Interstitial
16 to 34% of the population suffer from shoulder pain, the most common cause being rotator cuff tears. NICE guidance recommends using ultrasound scan (USS) or MRI to assess these patients, but does not specify which is preferable. This study assesses the accuracy of USS and MRI in rotator cuff tears in a DGH, to establish the most appropriate imaging modality. Patients who had at least two of shoulder ultrasound, MRI or arthroscopy within a seven month period (n=55) were included in this retrospective study. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated using arthroscopy as the true result, and kappa coefficients calculated for each pairing. 59 comparisons were made in total. Sensitivity for MRI in full
Aims. Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine fusion surgery. This study aimed to assess the effect of continuous PEMF on postoperative RC healing in a rat RC repair model. Methods. A total of 30 Wistar rats underwent acute bilateral
Background: It is commonly believed that rotator cuff tears do progress in size over time. Recent reports suggest that tear progression may not be necessarily true. It was the purpose of this study to review non-operatively treated isolated
Objectives. Rotator cuff tears are among the most frequent upper extremity injuries. Current treatment strategies do not address the poor quality of the muscle and tendon following chronic rotator cuff tears. Hypoxia-inducible factor-1 alpha (HIF-1α) is a transcription factor that activates many genes that are important in skeletal muscle regeneration. HIF-1α is inhibited under normal physiological conditions by the HIF prolyl 4-hydroxylases (PHDs). In this study, we used a pharmacological PHD inhibitor, GSK1120360A, to enhance the activity of HIF-1α following the repair of a chronic cuff tear, and measured muscle fibre contractility, fibrosis, gene expression, and enthesis mechanics. Methods. Chronic
Purpose: Short-term results of surgical repair of subscapularis tears are well known. The purpose of this study was to assess long-term outcome after surgical repair of 21 full-thickness tears of the subscapularis. Material and methods: Inclusion criteria were subscapularis tear (n=21) which were isolated (n=9) or associated with a
Critical shoulder angle (CSA), lateral acromial angle (LAA), and acromion index (AI) are common radiologic parameters used to distinguish between patients with rotator cuff tears (RCT) and those with an intact rotator cuff. This study aims to assess the predictive power of these parameters in degenerative RCT. This retrospective study included data from 92 patients who were divided into two groups: the RCT group, which included 47 patients with degenerative full-thickness
Eighty-eight consecutive patients with symptomatic rotator cuff tears were entered in to a prospect study with a novel technique of open double row repair using a ‘Capstan’ screw technique. The medial row has standard anchors, but the lateral suture row is a 35mm × 6.5mm ‘Capstan' screw. This allows up to 28 suture bridges to be taken from the medial row to the lateral row compressing the footprint and spreading the load. This creates a very robust repair or ‘bulletproof repair’. This was used for medium to large isolated
Rotator cuff repair is performed to treat shoulder pain and disability. Failure of the tendon repair site is common; one strategy to improve healing is to enforce a period of post-operative immobilisation. Immobilisation may have unintended effects on tendon healing. Tenocytes under uniaxial strain form more organised collagen and up regulate expression of proliferative genes. Vitamin C (ascorbic acid), an anti-oxidant that is a co-factor for collagen synthesis, has also been reported to enhance collagen deposition and organisation. The purpose of this study was to compare human tenocyte cultures exposed to uniaxial cyclical strain with or without slow-release ascorbic acid (ascorbyl-2 phosphate) to determine their individual and combined effects on tissue remodelling and expression of tissue repair genes. Rotator cuff tissues were collected from degenerative
The assessment of the arthroscopic findings in patients suffering from impingement syndrome and partial tear of the supraspinatus tendon, staged as type 1&
2 under Ellman, Gartsman, Snyder, that were treated by acromioplasty, debridment and repair of the
Purpose of the study: Data concerning the teres minor in the context of rotator cuff tears is scarce despite the fact that this muscle plays a crucial role in the event of an infraspinaus tear. The purpose of this study was to analyse the computed tomography and magnetic resonance images of the teres minor muscle in rotator cuff tears. Material and method: The aspect of the teres minor muscle was studied in 1624 shoulders with rotator cuff tears. The axial and sagittal CT or MRI aspect was noted as normal, hypertrophic, atrophic or absent (Walch classification). We searched for correlations with the tendon torn, tear mechanism (trauma, degeneration, mixed), gender, dominance, time to imaging, age at imaging, and fatty infiltration of the supraspinatus, infraspinatus and subscapularis. Results: The teres minor was noted normal in 90.9% of the shoulder, hypertrophic in 5.2%, atrophic in 3.2% and absent in 0.2%. The type of cuff tear had a significant impact (p<
