Aims

Rotator cuff disease (RCD) can considerably decrease quality of life. Here, we investigated whether health-related quality of life (HRQoL) influences the need for surgery in patients with RCD.

Introduction. The pathogenesis of rotator cuff disease (RCD) is complex and not fully understood. This systematic review set out to summarise the histological and molecular changes that occur throughout the spectrum of RCD. Methods. We conducted a systematic review of the scientific literature with specific inclusion and exclusion criteria. Results. A total of 101 studies met the inclusion criteria: 92 studies used human subjects exclusively, seven used animal overuse models, and the remaining two studies involved both humans and an animal overuse model. A total of 58 studies analysed supraspinatus tendon exclusively, 16 analysed subacromial bursal tissue exclusively, while the other studies analysed other tissue or varying combinations of tissue types including joint fluid and muscle. The molecular biomarkers that were altered in RCD included matrix substances, growth factors, enzymes and other proteins including certain neuropeptides. Conclusions. The pathogenesis of RCD is being slowly unravelled as a result of the significant recent advances in molecular medicine. Future research aimed at further unlocking these key molecular processes will be pivotal in developing new surgical interventions both in terms of the diagnosis and treatment of RCD

Rotator cuff injuries represent a significant burden to the health care system, affecting more than 30% of the population over the age of sixty. Despite the advanced surgical techniques that are available, poor results are sometimes seen in a subset of patients receiving surgical treatment for their rotator cuff disease. The reasons for this failure of treatment remain unclear, particularly if the surgery was ‘technically’ successful. An increasing body of evidence has demonstrated a strong correlation between pre-operative psychological factors and functional outcome following several orthopaedic procedures. This association, however, has not been fully demonstrated or effectively investigated in the context of rotator cuff treatment. The main objective for this study was to conduct a systematic review to determine the impact of psychosocial factors on the outcome of treatment in patients with rotator cuff disease. A systematic search was conducted of Medline, CINAHL, and PsychInfo databases for articles published from database inception until September 2018. The titles and abstracts were screened for all of the studies obtained from the initial search. Inclusion and exclusion criteria were applied, and a full text review was conducted on those studies meeting the eligibility criteria. A total of 1252 studies were identified. Following removal of duplicates and application of the inclusion and exclusion criteria, 46 studies underwent a full-text review. Ten studies were included in the final analysis. A total of 1,206 patients, with a mean follow-up of 13 months, were included. Three studies examined patient expectations prior to treatment. All three found that higher expectations prior to treatment led to a significantly improved outcome following both operative and non-operative treatment. Three studies assessed the association between pre-operative general psychological measures and post-operative pain and function. All three studies found patients with worse pre-operative general psychological scores demonstrated increased post-operative pain. Two of the studies also found a negative association with post-operative function, while one of the studies found no association with post-operative function. Three studies assessed the impact of pre-operative anxiety and depression on outcomes following surgical treatment of rotator cuff disease. Only one of the studies found a negative association with post-operative pain and function. The remaining two studies found no association between anxiety or depression and any outcomes following surgery. Finally, one study examined the impact of general distress on outcomes following the surgical treatment of rotator cuff disease and found no association with post-operative levels of pain or function. The results of this systematic review indicate that there is somewhat conflicting and contradictory evidence within the literature. Overall, however, there does appear to be an association between pre-operative psychological factors and post-operative function and pain, in that higher levels of pre-operative psychological dysfunction are predictive of poorer function and increased pain following the treatment of rotator cuff disease

Abstract. Background. Fractures Proximal humerus account for nearly 10 % of geriatric fractures. The treatment options varies. There is no consensus regarding the optimal treatment, with almost all modalities giving functionally poor outcomes. Hence literature recommends conservative management over surgical options. MULTILOC nail with its design seems to be a promising tool in treating these fractures. We hereby report our early experience in the treatment of 37 elderly patients. Objectives. To evaluate the radiological outcome with regards to union, collapse, screw back out/cut through, implant failures, Greater tuberosity migration. To evaluate the functional outcome at the end of 6 months using Constant score. Study Design & Methods. All patients aged >65 years who underwent surgery for 3,4-part fracture proximal humerus using the MULTILOC nail were included in the study after consent. Pre – existing rotator cuff disease were excluded. Within the time frame, a total of 39 patients underwent the said surgery. 2 patients were lost to follow up. All the measurements were taken at the end of 6 months and results tabulated and analysed. Results. Union was achieved in all the 37 patients. There were no varus collapse or screw backout/cut through seen in any of the patients. There was Greater tuberosity migration in 1 patient who underwent revision surgery at 6 weeks. All the patients got a minimum of 70 degrees of abduction and forward flexion. We had 29 excellent, 6 good, 2 fair and none poor results as per Constant scoring system. Study done in Tejasvini Hospital & SSIOT Mangaluru India

