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1

Arthroscopic surgery for partial rotator cuff tears  

Microsoft Academic Search

Rotator cuff pathology is one of the most common disorders of the shoulder. However, partial rotator cuff tears, treatment, and natural history are still in a state of flux. We believe that partial rotator cuff tears should be treated surgically when the rotator cuff is torn more than 50% of the thickness or when substantial thinning of the rotator cuff

Richard C Lehman; Clayton R Perry

2003-01-01

2

Rotator Cuff Tear - Surgery versus Rehabilitation  

Microsoft Academic Search

Rotator cuff tears are a common source of shoulder pain. . The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon, rather than injury from sports or trauma. While the information that follows can be used as a guide for all types of rotator cuff tears, it is intended specifically for

Hythem P. Shadid

3

Coracoacromial arch decompression in rotator cuff surgery  

Microsoft Academic Search

In rotator cuff surgery it is important to obtain adequate decompression of the coracoacromial arch. However, it is difficult\\u000a to localize the impingement site preoperatively. Based on histological and morphological studies and the clinical findings\\u000a in 45 patients and 15 cadavers, we have tried to determine the impingement site. In addition, as a part of these investigations,\\u000a we assessed the

N. Suenaga; A. Minami; N. Iwasaki; K. Kaneda

2000-01-01

4

Rotator Cuff  

Microsoft Academic Search

Over the last 20 yr, the frequency of surgical intervention for rotator cuff tears has risen dramatically. The surgery and\\u000a postoperative rehabilitation has been mostly empirical with little scientific foundation. There is a wide range of pathology\\u000a found in the rotator cuff, particularly the horizontal cleavage tear or delamination, which is frequently observed but rarely\\u000a studied.

Richard O. Evans; Peter J. Hughes; David H. Sonnabend

5

Captured shoulder: A complication of rotator cuff surgery  

Microsoft Academic Search

Thirteen patients who developed restrictive subdeltoid adhesions after rotator cuff repair were identified. These patients underwent second-look arthroscopy and takedown of adhesions at an average of 37 weeks after their index surgery. Clinical findings include pain and restricted motion that does not yield to manipulation under anesthesia. Arthroscopic findings are subdeltoid adhesions and a chondral lesion (companion lesion) of the

Matthew A. Mormino; R. Michael Gross; Jack A. McCarthy

1996-01-01

6

Biologics in Rotator Cuff Surgery: Management of Rotator Cuff Tears With an Extracellular Matrix Patch  

Microsoft Academic Search

Summary: Chronic large and massive rotator cuff tears remain a treatment challenge for the orthopaedic surgeon. The use of an extracellular matrix (ECM) biologic patch is an emerging field and offers potential for the treatment of patients with failed rotator cuff repairs or those with tears that are chronic and large in nature. There are several commercially available grafts that

Matthew T. Provencher; Augustus Mazzocca; Anthony A. Romeo

2007-01-01

7

[Conservative therapy and rehabilitation following surgery of the rotator cuff].  

PubMed

To achieve the best results after shoulder surgery, an optimal rehabilitation program is absolutely necessary. The physiotherapist must pay attention to some basic features such as biomechanics, functional anatomy and the current findings. The schedule of rehabilitation depends on the operative technique, the possibility of reconstruction of the rotator cuff and on the load capacity of the soft tissue. The goal of shoulder rehabilitation is the recovery of painless and normal shoulder function. PMID:8532340

Jessner-Kaplans, M; Jessner, A

1995-11-01

8

Rotator cuff repair  

MedlinePLUS

Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (" ... Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure may not always return ...

9

Serious rotator cuff injuries.  

PubMed

Usually, serious rotator cuff injuries can be operated upon and a high level of performance can be achieved afer surgery. This is not so for the substantial tears seen in baseball pitchers. However, a damaged rotator cuff can be rehabilitated and can recover from the threatened tear without surgery if detected early enough and given the proper treatment. PMID:9697647

Jobe, F W

1983-07-01

10

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment. Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repair surgery. Study Design: Controlled laboratory study. Methods: Thirty-nine patients (20 men,

Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews

11

Rotator Cuff Injuries  

MedlinePLUS

... had the torn rotator cuff. Treatment for torn rotator cuff includes: Rest Heat or cold to the sore area Medicines that reduce pain and swelling Electrical stimulation of muscles and nerves Ultrasound Cortisone injection Surgery NIH: National Institute on Arthritis and Musculoskeletal and ...

