no pre-post change in functional outcomes by type of MIRCT in all models (P > .05). There is an association between length of symptoms (P = .000), and the baseline values of the 3 functional measures (P = .000) are associated with changes in Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and VAS. In addition, changes in VAS are associated with body mass index (BMI) (P = .000), and changes in Constant-Murley are associated with gender (P = .023), BMI (P = .000), and tobacco consumption (P = .000). There is nodifference in functional outcomes by type of MIRCT after a physical therapy program controlling for potential confounders. In addition, there is an association of length of symptoms with all functional outcomes, an association of BMI with VAS and Constant-Murley questionnaire, and an association between tobacco consumption and Constant-Murley questionnaire. Our results could influence the orthopedic surgeon's decisions; thus, not predicting the functional outcome through imaging findings could lead clinicians to reconsider the need for surgery in the treatment algorithm in patients over 60 years with MIRCT. In addition, demographic characteristics and lifestyle behaviors might be considered within the patient's evaluation and follow-up to decide on surgical interventions and evaluate the clinical course of the disease. Further studies measuring additional variables and longer follow-up are needed to confirm these results.

Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness

To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness. A retrospectively study was performed on the data of 15 patients with rotator cuff tear combined with shoulder stiffness (stiff group) and 24 patients without stiffness (non-stiff group) between January 2014 and December 2015. The patients in the stiff group underwent arthroscopic rotator cuff repair with manipulation release and arthroscopic debridement while the patients in the non-stiff group only received arthroscopic rotator cuff repair. The patients in the stiff group were older than the patients in the non-stiff group, showing significant difference ( P<0.05). There was no significant difference in gender, type of rotator cuff tear, side of rotator cuff tear, and combined with diabetes between 2 groups ( P>0.05). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were used to evaluate the effectiveness after operation. All incisions healed by first intention without any complication after operation. The patients were followed up 13-31 months in the stiff group (mean, 19.2 months) and 13-23 months in the non-stiff group (mean, 20.3 months). There was no significant difference in follow- up time between 2 groups ( t=-0.573, P=0.570). The VAS score in the stiff group was higher than that in the non-stiff group before operation ( t=-2.166, P=0.037); there was no significant difference between 2 groups at 3, 6, 12 months and last follow-up ( P>0.05). The forward flexion and external rotation were significantly lower in the stiff group than those in the non-stiff group before operation and at 3 months after operation ( P<0.05); there was no significant difference between 2 groups at 6, 12 months and last follow-up ( P>0.05). At last follow-up, the internal rotation was beyond L 3 level in 2 groups. The preoperative UCLA score was significant lower in the stiff group than that in the non-stiff group ( P=0.037); but there was no significant difference in UCLA score at last follow-up between 2 groups ( P=0.786). There was no significant difference in pre- and post-operative ASES scores between 2 groups ( P>0.05). Satisfactory effectiveness can be achieved in the patients with rotator cuff tear combined with shoulder stiffness after rotator cuff repair with manipulation release and arthroscopic debridement, although the patients with shoulder stiffness had slower postoperative recovery of ROM until 6 months after operation.

Predictive Factors of Retear in Patients With Repaired Rotator Cuff Tear on Shoulder MRI

This study aimed to find independent prognostic factors related to retear of the rotator cuff tendon in patients with repaired full-thickness supraspinatus tendon tear by evaluation of pre- and postoperative MR images. Shoulder MR images were retrospectively analyzed for 83 patients who had undergone arthroscopic or open rotator cuff repair with acromioplasty for full-thickness supraspinatus tendon tear from April 2014 to March 2015. On preoperative MR images, the type of rotator cuff tear, extent of retraction of torn tendon, anteroposterior (AP) dimension of torn tendon, signal intensity of tear edge, degree of fat infiltration in supraspinatus and infraspinatus muscles, and acromiohumeral interval (AHI) were assessed. Postoperative cuff integrity seen on MR images was classified into five categories according to the Sugaya classification system, and patients were categorized into retear or intact groups. Factors assessed on preoperative MR images were compared between the two groups. The overall retear rate was 57.8%. Significant differences were observed between the retear and intact groups in terms of the mean values of the extent of tendon retraction (20.4 vs 11.7 mm), AP dimension of the tear (16.1 vs 11.4 mm), AHI (6.8 vs 8.7 mm), and degree of fat infiltration of the supraspinatus and infraspinatus muscles (for the supraspinatus muscle, 3, 30, and 15 patients in the retear group vs 5, 27, and three patients in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively; for the infraspinatus muscle, 27, 12, and 9 patients in the retear group vs 29, 5, and one patient in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively). Multivariable analysis revealed that AHI and degree of tendon retraction were independent predictive factors affecting retear of rotator cuff after repair. The retear rate of repaired rotator cuff tendon was about 57.8%. Independent prognostic factors of retear were degree of tendon retraction and AHI on preoperative MR images.