Magnetic resonance imaging (MRI) is the gold standard for the diagnosis of the pathologies affecting the glenohumeral joint and the rotator cuff diseases. MRI allows to highlight anatomic discontinuities of both muscles and tendons. However, MRI diagnostic accuracy has not proven to be highly sensitive in distinguishing between a partial-thickness tear and a full-thickness rotator cuff tear. The purpose of this study was to determine if MRI under axial traction can be helpful in increasing MRI sensitivity to identify partial-thickness rotator cuff tears. The study included 10 patients (4 males and 6 females) who had clinical examination and MRI suggesting a partial-thickness rotator cuff tear. They were candidates for shoulder arthroscopy because of persistent symptoms after at least three months of conservative treatment. The patients underwent a new MRI (under axial traction: MRI-AT) with a 4-kg weight applied to the affected arm. Then the patients underwent arthroscopy to confirm the diagnosis. Patients with a suspected full-thickness rotator cuff tear were excluded from the study. Patients’ average age was 52.4 years, and the dominant side was affected in 77.7% of the cases. Preoperative Constant-Murley Score was 57. MRI-AT showed that 3 patients were affected by a complete tear of the rotator cuff, 3 patients by a partial-thickness rotator cuff tear and 4 patients had no lesion. The analysis of data showed that: under axial traction the subacromial space increased by 0,2 mm (P value = 0,001075), the superior glenohumeral space decreased by 2.4 mm (P value = 0,07414), the inferior glenohumeral space increased by 0.3 mm (P value = 0,02942), the acromial angle decreased by 1.9° (P value = 0,0002104) and the acromion-glenohumeral angle decreased by 0.3° (P-value = 0,01974). Two experienced evaluators analyzed previous standard MRI and MRI-AT scans in a double-blinded fashion, with inter-rater evaluation of all the images and measures. Intraclass correlation coefficient (ICC) has been utilized to assess the reliability of the measures performed by different operators. ICC always resulted in more than 0.7, showing a high concordance among values in the same group. A comparative evaluation between standard MRI and MRI-AT has been conducted to highlight possible discrepancies and this has been compared to intraoperative findings. Concordance of the values was 89% between standard MRI and MRI-AT and 100% between MRI under axial traction and intraoperative findings. This study showed a high correlation between the diagnosis achieved with MRI-AT and the intraoperative arthroscopic findings. The use of MRI-AT in clinical practice may improve the diagnostic sensitivity of this method to detect a partial-thickness rotator cuff tear

Aims: The purpose of this study is to examine the relationship between synovitis and shoulder pain in rotator cuff disease. Methods: Thirty-nine patients with rotator cuff disease were candidates. Subacromial synovium around the greater tuberosity and glnohu-meral synovium around the rotator interval were harvested for specimens during operation. The expression levels of inflammatory cytokine mRNA of interleukin-1β and its naturally occurring antagonists (secreted and intracellular interleukin-1 receptor antagonists) were measured by reverse transcription plolymerase chain reaction (RT-PCR). The cytokine-mRNAs producing cells were identified by RT- in situPCR. For control specimens, subacromial bursae were obtained from 10 patients with anterior instability of the shoulder that exhibited no signs of subacromial impingement. All specimens were obtained with patient’s informed consent. The level of shoulder pain was evaluated in each patients before the operation with a visual analogue scale: 0 as no pain, 5 as moderate, and 10 as severe. Results:The expression levels of the cytokine-mRNAs in the subacromial bursa well correlated to the level of shoulder pain, but not those in the glenohumeral joint. A variety of the cells (synovial and inflamatory cells) produced the cytokines at the protein and gene level in both subacromial and glenohuemeral synovium. Conclusions: Subacromial bursa is the site associated the shoulder pain caused by rotator cuff disease, and targeting the subacromial bursa for treatment leads to successful pain relief in patients with the disease