12

Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair  

PubMed Central

Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate interpretation of the results. However, we hypothesized the indications for surgery are poorly described in outcome studies of rotator cuff surgery. We undertook a detailed literature review over 11 years of six major orthopaedic journals to assess whether the indications for surgery were described adequately in studies of rotator cuff repair. Eighty-six papers fit the criteria for the study and were reviewed. Limitations of activities of daily living (31%), failure of nonoperative treatment (52%), duration of nonoperative treatment (26%), and history of nocturnal pain (16%) were reported in a minority of papers overall. The patients’ characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Koulouvaris, Panagiotis; Chu, Samuel K.; Levy, Bruce A.

2008-01-01

13

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment.Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repair surgery.Study Design: Controlled laboratory study.Methods: Thirty-nine patients (20 men, 19 women) who

Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews

2008-01-01

14

Rotator cuff repair - series (image)  

MedlinePLUS

The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder. These muscles and ... Surgery to repair a torn rotator cuff is usually very successful at ... is less predictable at returning strength to the shoulder. ...

15

Rotator cuff repair  

Microsoft Academic Search

Rotator cuff surgery is developing at a fast pace, with progress in arthroscopic techniques driving much of its advance. Overall, functional outcomes are satisfactory. Tendon healing, however, is inconsistently obtained. Tendon healing correlates with better outcomes, most notably greater strength. Therefore, the best candidates for surgery are patients with lesions that are likely to heal. Factors associated with healing are

Luc Favard; Guillaume Bacle; Julien Berhouet

2007-01-01

16

Rotator cuff problems  

MedlinePLUS

... of demand on the shoulder. You may need surgery to repair the tendon if the rotator cuff has had a complete tear, or if the symptoms persist despite conservative therapy. Most of the time, arthroscopic surgery can be used. Some large tears require open ...

17

Rotator Cuff Injuries.  

ERIC Educational Resources Information Center

|Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

Connors, G. Patrick

18

Mode of failure for rotator cuff repair with suture anchors identified at revision surgery  

Microsoft Academic Search

Rotator cuff tears are a common cause of shoulder pain and dysfunction. After surgical repair, there is a significant re-tear rate (25%-90%). The aim of this study was to determine the primary mode of mechanical failure for rotator cuffs repaired with suture anchors at the time of revision rotator cuff repair. We prospectively followed 342 consecutive torn rotator cuffs, repaired

Craig A. Cummins; George A. C. Murrell

2003-01-01

19

What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery?  

PubMed Central

Background To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. Methods We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. Results Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively.

Yoon, Jong Pil; Min, Woo-Kie; Kim, Joon Woo; Jeong, Won-Ju; Lee, Hyun-Joo

2012-01-01

20

Atrophy of the Deltoid Muscle Following Rotator Cuff Surgery  

Microsoft Academic Search

Results: The thickness of the anterior deltoid fibers did not change significantly after surgery in the mini-open repair group, whereas it was significantly decreased in the open repair group at six months as well as at twelve months postoperatively (p < 0.05). At three months postoperatively, the mean University of California at Los Angeles score for active forward flexion in

YUKIHIKO HATA; SATORU SAITOH; NARUMICHI MURAKAMI; HIROKAZU KOBAYASHI; KUNIO TAKAOKA

21

Treatment Options for Rotator Cuff Tears: A Guide for Adults  

MedlinePLUS

... and how long treatment may take. Treating your rotator cuff tear without surgery Rotator cuff tears are treated without surgery in ... when you should start feeling better. Repairing your rotator cuff tear with surgery How long do I wait before choosing surgery? ...

22

[Rupture of the rotator cuff].  

PubMed

Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation in the shoulder joint. Both the classic technique of open surgery and the arthroscopic technique are employed to reconstruct the rotator cuff. This review tries to answer the question which of both surgical techniques is superior by a review of the literature. The recent literature demonstrates a shorter follow-up period for publications concerning arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results between 68 to 96%, open reconstruction between 77 and 91%. Longevity of reconstructed rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic technique was used. Several authors mentioned size of tear as a major factor influencing longevity. However in patients treated arthroscopically despite rerupture of the rotor cuff patient's satisfaction and clinical outcome is still very good in short-term follow-up. In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique seems to be superior. If large tears occur (two or three tendons) the open surgical technique may be more reliable with regard to longevity of the repair. For the future it seems necessary to obtain long-term results to be able to compare both principles of reconstruction of the rotator cuff. Furthermore these future studies should include quality of life scores as measurements tools besides the already employed parameters as size of the tear, age at surgery, patient satisfaction and outcome scores. PMID:17187328

Wurmig, C

23

Rotator cuff interval reconstruction.  