0.0005). Regarding the aspect of the teres minor muscle, the highest percentages were as follows: normal for isolated
Aim:. To assess the long term MRI pathoanatomical changes of unrepaired, isolated full thickness
Ultrasound imaging has become an essential adjunct to clinical examination when assessing a patient with suspected rotator cuff pathology. With the new high-resolution portable machines it has become feasible for the shoulder surgeon to perform the scans himself in the clinic and save a great deal of time. This study was conducted to examine the accuracy of the ultrasound scans performed by a single surgeon over a period of four years (2001-2004). The ultrasound findings were uniformly documented and collected prospectively. Out of a total of 364 scanned patients we selected 143 who ultimately received an operation and we compared the surgical findings with the ultrasound reports. The intra-operative findings included 77 full thickness
Seven patients with osteochondral defects of the humeral head were treated over a 3 year period (2002–2005). In six of the patients the diagnosis was made incidentally at time of arthroscopy with the seventh patient being diagnosed preoperatively. There were 5 males and 2 females with an average age of 48 years. Four patients had a history of trauma. The preoperative diagnosis was impingement in 5, supraspinatus partial thickness tear in one and an osteochondral defect in the seventh. Ultrasound revealed a supraspinatus partial thickness tear in one, fluid in the biceps grove in one, and was normal in the other 5. One patient had a MRI which showed a SLAP lesion. All patients had conservative treatment with subacromial injection with 2 patients having complete relief of pain, 2 having almost complete relief, and the other 4 having improvement but not complete relief of pain. Only 2 of the patients had a minor reduction in movement. At arthroscopy the osteochondral defect measured 1x 1 cm in four cases and 1 x 1,5 cm in the other 3. In all patients the osteochondral defect was debrided and the exposed bone abraded. Four patients had an acromioplasty, one had an acromioplasty and excision of the AC joint, one had a debridement only and the seventh patient had an acromioplasty, SLAP repair and debridement of a partial thickness
Ultrasound imaging has become an essential adjunct to clinical examination when assessing a patient with suspected rotator cuff pathology. With the new high-resolution portable machines it has become feasible for the shoulder surgeon to perform the scans himself in the clinic and save a great deal of time. This study was conducted to examine the accuracy of the ultrasound scans performed by a single surgeon over a period of four years. The ultrasound findings were uniformly documented and collected prospectively. Out of a total of 364 scanned patients we selected 143 who ultimately received an operation and we compared the surgical findings with the ultrasound reports. The intra-operative findings included 77 full thickness
Purpose of the study: When repairing rotator cuff tears, injury to the infraspinatus is generally a posterior extension of a
Purpose of the study: A statistical analysis of correlations between clinical outcome and anatomic results after arthroscopic repair of rotator cuff tears. Material and methods: This multicentric series of rotator cuff tears was limited to the supraspinatus and infraspinatus. The statistical analysis searched for correlations between the clinical outcome (Constant score) and anatomic results (arthroscan and arthroMRI). The series included 576 patients, mean age 57.7 years, 52%μ males and 60% manual laborers. The tear was limited to the suprapsinatus in 69% of patients, with extension to the upper third of the infraspinatus in 23.5% and all tendons in 7.5%. The
Purpose of the study: Arthroscopic repair of rotator cuff tendons is a well-described technique. Clinical outcome is good. The purpose of this work was to assess tendon healing as observed with the arthroscan after arthroscopic repair of rotator cuff tears. We search for epidemiological, anatomic, and technical factors predictive of healing. Material and methods: This was a prospective consecutive non-randomized series of 167 shoulders. All patients were assessed preoperatively with the Constant clinical score and had a standard imaging protocol for assessing the status of the rotator cuff. Arthroscopic repair was used in all cases. Outcome was assessed with the Constant score and an arthroscan was available for 148 patients. Results: Mean patient age was 59 years, 49% male and 77% dominant side. Mean duration of symptoms before repair was nine months. The tear resulted from trauma in 28% and was a work accident in 9%. The preoperative functional assessment was 52.48. An isolated
Summary. Strong mechanical fixation is critical to the success of rotator cuff repairs. In this comparative study in cadaveric shoulders, single-tendon full-thickness
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