Synovitis in the subacromial bursa (SAB) and the gle-nohumeral joint (GHJ) is often seen in rotator cuff diseases. In order to clarify its significance, following studies were conducted. The mRNA expression levels of IL-1B, sIL-1ra and icIL-1ra and the amount of substance P in the SAB synovium were correlated with the degree of shoulder pain. The cytokine-mRNAs in the GHJ synovium expressed more significantly in full-thickness tears (perforating tears) than in non-perforating tears. Biochemical markers (MMP-1, MMP-3) in the GHJ fluid were significantly higher in massive cuff tears than in smaller tears. These findings suggest the possibility that SAB and GHJ synovitis in rotator cuff diseases are associated with shoulder pain and the development of glenohumeral arthropathy, respectively

Purpose. Chemokines produced by synoviocytes of the subacromial bursa are up-regulated in subacromial inflammation (bursitis) and rotator cuff disease. SDF-1a is an important chemotactic factor in the subacromial bursa that stimulates recruitment of inflammatory cells; however, its mechanism of induction and regulation in the subacromial bursa is unknown. We hypothesised that SDF-1a production in bursal synoviocytes may be induced by local cytokines such as interleukin IL-1β and IL-6. Methods. Subacromial bursa specimens were obtained following an institutional review board-approved protocol from patients undergoing shoulder surgery. Bursal specimens were stained with anti-human antibodies to IL-1, IL-6 and SDF-1a by immunohistochemistry and compared to normal and rheumatoid controls. Bursal cells were also isolated from specimens and cultured. Cultured cells were labelled with fluorescent probes and analysed by flow cytometry to determine cell lineage. Early-passaged cells were then treated with cytokines IL-1β and IL-6 and SDF-1a production and expression were measured by ELISA and RT-PCR. Results. SDF-1a, IL-1β and IL-6 were expressed at high levels in bursitis specimens from human subacromial bursa compared to normal controls. In bursal synoviocytes, there was a dose-dependent increase in SDF-1a production in the supernatants of cells treated with IL-1β. SDF-1a mRNA expression was also increased in bursal cells treated with IL-1β, with stimulation occurring at 6 hours and increasing to five-fold stimulation by 48 hours. IL-6 caused a minimal but not statistically significant increase in SDF-1a expression. Conclusion. SDF-1a, IL-1β, and IL-6 are expressed in the inflamed human subacromial bursal tissues in patients with subacromial bursitis. In cultured bursal synoviocytes, SDF-1a production is stimulated by IL-1β. These cytokines may stimulate or potentiate the inflammatory response that occurs in subacromial bursitis and rotator cuff disease, and may provide a potential new target mechanism for inhibition of this common clinical problem

The purpose of this diagnostic, cross-sectional study, was to determine the predictive value of clinical examination versus ultrasonographic evaluation in rheumatoid arthritis patients, suspected of having rotator cuff disease. The left and right shoulders of fifty consecutive patients from the rheumatoid clinic were subjected to clinical examination by a senior registrar in the department. Impingement was evaluated using the Neer, Hawkins and posterior impingement tests. The supra-spinatus tendon insertion (Jobe test), infraspinatusteres minor tendon insertions (resisted external rotation) and subscapularis tendon insertion (Gerber lift-off and push-off tests) into the rotator cuff were evaluated for a possible tear. A Professional Sport Sonographer, located in a separate examination room then performed an ultrasonographic evaluation on all of the patients. The clinical results were compared to the ultrasound results, hoping to find a method that will improve our current screening of rheumatoid patients for rotator cuff disease and planning of possible surgical treatment. A significant difference was found between the clinical and sonographic evaluation of the rotator cuffs. Impingement tests showed a false positive result of 85–89%, while the tests for cuff tears had a false negative value of 87–91% compared to ultrasound evaluation. A total disagreement of 45.8–60% and total agreement of 39.5–54.1% could be explained by the fact the synovitis is the hallmark of rheumatoid disease, which could cause pain without tears or impingement. The authors conclude that clinical examination of the rotator cuff in patients with rheumatoid disease is unreliable, and that ultrasound examination should form a routine part of the evaluation of all rheumatoid shoulders