PubMed

Five pairs of cadaveric shoulders underwent posterior and anterior drawer and inferior sulcus tests in five progressive conditions: intact, vented, following opening of the rotator cuff interval, reconstruction of the interval, and transfer of the coracoacromial ligament. The surgical treatments--vented, open rotator cuff interval, reconstruction, and coracoacromial ligament transfer--had an effect compared to the intact shoulders on the inferior stiffness (P = .00002) and on the anteroposterior stiffness (P = .00031). The difference between the stiffness of the reconstructed rotator cuff interval compared to the coracoacromial ligament transfer was significant for loading in the AP direction (P = .006) and for loading in the inferior direction (P = .005). PMID:17134054

Roidis, Nikolaos T; Stennette, Denise; Burkhead, Wayne; Karachalios, Theofilos S; Malizos, Konstantinos N; Itamura, John Minoru

2006-11-01

24

The Rotator Cuff Functional Index  

Microsoft Academic Search

Background: Despite improvements in the clinical assessment of rotator cuff injuries, shortcomings exist in diagnosing rotator cuff tears.Purpose: To formulate a clinical rotator cuff functional index for predicting rotator cuff tears based on handheld dynamometer measurements for shoulder strength testing and to assess its ability to diagnose a rotator cuff tear.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: Preoperative

Daryl C. Osbahr; George A. C. Murrell

2006-01-01

25

Rotator cuff exercises  

MedlinePLUS

... torn due to overuse or injury See also: Rotator cuff problems These injuries often lead to pain, weakness, and stiffness when you use your shoulder. A key part in your recovery is starting exercises to make the muscles and ...

26

Rotator Cuff Injuries  

MedlinePLUS Videos and Cool Tools

... often have rotator cuff injuries, due to the physical nature of their activities. Factors that increase the ... after a good medical history and a thorough physical examination are performed. Tests such as shoulder x- ...

27

Revision rotator cuff repair.  

PubMed

The management of patients with a failed rotator cuff repair is challenging. Revision arthroscopic repairs can be entertained in select patients when realistic outcomes are understood. Complete evaluation of the shoulder is needed to identify and treat potential confounding pain generators. The ability to determine if a recurrent tear is repairable is difficult, because there are no established criteria to make this determination. If a recurrent tear is found to be repairable, the results of the surgery are encouraging, although persistent limitations in shoulder function are common. Strategies to improve the rates of tendon healing should be used and include the use of stronger repair constructs, when possible, and implementation of a slower rehabilitation progression. PMID:23040555

Keener, Jay D

2012-09-01

28

Costs analysis of successful rotator cuff repair surgery: An outcome study. Comparison of gatekeeper system in surgical patients  

Microsoft Academic Search

In an effort to determine the cost effectiveness of rotator cuff repair surgery in workers' compensation patients, a financial analysis of 50 consecutive patients with a “successful” result was performed. Treatment cots were analyzed from the date of initial injury through all evaluations, diagnostic studies, surgical reconstruction, physical therapy and work hardening. Additionally, all workers' compensation payments and the cost

F. H. Savoie; Larry D. Field; R. Nan Jenkins

1995-01-01

29

Physical and rehabilitation medicine (PRM) care pathways: "patients after rotator cuff tear surgery".  

PubMed

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after rotator cuff tear surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (ICF) (WHO). PMID:22018888

Ribinik, P; Calmels, P; Barrois, B; Le Moine, F; Yelnik, A P

2011-10-06

30

Rotator Cuff Exercises  

MedlinePLUS

... rotator cuff--the part that helps with circular motion). These exercises should not cause you pain. If you feel any pain, stop exercising. Start again with a lighter weight. Look at the pictures with each exercise so you can use the ...

31

Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear  

Microsoft Academic Search

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior

Naoki Suenaga; Akio Minami; Kiyoshi Kaneda

2000-01-01

32

Indications for repair of full-thickness rotator cuff tears.  

