Purpose of the study: A systematic isokinetic assessment of both shoulders was performed in 103 men with shoulder instability subsequent to several anterior or antero-inferior trauma-induced dislocations. The assessment was part of the preoperative workup which included a clinical examination and an imaging protocol (standard x-rays + tomographies as needed). The purpose of the present study was to evaluate the force of the rotator muscles of the injured shoulder and to compare the findings with those obtained for the healthy shoulder. The objective was to determine the impact of instability on muscle balance in the injured shoulder.

Material and methods: This study concerned 103 men, mean age 24.8 years. The injured shoulder was dominant for 65 and non-dominant for 38. Time from the first episode of instability and the test was at least 2 months. One operator performed all tests using a unique dynamometer: Cybex Norm operating in concentric mode at 60 to 180/s.

Results: Overall, the results for 103 subjects at 60/s did not reveal any difference between the injured and the healthy side for internal rotators. There was a 2% deficit for the external rotators. At 180/s, the deficit was 5% for the internal rotators and 3% for the external rotators. For the injured dominant shoulders (n=65 subjects): at 60/s, there was no deficit; at 180/s, the deficit was 2% for internal rotators and 1% for internal rotators. For the injured non-dominant shoulders (n=38 subjects: the deficit was less than 10% compared with the healthy side for both 60/s and 180/s.

Conclusion: No significant deficit in internal or external rotation power was observed in the injured shoulder. Inclusion of an isokinetic test as a systematic part of the preoperative work-up for post-trauma instability in male subjects would not be warranted. The present findings can be used as control data for research involving non-trauma-induced uni- or multidirectional shoulder instability.

Purpose of the study: Little is known about the clinical profile of patients aged less than 65 years who present a large or massive rotator cuff tear. We hypothesized that this clinical profile depends on the type of tear.

Material and method: This was a prospective descriptive multicentric study over a period of six months which included 112 patients aged less than 65 years, 66 men and 46 women, mean age 56.3 years (range 35–65) who had a large or massive rotator cuff tear. The Constant score and active and passive range of motion, subacromial height and fatty infiltration according to the Goutallier classification were noted. Patients were divided into four classes according to deficit in active elevation and external rotation: class A (n=55, no deficit), class B (n=19, deficient elevation alone), class C (n=28, deficient external rotation alone), class C (n=10, deficient elevation and external rotation).

Results: These classes were not significantly different for age, sex-ratio, duration of symptoms, or presence of subscapular involvement. Trauma was involved more often in patients in class B and class D. The mean absolute Constant score was significantly lower in patients in class B (30.2) or D (23.5) than in class A (53.3) or C (44.7). The subacromial space was significantly narrower in group D (5 mm) than in the other groups. Fatty infiltration of the infraspinatus scores > II was significantly more common in groups C and D. Severe fatty degeneration of the subscapular (> II) was found in only eight shoulders and was not correlated with defective active elevation.

Discussion: This study demonstrates that deficient external rotation is correlated with the type of tear but has little impact on the Constant score. Conversely, patients with deficient active elevation have a lower Constant score but do not exhibit characteristically different tears than patients without deficient active elevation. Thus, the management scheme should be no different in patients with deficient elevation than in patients with out deficient elevation, excepting cases with a major lesion of the subscapularis.

In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score.

A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (−20.7 to 47.5) points (p < 0.0001). The improvement was not significant in the low-energy group. Total or subtotal resorption of the calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group.

High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains unchanged in size in the majority of patients.