Rotator cuff disease encompasses a spectrum from partial to full thickness tears. Despite being 2–3 times more common than full–thickness tears, effective non-operative treatment for partial thickness tears has remained elusive. Platelet enriched plasma (PRP) has been proposed to enhance rotator cuff healing by enhancing the natural healing cascade. However, its utility in rotator cuff disease remains controversial. The purpose of this study was to compare the patient reported outcomes between PRP and corticosteroid injection in patients with symptomatic partial thickness tears. This double blind randomized controlled trial enrolled patients with symptomatic, partial thickness rotator cuff tears or rotator cuff tendinopathy proven on ultrasound or MRI. Patients were randomized to either corticosteroid or PRP ultrasound-guided injection of the affected shoulder. Patients completed patient reported outcomes at 6 weeks and 12 weeks. The primary outcome was Visual Analog Scale (VAS) pain scores. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) index, American Shoulder and Elbow Surgeons (ASES) score, and failure of non-operative management as determined by consent for surgery or progression to operative intervention. Ninety-nine patients were enrolled in the study with equal demographics between the two groups. Taking into account pre-injection scores, patients with PRP injections demonstrated a statistically significant improvement in VAS scores compared to patients receiving corticosteroid injections at 12 weeks (p=0.045) but not at 6 weeks (p=0.704). There was no difference in other outcome measures or progression of the two groups to surgical intervention. The use of PRP in the management of partial thickness rotator cuff tears demonstrates significant improvement of pain scores at 12 week follow up compared to corticosteroid injections. However, this did not affect the rate of progression to surgical intervention. Continued study is required to determine the utility of PRP in this patient population

Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. Standardized response means were used to determine responsiveness. The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). These results suggest that the DASH may be preferable to either a disease specific scale or a shoulder scale for detecting clinical progress following cuff repair. A number of self-report scales exist for shoulder problems, including regional, joint-specific and disease specific scales. Determining the most responsive scale is essential for outcome evaluation and clinical trials. Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. An independent research assistant administered scales. Standardized response means were used to determine responsiveness. The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). The subscale of the WORC that showed the most change was lifestyle. Physical subscales of the SF-36 showed improvement; whereas, minimal impact on mental health was observed. The DASH can be used for a variety of upper extremity conditions, whereas the WORC was designed specifically for rotator cuff disease. Unless a disease specific scale is more responsive, there is little reason to adopt a scale than can only be used for one condition. This data supports the ability of the DASH to indicate upper extremity function and the important role of the rotator cuff in function. The implications of these findings are that the DASH may be preferable to either a disease specific scale for rotator cuff disease or a shoulder scale for detecting clinical progress

Aim: We investigated the accuracy of clinical signs for the diagnosis of rotator cuff disease. Methods: Fifty patients with history of rotator cuff disease (subacromial impingement syndrome or rotator cuff tear) were examined by two observers to determine the accuracy of clinical tests for the condition. The observers were a consultant (cons.) with an established shoulder practice and a senior registrar (reg.) with an interest in shoulder surgery. The clinical signs evaluated include the painful arc, the drop arm test, Neer’s sign and Hawkins’ sign. For rotator cuff pathology we evaluated the strength of abduction initiation and at 90 degrees abduction for supraspinatus, Speed’s and Yergason’s tests for biceps, strength of shoulder external rotation for infraspinatus and the Gerber lift-off test for subscapularis. We compared our clinical accuracy against a positive subacromial injection test for impingement syndrome, and the findings of rotator cuff tears at arthroscopy. Results: The consultant and the registrar did not differ significantly in their assessments (paired t-test, p> 0.05). The highly sensitive tests have poor specificity. The most sensitive tests for impingement syndrome were the Hawkins’ sign (cons: 100%, reg: 97%) and the Neer’s sign (cons: 94%, reg: 81%). The Hawkins’ sign also had high negative and positive predictive values. The painful arc and the drop arm tests both had low sensitivity and specificity. Testing the supraspinatus strength at 90 degrees abduction was more sensitive for full thickness cuff tear than testing strength of abduction initiation (cons: 100% vs 67%; reg: 90% vs 50%). These tests were poor at differentiating partial thickness tears from full thickness tears. Conclusion: The Neer’s and Hawkins’ signs were the most sensitive for impingement syndrome. Testing the supraspinatus at 90 degrees abduction was more sensitive than abduction initiation for full thickness supraspinatus tear