PubMed

Rotator cuff repair surgery for full-thickness tears is common and accepted in orthopaedics today. Given that a significant number of people have asymptomatic rotator cuff tears, the indications for surgery are, however, somewhat unclear. Multiple factors such as duration of symptoms, acuity and size of the tear, patient age, and others require consideration and can influence the decision to perform surgery. This article reviews these variables and the indications for surgery to repair full-thickness rotator cuff tears. PMID:17337723

Wolf, Brian R; Dunn, Warren R; Wright, Rick W

2007-03-02

33

Local anesthesia for arthroscopic rotator cuff surgery: patient–physician relationship as the origin of technical innovation  

Microsoft Academic Search

We report a series of 12 patients suffering from rotator cuff tears of the shoulder who were operated under local anesthesia\\u000a (direct injection of local anaesthetics in the shoulder) and light sedation. They all had a medical contra-indication for\\u000a elective surgery under general or regional nerve block anaesthesia (interscalene). Complete pain control was achieved in all\\u000a cases and all the

Marc Beauchamp; Jean-Denis Roy

2011-01-01

34

Rotator Cuff and Impingement  

Microsoft Academic Search

Shoulder pain due to trauma or overuse is a common complaint in the populations of athletes in general, with a variety of\\u000a causes that are frequently diffi cult to differentiate by physical examination alone.\\u000a \\u000a MR imaging and ultrasonography are optimal and complementary tools to discriminate different forms of impingement and to localize\\u000a and classify rotator cuff injuries. A native MR

Henk-Jan Van der Woude; Diana G. Franssen-Franken; W. Jaap Willems

35

Partial Rotator Cuff Ruptures  

Microsoft Academic Search

\\u000a Partial rotator cuff ruptures are not rare and occur mainly in the supraspinatus tendon and may extend to that of infraspinatus,\\u000a but rarely to the tendon of subscapularis. Isolated lesions in the tendons of infraspinatus, teres minor or subscapularis\\u000a are rare. Partial ruptures usually occur before the sixth decade of life and can be a cause of unexplained pain in

Antonio Cartucho

36

Histopathology of rotator cuff tears.  

PubMed

The pathogenesis of rotator cuff tears is multifactorial. Tendon abnormalities of the rotator cuff include alteration of collagen fiber structure, tenocytes, cellularity, and vascularity. Ruptured tendons show marked collagen degeneration and disordered arrangement of collagen fibers. Fibroblast population decreases as the size of the tear in the rotator cuff increases. The larger fibroblast population seen in the smaller tears is also actively proliferating and is part of an active reparative process. Inflammatory cell infiltrate correlates inversely to rotator cuff tear size in the torn supraspinatus tendon samples, with larger tears showing a marked reduction in all cell types. As tear size increase, there is also a progressive decrease in the number of blood vessels. Whether rotator cuff tear heals spontaneously is an important pathologic and clinical question. Histologic changes indicative of repair and inflammation lead to consider biological options in addition to biomechanical treatment of the rotator cuff tears. PMID:21822106

Longo, Umile Giuseppe; Berton, Alessandra; Khan, Wasim S; Maffulli, Nicola; Denaro, Vincenzo

2011-09-01

37

Rotator cuff repair. Long-term results  

Microsoft Academic Search

Objectives. – To evaluate the results of rotator cuff repair and to look for preoperative and\\/or intraoperative predictors of long-term outcomes.Patients and methods. – All patients who underwent open rotator cuff repair surgery for a full-thickness tear between 1990 and 1996 and who were subsequently followed-up for at least 4 years were contacted. The surgical technique and postoperative rehabilitation program

Daniel Van Linthoudt; Jacques Deforge; Laurent Malterre; Harry Huber

2003-01-01

38

Optimizing the management of rotator cuff problems.  

PubMed

Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal anti-inflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery. PMID:21628648

Pedowitz, Robert A; Yamaguchi, Ken; Ahmad, Christopher S; Burks, Robert T; Flatow, Evan L; Green, Andrew; Iannotti, Joseph P; Miller, Bruce S; Tashjian, Robert Z; Watters, William C; Weber, Kristy; Turkelson, Charles M; Wies, Janet L; Anderson, Sara; St Andre, Justin; Boyer, Kevin; Raymond, Laura; Sluka, Patrick; McGowan, Richard