Fosbury flop tear of the rotator cuff: diagnostic assessment with magnetic resonance arthrography.

The aim was to assess the diagnostic performance of magnetic resonance arthrography (MRA) of the shoulder for the detection of "Fosbury flop" tears. All patients undergoing arthroscopic rotator cuff repair were considered as potentially eligible for inclusion in this prospective case series. Preoperative MRAs were consecutively performed and compared with intraoperative findings being the gold standard control. Two experienced musculoskeletal radiologists, blinded to the arthroscopic findings, independently analysed all MRAs for the presence of typical signs of Fosbury flop tears. 423 patients were included. Among this group, 11 presented a Fosbury flop tear with a prevalence of 2.6%. Interobserver agreement was considered as excellent for thickened tendon, tendon stump, fluid accumulation, abnormal fibres orientationand adherences between tendon and bursa. The most sensitive and specific criterion was the tendon thickness[90.9% CI(62.3-98.4) and97.1% CI(95.0-98.3), respectively]. Conclusions: Fosbury flop tear is an uncommon condition that should be recognized to allow optimal anatomic repair. MRA is a valuable tool in making the diagnosing of this lesser recognized type of rotator cuff tear. An abnormally thickened supraspinatus tendon tear should especially raise suspicion for a Fosbury flop tear of the posterosuperior rotator cuff. Advances in knowledge: MRA is a valuable tool in making the diagnosing of Fosbury flop tears. An abnormally thickened supraspinatus tendon tear should especially raise suspicion for such lesion.

Surgical Technique to Repair Musculotendinous Junction Tear of Supraspinatus Using Lateral-Row Anchors to Avoid Cut-Through

A musculotendinous junction tear is a rare type of rotator cuff tear. There is very little literature available on musculotendinous junction tears. We propose a technique for repair of this type of tear using lateral-row anchors. In this technique, the torn tendon is freshened and sutures are passed through the medial part of the torn tendon. When it is fixed with lateral-row anchors, the tear is reduced and tendon-to-tendon healing is seen. The enthesis and the tendon length are preserved.

A Comparison of Levels of Muscle Activity Based on Stabilization Exercise Methods Applied to Patients with Rotator Cuff Tendon Tears

For normal shoulder joint movements, sternoclavicular articulation, the acromio-clavicular joint, the glenohumeral joints, and the scapulothoracic joints should be coordinated. For remedial program after arthroscopic surgery for rotator damage, muscle exercise for the rotator should be regarded as an important factor, and clinical approaches should be adopted to promote muscle control and balance. This study was conducted on 30 patients in their 30s and 40s who underwent arthroscopic surgery for supraspinous muscle tendon rupture 4–6 weeks prior; such rupture represents one of the most common types of rotator cuff tear. Four types of remedial treatments—rowing in prone position, Superman ‘T’, prone supported on elbow and pushup with hands—were used to measure the muscle activity of the upper trapezius, lower trapezius, and serratus muscle. Considering all these factors, it was determined that each exercise method led to different muscle activities. No ideal exercise method was found to reduce the muscle activity of upper trapezius muscle and increase that of the lower trapezius and serratus muscle. Therefore, it is considered that each stabilization exercise should be applied in a selective manner based on the patient’s condition and a doctor’s diagnosis.

RETRACTED: Abduction external rotation position in magnetic resonance arthrography for the diagnosis of rotator cuff tears.

This article aims at evaluating the effectiveness of abduction and external rotation (ABER) position used in magnetic resonance (MR) arthrography for diagnosing rotator cuff tears. A retrospective analysis was performed using 183 MR arthrography images of shoulder joint. Each patient was either examined in a neutral position or ABER position. Then the imaging results were compared with those diagnostic results obtained from shoulder arthroscopy. Also the specificity, sensitivity, negative predictive value, positive predictive value, and accuracy of MR arthrography in the two positions described above were evaluated. A total of 64 patients were diagnosed with rotator cuff tears using arthroscopy and the diagnostic results include 16 complete rotator cuff tears and 48 partial tears; 47 supraspinatus tendon tears and 17 posterosuperior cuff tears; 22 delamination tears and 26 tears complicated with anteroinferior labrum-ligament complex injuries. The differences in specificity, sensitivity, negative predictive value, positive predictive value and accuracy between neutral position and ABER position using MR arthrography were not statistically significant (all P>0.05). For diagnosing posterosuperior cuff tears, the sensitivity of ABER position was significantly higher than that of the neutral position (94.12% vs. 64.71%, P=0.034). For diagnosing delamination tears, the sensitivity and negative predictive value of ABER position were significantly higher than those of the neutral position (P=0.009 and P=0.036 respectively). For diagnosing rotator cuff tears complicated with anteroinferior labrum-ligament complex injuries, the sensitivity of ABER position was statistically higher than that of the neutral position (96.15% vs. 73.08%, P=0.021). This study suggests that MR arthrography in ABER position is a superior tool for diagnosing certain types of rotator cuff tears. Apart from that, MR arthrography in ABER position improved the detection rate of posterosuperior cuff tears, delamination tears and rotator cuff tears complicated with anteroinferior labrum-ligament complex injuries.