We investigated the accuracy of clinical signs for the diagnosis of rotator cuff disease. Fifty patients with history suggestive of rotator cuff disease (subacromial impingement syndrome or rotator cuff tear) were examined by two observers to determine the accuracy of commonly used clinical tests for the condition. The observers were a consultant (cons.) with an established shoulder practice and a senior registrar (reg.) with an interest in shoulder surgery. The clinical signs of impingement syndrome we evaluated include the painful arc, the drop arm test, Neer’s sign and Hawkins’ sign. For rotator cuff pathology we evaluated the strength of abduction initiation and at 90 degrees abduction for supraspinatus, Speed’s and Yergason’s tests for biceps, strength of shoulder external rotation for infraspinatus and the Gerber lift-off test for subscapularis. We compared our clinical accuracy against a positive subacromial injection test for impingement syndrome, and the findings of rotator cuff tears at arthroscopy. The consultant and the registrar did not differ significantly in their assessments (paired t-test, p> 0.05). The highly sensitive tests have poor specificity. The most sensitive tests for impingement syndrome were the Hawkins’ sign (cons:100%, reg: 97%) and the Neer’s sign (cons: 94%, reg: 81%). The Hawkins’ sign also had high negative and positive predictive values. The painful arc and the drop arm tests both had low sensitivity and specificity. Testing the supraspinatus strength at 90 degrees abduction was more sensitive for full thickness cuff tear than testing strength of abduction initiation (cons: 100% vs 67%; reg: 90% vs 50%). These tests were poor at differentiating partial thickness tears from full thickness tears. Our findings echoed the conclusions of other papers in that the Neer’s and Hawkins’ signs are the most sensitive for impingement syndrome. Testing the supraspinatus at 90 degrees abduction was more sensitive than abduction initiation for full thickness supraspinatus tear

Introduction. Glenoid inclination, defined as the angle formed by the intersection of a line made of the most superior and inferior points of the glenoid and a line formed by the supraspinatus fossa, has been postulated to impact the mechanical advantage of the rotator cuff in shoulder abduction. An increase in glenoid inclination has previously been reported in patients with massive rotator cuff tears and multiple studies have correlated rotator cuff tears to an increase of the critical shoulder angle, an angle comprised of both the glenoid inclination and acromical index. Glenoid inclination is best measured by the B-angle as it has been shown to be both an accurate and reliable. The purpose of this study was to determine the correlation of glenoid inclination and the presence of degenerative rotator cuff tears. Methods. Data was prospectively collected for study patients assigned to one of two groups. The tear group consisted of patients with degenerative, atraumatic rotator cuff tears, confirmed by MRI and the control group consisted of healthy volunteers without shoulder pain. Inclusion criteria for both groups included age 45 or older. Exclusion criteria included history of previous shoulder surgery, previous patient-recalled injury to the shoulder, presence of glenoid weak, and previous humerus or glenoid fracture. Patients were also excluded from the control group if any shoulder pain or history of rotator cuff disease was present. All patients had standard anterior/posterior shoulder radiographs taken and glenoid inclination was digitally measured with Viztek OpalRad PACS software (Konica Minolta, Tokyo, Japan). The beta angle was measured to determine the glenoid inclincation. Statistical analysis was performed using SPSS version 23 (IBM, Aramonk, NY). Patient age and glenoid inclination were examined with the Shapiro-Wilk test of normality and then compared with student t tests. Gender distribution was compared with chi square test. A p-value of 0.05 was used to represent significance. Results. The study included 26 patients in the tear group and 23 patients in the control group. There was no difference in the age of the two groups (57 vs 54, p=0.292) or gender distribution (p=0.774). The average glenoid inclination was 11.18 (SD=2.67) degrees for the tear group and 5.97 (SD=2.55) degrees for the control group. This difference was statistically significant (p<0.001). Discussion. Glenoid inclination is significantly increased in patients with degenerative rotator cuff tears compared to healthy controls. Tendon overload secondary to increased glenoid inclination may be the primary anatomical factor contributing to the development of degenerative rotator cuff tears