2011-06-01

39

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis  

PubMed Central

Background The assessment of post-surgical outcomes among patients with Workers’ Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients’ time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients. Findings Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers’ Compensation patients versus their non-compensated counterparts. We assessed the studies’ quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p?rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition. Type of study/level of evidence Meta-analysis of prospective Studies/ Level III

2013-01-01

40

Intramuscular Rotator Cuff Cysts: Association with Tendon Tears on MRI and Arthroscopy  

Microsoft Academic Search

OBJECTIVE. This study was designed to explore the relationship between intramuscular cysts and rotator cuff tendon tears. CONCLUSION. Intramuscular cysts are strongly associated with rotator cuff tendon tears. Identification of such a cyst should prompt a search for a rotator cuff tear. Findings on MR arthrography and surgery suggest that a delaminating component of the rotator cuff tear may lead

Ara Kassarjian; Martin Torriani; Hugue Ouellette; William E. Palmer

41

Medial rotator cuff failure after arthroscopic double-row rotator cuff repair.  

PubMed

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients. PMID:18514118

Trantalis, John N; Boorman, Richard S; Pletsch, Kristie; Lo, Ian K Y

2008-06-01

42

Rotator cuff tears: pathology and repair.  

PubMed

By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others). In an era of emerging biologic interventions, our interventions are increasingly being modulated by our understanding of these core processes, many of which remain uncertain today. When we do intervene surgically, the techniques we employ are particularly challenging in the context of the tremendous pace of advancement. Several recent studies have shown that arthroscopic repair gives similar functional results to that of mini-open and open procedures, with all the benefits of minimally invasive surgery. However, the 'best' repair construct remains unknown, with wide variations in surgeon preference. Here we present a literature review encompassing recent developments in our understanding of basic science in rotator cuff disease as well as an up-to-date evidence-based comparison of different techniques available to the surgeon for cuff repair. PMID:19104772

Yadav, Hemang; Nho, Shane; Romeo, Anthony; MacGillivray, John D

2008-12-23

43

Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis  

Microsoft Academic Search

OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons

G P Riley; R L Harrall; C R Constant; M D Chard; T E Cawston; B L Hazleman

1994-01-01

44

Autologous blood products in rotator cuff repair.  

PubMed

We review the management of rotator cuff tears, the mechanism of action of autologous blood products, principally platelet-rich plasma, and the current evidence for effective use of platelet-rich plasma, particularly in relation to the shoulder and chronic rotator cuff tears, for biological augmentation of rotator cuff repair. PMID:21986046

Mei-Dan, Omer; Carmont, Michael R

2011-10-04

45

All arthroscopic rotator cuff repairs  

Microsoft Academic Search

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages ofglenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in both

Gary M. Gartsman

2000-01-01

46

Arthroscopic repair techniques for massive rotator cuff tears.  

PubMed

Patients with massive rotator cuff tears present with pain, weakness, and loss of function. Candidates for arthroscopic repair include symptomatic, young, active patients; those with an acute tear or tears with early changes of atrophy; and patients willing to comply with recovery and rehabilitation processes after surgery. As massive rotator cuff tears extend, the glenohumeral articulation is destabilized, allowing superior migration. Repair of the force couples and reinforcement of the anterosuperior rotator cuff cable can restore functional elevation via the deltoid. Muscle changes, including rotator cuff atrophy and fatty infiltration, will affect shoulder strength and function. As chronic changes become more extensive (such as the absence of the acromiohumeral interval and degenerative joint changes), other repair options may be more durable. Other arthroscopic options, including partial rotator cuff closure, graft to augment the repair, and use of the long head of the biceps tendon, have been helpful in pain relief and functional gains. PMID:22301227

Abrams, Jeffrey S; Song, Frederick S

2012-01-01

47

The difficulties of ambulatory interscalene and intra-articular infusions for rotator cuff surgery: a preliminary report  

Microsoft Academic Search

Purpose  Rotator cuff repair may result in severe postoperative pain. We compared a continuous intra-articular infusion to a continuous\\u000a interscalene block with ropivacaine for patients undergoing outpatient rotator cuff repair.\\u000a \\u000a \\u000a \\u000a Methods  Seventeen patients were randomized to one of two groups: 1) interscalene block with 0.5% ropivacaine (40 mL) followed by a\\u000a postoperative intra-articular infusion or; 2) interscalene block with 0.5% ropivacaine (40

Stephen M. Klein; Susan M. Steele; Karen C. Nielsen; Ricardo Pietrobon; David S. Warner; Aliki Martin; Roy A. Greengrass

2003-01-01

48

Partial cuff debridement for irreparable defects of the rotator cuff  

Microsoft Academic Search

The treatment of massive rotator cuff tears can pose a difficult problem for the unprepared orthopaedic surgeon.There are many ways to treat massive rotator cuff tears, and one viable option is debridement with acromioplasty. For this form of treatment to be successful, the surgeon must choose his patient carefully. This report will focus on patient selection, biomechanics, and postoperative rehabilitation.