Combined Subscapularis Tears in Massive Posterosuperior Rotator Cuff Tears

Background: Previous studies on massive rotator cuff tears have not addressed the outcomes of tears extending to the subscapularis tendon. Hypothesis: The retear rate in patients with a massive posterosuperior rotator cuff tear combined with a subscapularis tear is higher than that in patients with a massive posterosuperior rotator cuff tear with an intact subscapularis tendon. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected and analyzed from 92 consecutive patients who underwent arthroscopic repair of a massive posterosuperior rotator cuff tear. Patients were divided into 3 groups according to the status of the subscapularis tendon: intact subscapularis tendon (I-massive tear; n = 42), tear involving half or less than half of the subscapularis tendon (S-massive tear; n = 22), and tear involving more than half of the subscapularis tendon (L-massive tear; n = 28). The integrity of the rotator cuff was determined by ultrasonography at 4.5 and 12 months or later after surgery. Clinical evaluations were performed using the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Constant score, and active shoulder range of motion. Data were collected on the day before surgery and at final follow-up (at least 24 months postoperatively). Results: A total of 25 retears (27%) were identified based on an ultrasonographic evaluation. Although statistical significance was not found, there was a trend toward a higher retear rate in patients with an L-massive tear (43%) compared with those with an S-massive tear (18%; P = .050) or I-massive tear (21%; P = .059) at final follow-up. The subclassification of retears according to the involved tendons revealed that subsequent retears of the subscapularis tendon were noted only in patients with an L-massive tear. In patients with an L-massive tear, postoperative data comparison between patients with intact subscapularis tendons and those with failed subscapularis tendons revealed that a significant difference was noted in the VAS (1.1 vs 3.8, respectively) and ASES (90.6 vs 58.5, respectively) scores. The improvement in clinical scores after repair was statistically significant in all groups but not different between the groups. Conclusion: The arthroscopic repair of massive tears results in substantial improvements in shoulder function, regardless of the presence of combined subscapularis tears. However, this study showed a trend toward a high failure rate for the repair of massive posterosuperior rotator cuff tears extending over half of the subscapularis tendon. Therefore, other treatment options should also be considered for this type of rotator cuff tear.

Operative Technique on Arthroscopic Partial-Thickness Articular Rotator Cuff Repairs

Since its first description in 1931, there has been an evolution in the understanding of partial articular tears of the supraspinatus. Partial articular supraspinatus tendon avulsion represents a Southern California Orthopaedic Institute type 3 or 4 tear classification with a traumatic etiology. Partial-thickness tears have little active healing response and may progress to a full-thickness tear. These tears are painful for patients and are particularly debilitating for overhead activities. A tear that involves more than 50% of the tendon may require surgical intervention after extensive conservative management. Arthroscopic repair of these lesions have proven to be successful. There are various techniques of repairing the tear, which can involve a transtendinous or conversion approach. The goal of our technique is to anatomically reduce the delaminated layer to the greater tuberosity under direct visualization, thereby maximizing the biomechanical advantage of fixation while minimizing iatrogenic injury to the remaining fibers. This article outlines the historical and current literature, outcomes, techniques, and our preferred approach with pearls to this type of rotator cuff tear.

Rotator cuff crepitus: could Codman really feel a cuff tear?