Increasingly often diagnosed by sophisticated investigation, rotator cuff disease may be treated conservatively or surgically. Surgical options are decompression alone, decompression and debridement, partial rotator cuff repair, full reconstruction, tendon transfer and prosthetic replacement. Emphasising the quality of the repair rather than the classification of the injury, this paper details the criteria used in reaching a decision about the type of surgical treatment. Clinical, radiological, ultrasonographic and arthroscopic findings are used. The prognosis is directly related to the repair

Introduction: Diagnosis of rotator cuff tears by clinical examination and MRI is not always accurate. If the extent of the tear could be predicted pre-operatively, both the patient and the surgeon would be better equipped for the subsequent operation and rehabilitation. Aim: To assess the accuracy of clinical examination and MRI in detecting the presence of rotator cuff tears. Method and Results: Retrospective analysis of 86 patients with symptoms and signs of rotator cuff disease. All underwent clinical examination of the shoulder followed by an MRI scan. The diagnosis was confirmed intra-operatively. Sensitivity of clinical examination for all tears was 69%, with a specificity of 64% and a positive predictive value of 80%. Individual sensitivities were as follows: grade I 50%, II 76%, III 100%. MRI had a sensitivity of 82.8% for all tears, specificity of 57% and a positive predictive value of 80%. Individual sensitivities: I 69%, II 90%, III 100%. Conclusion: In some patients clinical examination remains uncertain, MRI is helpful but the diagnosis is not always reliable

Introduction. In patients with shoulder pain one of the important initial determinations is to assess the integrity of the rotator cuff. Clinical examination is often inconclusive. Compared with MRI and arthrography, ultrasound allows dynamic evaluation, is non-invasive, less expensive, less time-consuming and more acceptable to patients. The aim of the present study was to evaluate the accuracy of high resolution shoulder ultrasonography compared with arthroscopy in a series of consecutive patients with clinically suspected rotator cuff disease. Materials and methods. 100 shoulders in 99 consecutive patients with shoulder pain who had undergone standardised pre-operative ultrasonography and subsequent arthroscopy between May 2004 and March 2006 were included in the study. There were 53 males and 46 females with a mean age of 59 years. The mean time interval between the ultrasonographic and the arthroscopic examinations was 227 days. For full thickness tears ultrasonography showed a sensitivity of 100%, specificity 83%, positive predictive value 80%, negative predictive value 100% and accuracy 90%. Ultrasonography showed a sensitivity of 83% in detecting partial thickness tears, specificity 94%, positive predictive value 86%, negative predictive value 93% and accuracy 91%. Discussion. The use of high resolution shoulder ultrasonography to diagnose rotator cuff tears has achieved only limited acceptance by orthopaedic surgeons. Refinements in scanning technique, modern equipment with improved resolution capabilities and clarification of criteria for diagnosing rotator cuff tears have improved the accuracy of shoulder ultrasonography. Conclusion. In our experience ultrasonography is found to be a highly accurate technique for detecting rotator cuff tears. However the success of an ultrasonographic examination is heavily dependent on the experience of the operator

