Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the
Aims. Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable
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
The aim of our biomechanical study was to find out whether the prosthetic design, especially of the metaphyseal part, and the type of tuberosity fixation influences the primary stability in shoulder arthroplasty. Materials and Methods: 16 fresh frozen human cadaveric humeri were dissected until only the rotator cuff remained. A four-part fracture was simulated by osteotomy. In a first step two types of shoulder prosthesis (open stem versus closed stem) were used. The Tornier Aequalis prosthesis (open stem) using suture fixation and the Mathys Affinis fracture prosthesis (closed stem) using cable fixation were implanted according to standard techniques. The specimens were then loaded into a servo-pneumatic testing device in 25° of abduction. In 20 consecutive cycles traction of 40 Newton was alternating exerted on the
Introduction: We have devised a new technique of lesser tuberosity osteotomy with double row fixation of the subscapularis using suture anchors. Aim: To evaluate the biomechanical properties of this novel technique against two established methods of
The benefit of open stabilization for recurrent shoulder instability is well known, however there have been recent reports of postoperative dysfunction of the
Two dimensional ultrasound of the shoulder joint has become a well established diagnostic tool. Difficult interpretation of ultrasonographic findings, however, suggests that ultrasound appears not to be an always reliable method, especially in partial thickness tears. The present study was performed to determine whether the use of three dimensional (3D) sonography further increases the diagnostic yield of ultrasound. On a total of 22 externally intact appearing rotator cuffs of cadaveric shoulder joints 7 full thickness and 15 partial thickness incisions were carried out on the M. supraspinatus,
Internal rotation contracture/tightness presents a functional problem for the patient and a technical challenge for the surgeon performing total shoulder arthroplasty most commonly occurring in cases of osteoarthritis. Internal rotation contractures result from a number of physiologic and biomechanical conditions. Osteophytes, which form around the head and neck of the humerus and glenoid provide a mechanical block to external rotation, which occurs over time. The inability to pass through a full excursion of external rotation tightens the anterior capsular structures over time and causes a contracture of the musculotendinous units (subscapularis and pectoralis major), responsible for internal rotation. The osteophytes themselves also change the vector of pull of the internal rotators and cause them to be “tented” anteriorly. Hence the issues causing an internal rotation contracture and inhibiting external rotation following total shoulder arthroplasty include a mechanical bone block, diminished tissue compliance and abnormal tendon excursion. Management of this problem has frequently been focused predominantly on fractional lengthening the
Introduction: Latarjete operation for anterior shoulder instability, first described by Latarjete in 1954 consists of transfer of the coracoid process through the sub-scapularis tendon to the neck of the scapula. Many modifications were described in the English literature as described by Mc Murray in 1958, by Bonin in 1969 or May in 1970. In 1985, Braly and Tullos emphasized that the Bankart lesion, when present, should be corrected. Rockwood transplants the entire coracoid process onto the neck by “laying it flat” onto the neck of the scapula using two screws instead of one, which gives a larger base for the coracoid transplant. The disadvantages of this procedure, as described in the English literature, are relative shortening of the sub-scapularis tendon, thereby decreasing internal rotation power, limited external rotation and the possibility to damage the musculocutaneous nerve. Purpose of the Study: To demonstrate that transplantation of the coracoid process with its tendon attachments through a split in the
The December 2023 Shoulder & Elbow Roundup360 looks at: Clavicle fractures: is the evidence changing practice?; Humeral shaft fractures, and another meta-analysis…let’s wait for the trials now!; Hemiarthroplasty or total elbow arthroplasty for distal humeral fractures…what does the registry say?; What to do with a first-time shoulder dislocation?; Deprivation indices and minimal clinically important difference for patient-reported outcomes after arthroscopic rotator cuff repair; Prospective randomized clinical trial of arthroscopic repair versus debridement for partial subscapularis tears; Long-term follow-up following closed reduction and early movement for simple dislocation of the elbow; Sternoclavicular joint reconstruction for traumatic acute and chronic anterior and posterior instability.