The objective of this study was to assess the accuracy of palpating crepitus to diagnose rotator cuff tears. Seventy consecutive consenting patients who presented with shoulder pain and no previous imaging or surgery on the affected shoulder were prospectively enrolled during a 10-month period. A standardized patient history and examination, including the crepitus test, were recorded in addition to obtaining standard radiographs. Additional imaging after initial evaluation was performed with magnetic resonance imaging and interpreted by a musculoskeletal radiologist blinded to the examination findings. Statistical analysis was used to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the crepitus test in the clinical diagnosis of a rotator cuff tear. Sixty-three patients had histories, examinations, and imaging studies available for analysis. The crepitus test had a sensitivity of 67%, specificity of 80%, PPV of 91%, and NPV of 43% for all types of rotator cuff tears. The sensitivity and specificity for full-thickness or high-grade partial tears was 82% and 73%, respectively; the PPV and NPV were 77% and 79%. Increasing age improved accuracy as the presence of crepitus in patients older than 55 years had a sensitivity of 76%, specificity of 100%, PPV of 100%, and NPV of 38%. The crepitus test has a favorable sensitivity, specificity, PPV, and NPV to assess the integrity of the rotator cuff and may be a useful examination in the clinical diagnosis of a rotator cuff tear.

The appearance of the teres minor muscle in rotator cuff tears

BackgroundIn large and massive rotator cuff repair or total shoulder arthroplasty with severe atrophy of rotator cuff muscle, the appearance of the teres minor was reported to be a prognostic factor postoperatively. The purpose of this study was to examine the appearance of teres minor on MRI in patients with the various types of rotator cuff tears.Materials and methodsThis MRI study consists of 198 subjects (112 shoulders in males, 87 shoulders in females, average age of 61.9 years). We classified the198 shoulders into the 7 groups of rotator cuff tears using conventional planes of MRI. Using the Image J software, we measured the area of ISP, TM, external rotation (ER) muscles area on the most lateral side on which the scapular spine was in contact with the scapular body on the oblique sagittal image of MRI. The size and quality of teres minor were compared in each group. The size of teres minor to the infraspinatus was assessed. One factor ANOVA was used for statistical analysis; p less than 0.05 was considered to indicate a statistically significant result.ResultsThe normal group was confirmed to apply to the normal distribution, so TM / ER less than 0.105 was defined as atrophic, and TM / ER greater than 0.304 as hypertrophic. TM / ER in the SSP+ISP group were statistically higher than those of other groups. A negative correlation was found between the size of infraspinatus and teres minor.ConclusionsThe progression of atrophy of infraspinatus induced the hypertrophy of teres minor, especially in posterosuperior tears. BackgroundIn large and massive rotator cuff repair or total shoulder arthroplasty with severe atrophy of rotator cuff muscle, the appearance of the teres minor was reported to be a prognostic factor postoperatively. The purpose of this study was to examine the appearance of teres minor on MRI in patients with the various types of rotator cuff tears. In large and massive rotator cuff repair or total shoulder arthroplasty with severe atrophy of rotator cuff muscle, the appearance of the teres minor was reported to be a prognostic factor postoperatively. The purpose of this study was to examine the appearance of teres minor on MRI in patients with the various types of rotator cuff tears. Materials and methodsThis MRI study consists of 198 subjects (112 shoulders in males, 87 shoulders in females, average age of 61.9 years). We classified the198 shoulders into the 7 groups of rotator cuff tears using conventional planes of MRI. Using the Image J software, we measured the area of ISP, TM, external rotation (ER) muscles area on the most lateral side on which the scapular spine was in contact with the scapular body on the oblique sagittal image of MRI. The size and quality of teres minor were compared in each group. The size of teres minor to the infraspinatus was assessed. One factor ANOVA was used for statistical analysis; p less than 0.05 was considered to indicate a statistically significant result. This MRI study consists of 198 subjects (112 shoulders in males, 87 shoulders in females, average age of 61.9 years). We classified the198 shoulders into the 7 groups of rotator cuff tears using conventional planes of MRI. Using the Image J software, we measured the area of ISP, TM, external rotation (ER) muscles area on the most lateral side on which the scapular spine was in contact with the scapular body on the oblique sagittal image of MRI. The size and quality of teres minor were compared in each group. The size of teres minor to the infraspinatus was assessed. One factor ANOVA was used for statistical analysis; p less than 0.05 was considered to indicate a statistically significant result. ResultsThe normal group was confirmed to apply to the normal distribution, so TM / ER less than 0.105 was defined as atrophic, and TM / ER greater than 0.304 as hypertrophic. TM / ER in the SSP+ISP group were statistically higher than those of other groups. A negative correlation was found between the size of infraspinatus and teres minor. The normal group was confirmed to apply to the normal distribution, so TM / ER less than 0.105 was defined as atrophic, and TM / ER greater than 0.304 as hypertrophic. TM / ER in the SSP+ISP group were statistically higher than those of other groups. A negative correlation was found between the size of infraspinatus and teres minor. ConclusionsThe progression of atrophy of infraspinatus induced the hypertrophy of teres minor, especially in posterosuperior tears. The progression of atrophy of infraspinatus induced the hypertrophy of teres minor, especially in posterosuperior tears.