Ultrasonography for rotator cuff disease is a cheap and non-invasive investigation. Our study investigates the tendon specific pathologies leading to misinterpretation of ultrasound findings and their implication for the surgical management. On hundred and five consecutive patients who had an ultrasound scan by a single musculoskeletal radiologist and then underwent shoulder arthroscopy by a single shoulder surgeon for rotator cuff pathologies were included. Surpraspinatus Tendon (SST): There was a sensitivity of 90%. The relatively low positive predictive value (76%) and specificity (42.5%) were influenced by a high number of false positives. This was a mixed group of 23 cases, in which ultrasonography had described either a full-thickness (FTT) or partial-thickness (PTT) tear when arthroscopy did not show any evidence for a cuff tear. Seven of these cases were described as FTT with dimensions less than 1 cm and in ten cases the radiologist described a “possible sub-centimetre tear”. Subscapularis Tendon (SSC): There was a specificity of 100%. The poor negative predictive value (78%) and sensitivity (26%) were caused by a high number of false negatives. Further analysis of the 20 “false negative” patients showed four FTT and sixteen PTT. All partial thickness tears involved the superior fibres of the subscapularis tendon. Our results confirm that USG is a reliable investigation in larger full thickness tears, particularly of the superior rotator cuff (SST). The reliability is significantly reduced in sub-centimetre tears and partial thickness tears, particularly of the subscapularis tendon. Associated tendon pathologies like intra-tendinous calcifications and intra-substance tears make an accurate diagnosis even more difficult and add to the tendency to ‘over-diagnose’ tears of the rotator cuff with use of ultrasonography. The shoulder surgeon should be aware of the potential misinterpretation of ultrasonography findings and be prepared to adjust the surgical procedure accordingly

Rotator cuff or long head of biceps tendon tears are common in patients with degenerative shoulder rotator cuff disease. Most often they are investigated with an MRI scan. Diagnosis prior to surgery is useful for the appropriate surgical planning. We present 63 consecutive patients who had arthroscopic shoulder surgery and prior to that had MRI investigation between 1994 and 2001. Their medical records were reviewed; arthroscopic operative findings as well as the report of the MRI scan were recorded and compared retrospectively. The aim of our study was to assess the accuracy of MRI findings comparing the arthroscopic ones regarding rotator cuff and biceps tendon pathology. There were 63 patients with mean age 58 years. All of these had MRI scan investigation and the waiting time prior to surgery was 10 months. It was found that there were 6 false (−)ve, 1 false (+)ve and two cases with full thickness cuff tears which were reported as probable tears. Further to that, there were 11 frayed biceps tendons, 8 partially ruptured, 3 subluxed, 4 complete ruptures and 1 SLAP lesion. All biceps lesions were not commented in the MRI scan reports. MRI scan is very sensitive detecting soft tissue pathology in shoulder investigation. However, even on that basis, rotator cuff and in particular biceps tendon pathology can be missed. The shoulder arthroscopy is the best method to accurately diagnose those lesions. However, it should be noted that often the surgeon has got to alter to working surgical plan in order to address the problem intraoperatively. In this study it is demonstrated the MRI scan often misses rotator cuff or long head of biceps tendon pathology. The most sensitive method for the diagnosis of it is the shoulder arthroscopy, which address its treatment in the same time

There is an association between SLAP lesions and laxity of the shoulder. The relationship between rotator cuff disease and hypermobility has also been implied. The purpose of this case-control study was to assess the impact of rotator cuff and superior labral pathologies on degree of glenohumeral translation and range of motion of the shoulder in comparison with individuals with normal shoulders. This study involved individuals with asymptomatic shoulders (control group), and individuals with Rotator Cuff (RC) and Superior Labral Anterior and Posterior (SLAP) pathologies who underwent a repair. Subjects were matched by age, gender and hand dominance side. To assess laxity, all subjects including the control group were examined under anesthesia. The degree of humeral head translation was recorded in three (anterior, posterior and inferior) directions. Range of motion was documented in five directions. Forty-six females and forty-four males with RC pathology and twenty-seven men with SLAP pathology were compared with the age and gender matched control group. The number of women with SLAP pathology was not sufficient for analysis. Rotator cuff pathology reduced range of motion of the affected side in all directions including flexion, elevation in scapular plane, internal rotation at ninety degrees of abduction and external rotation at zero and ninety degrees of abduction (p=0.02 to p< 0.001) as compared to normal population. Men with SLAP pathology had reduced range of motion in all directions (p< 0.001) except external rotation at ninety degrees of abduction. There were no statistically significant differences in glenohumeral glides between the normal group and SLAP group. However, the affected side of the patients with RC pathology had less laxity than normal population in anterior and posterior directions. Presence of rotator cuff and superior labral pathologies affect biomechanics and consequently range of motion and accessory movements of the glenohumeral joint. We were unable to confirm a positive relationship between laxity and SLAP and RC pathologies. Prolonged disuse of the shoulder in these pathologies might have played a role in our findings