Excessive apoptosis has been found in torn supraspinatus tendon1 and mechanically loaded tendon cells2. Following oxidative and other forms of stress, one family of proteins that is often unregulated are Heat Shock Proteins (HSPs). The purpose of this study was to determine if HSPs were unregulated in human and rat models of tendinopathy and to determine if this was associated with increased expression of regulators of apoptosis (cFLIP, Caspases 3&
8). A running rat supraspinatus tendinopathy overuse model 3 was used with custom microarrays consisting of 5760 rat oligonucleotides in duplicate. Seventeen torn supraspinatus
Purpose: The purpose of this study was to assess long-term functional outcome after arthroscopic acromioplasty for full-thickness rotator cuff tears, to evaluate the efficacy of complementary procedures (biceps tenotomy, extended acromioclavicular resection), and to examine the course of anatomic lesions. Material and methods: From 1988 to 1994, 141 full-thickness rotator cuff tears were treated by arthroscopic acromioplasty. Ninety-eight patients, mean age 60 years, were reviewed clinically, radiographically, and sonographically at more than eight years. The mean preoperative Constant score was 48.5 points. The tear involved the supraspinatus in 18 cases, the supraspinatus and infraspinatus in 40, the supraspinatus and the subscapularis in ten, and all three tendons in 20. Coronal extension showed a distal tear in four, an intermediate tear in 52, and a retracted stump in 32. Systemic acromioplasty was associated in 36 patients with tenotomy of the long head of the brachial biceps and in 44 with acromioclavicular extension. Results: At mean follow-up of 10.7 years (8–13.5), the mean Constant score was 60 points. The clinical outcome was excellent or good in 39.7%, fair in 45.5%, and poor in 14.8. 62.5% of the patients were satisfied or very satisfied. The height of the subacromial space was 5.19 mm at last follow-up compared with 4.3 mm preoperatively. The antalgesic effect of biceps tenotomy was significant when the initial acromiohumeral space was less than 5 mm. This procedure did not produce any significant change in the subacromial height or development of osteoarthritis at last follow-up. Sonography showed stability of the size of the tear in 83.8% of the cases. The results were significantly less satisfactory when the initial tear involved the
Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant–Murley score (CS) two years after repair.Aims
Patients and Methods
This pilot study reports the clinical outcomes
of a combination of partial
This study reports the clinical and sonographic
outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years
and aimed to determine factors associated with re-tear. A total
of 69 consecutive repairs were performed in 68 patients with a mean
age of 77 years (70 to 86). Constant-Murley scores were collected
pre-operatively and at one year post-operatively. The integrity
of the repair was assessed using ultrasound. Re-tear was detected
in 20 of 62 patients (32%) assessed with ultrasound. Age at operation We conclude that arthroscopic rotator cuff repair in patients
aged ≥ 70 years is a successful procedure. The gender and age of
the patient are important factors to consider when planning management. Cite this article:
An internal rotation contracture is a common complication of obstetric brachial plexus palsy. We describe the operative treatment of seven children with a recurrent internal rotation contracture of the shoulder following earlier corrective surgery which included subscapularis slide and latissimus dorsi transfer. We performed z-lengthening of the
We have examined the accuracy of 143 consecutive ultrasound scans of patients who subsequently underwent shoulder arthroscopy for rotator-cuff disease. All the scans and subsequent surgery were performed by an orthopaedic surgeon using a portable ultrasound scanner in a one-stop clinic. There were 78 full thickness tears which we confirmed by surgery or MRI. Three moderate-size tears were assessed as partial-thickness at ultrasound scan (false negative) giving a sensitivity of 96.2%. One partially torn and two intact cuffs were over-diagnosed as small full-thickness tears by ultrasound scan (false positive) giving a specificity of 95.4%. This gave a positive predictive value of 96.2% and a negative predictive value of 95.4%. Estimation of tear size was more accurate for large and massive tears at 96.5% than for moderate (88.8%) and small tears (91.6%). These results are equivalent to those obtained by several studies undertaken by experienced radiologists. We conclude that ultrasound imaging of the shoulder performed by a sufficiently-trained orthopaedic surgeon is a reliable time-saving practice to identify rotator-cuff integrity.
We undertook clinical and ultrasonographic examination of the shoulders of 420 asymptomatic volunteers aged between 50 and 79 years. MRI was performed in selected cases. Full-thickness tears of the rotator cuff were detected in 32 subjects (7.6%). The prevalence increased with age as follows: 50 to 59 years, 2.1%; 60 to 69 years, 5.7%; and 70 to 79 years, 15%. The mean size of the tear was less than 3 cm and tear localisation was limited to the supraspinatus tendon in most cases (78%). The strength of flexion was reduced significantly in the group with tears (p = 0.01). Asymptomatic tears of the rotator cuff should be regarded as part of the normal ageing process in the elderly but may be less common than hitherto believed.
The indications for reverse shoulder arthroplasty
(RSA) continue to be expanded. Associated impairment of the deltoid
muscle has been considered a contraindication to its use, as function
of the RSA depends on the deltoid and impairment of the deltoid
may increase the risk of dislocation. The aim of this retrospective
study was to determine the functional outcome and risk of dislocation
following the use of an RSA in patients with impaired deltoid function.
Between 1999 and 2010, 49 patients (49 shoulders) with impairment
of the deltoid underwent RSA and were reviewed at a mean of 38 months
(12 to 142) post-operatively. There were nine post-operative complications (18%),
including two dislocations. The mean forward elevation improved
from 50° ( These results suggest that pre-operative deltoid impairment,
in certain circumstances, is not an absolute contraindication to
RSA. This form of treatment can yield reliable improvement in function
without excessive risk of post-operative dislocation. Cite this article:
We compared the long-term function of subscapularis after the Latarjet procedure using two surgical approaches. We treated 102 patients (106 shoulders) with a mean age of 26.8 years (15 to 51) with involuntary unidirectional recurrent instability. The operation was carried out through an L-shaped incision with trans-section of the upper two-thirds of the muscle in 69 cases and with a subscapularis split in 37. All clinical results were assessed by the Rowe and the Duplay scores and the function of subscapularis by evaluating the distance and strength at the lift-off position. Bilateral CT was performed in 77 patients for assessment of fatty degeneration. The mean follow-up was 7.5 years (2 to 15) and 18% of cases were lost to follow-up. The mean Duplay score was 82 of 100 for the L-shaped incision group and 90 of 100 for those with a subscapularis split (p = 0.02). The mean fatty degeneration score was 1.18 after an L-shaped incision compared with 0.12 after subscapularis split (p = 0.001). The subscapularis split approach is therefore recommended.