Craig Zeman; Kari M. Babinski; W BURKHEADJR

1998-01-01

49

The relative importance of acromial morphology and age with respect to rotator cuff pathology 1  

Microsoft Academic Search

The purpose of this study was to examine the relationship between patient age, acromial morphology, and rotator cuff pathology. Data on 523 patients who had arthroscopic and\\/or open shoulder surgery were reviewed. Acromial morphology was classified by the system of Bigliani. All patients were categorized by postoperative diagnosis as having tendinitis of the rotator cuff, partial rotator cuff tear, complete

Thomas J Gill; Elizabeth McIrvin; Mininder S Kocher; Karen Homa; Scott D Mair; Richard J Hawkins

2002-01-01

50

Mini-open Rotator Cuff Repair  

Microsoft Academic Search

\\u000a Rotator cuff pathology is a common cause of shoulder pain and disability, and becomes more common with advancing patient age.\\u000a Most symptomatic rotator cuff disease is seen in patients in their fifth and sixth decades. Tears of the rotator cuff are\\u000a associated with pain and weakness and can result in significant disability.1 However, it is also known that asymptomatic rotator

W. Anthony Frisella; Frances Cuomo

51

A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair  

PubMed Central

Objectives The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR. Methods This study compared questionnaire- and clinical examination-based outcomes over two years or longer for two series of patients who met the inclusion criteria: 200 open RCR and 200 arthroscopic RCR patients. All surgery was performed by a single surgeon. Results Most pain measurements were similar for both groups. However, the arthroscopic RCR group reported less night pain severity at six months, less extreme pain and greater satisfaction with their overall shoulder condition than the open RCR group. The arthroscopic RCR patients also had earlier recovery of strength and range of motion, achieving near maximal recovery by six months post-operatively whereas the open RCR patients took longer to reach the same recovery level. The median operative times were 40 minutes (20 to 90) for arthroscopic RCR and 60 minutes (35 to 120) for open RCR. Arthroscopic RCR had a 29% re-tear rate compared with 52% for the open RCR group (p < 0.001). Conclusions Arthroscopic RCR involved less extreme pain than open RCR, earlier functional recovery, a shorter operative time and better repair integrity.

Walton, J. R.; Murrell, G. A. C.

2012-01-01

52

Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff  

Microsoft Academic Search

Recently, there has been an increased interest in the normal anatomy of the rotator cuff footprint and the re-establishment of the footprint during rotator cuff repair. Single-row suture anchor techniques have been criticized because of their inability to restore the normal medial-to-lateral width of the rotator cuff footprint. In this report, the authors describe a double-row technique for rotator cuff

Ian K. Y Lo; Stephen S Burkhart

2003-01-01

53

Biological Augmentation of Rotator Cuff Tendon Repair  

PubMed Central

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.

Kovacevic, David

2008-01-01

54

[Diagnosis and treatment of rotator cuff tears].  

PubMed

A rotator cuff tear is a highly prevalent disorder, occurring in 25% of people over 60 years of age. In two thirds of patients the tear is small and asymptomatic. Acute, symptomatic cuff tears may occur in active sportsmen and women aged 30-50. There is often a considerable delay in diagnosis in this group, due to a lack of recognition by either the patient or the doctor. Recently identified risk factors for the development of cuff tear are nicotine abuse, hypercholesterolaemia, contralateral cuff tear and genetic predisposition. Conservative treatment can be very successful and consists of physical therapy and effective analgesics. Repeated steroid injections are harmful to the tendinous tissue and should be avoided. The aim of surgery is anatomical reinsertion of the ruptured tendon using an open or arthroscopic procedure. The arthroscopic procedure enables the surgeon to perform a more extensive evaluation and treatment of the joint. The arthroscopic procedure is technically more demanding than the open procedure, but seems to have a shorter rehabilitation period. PMID:21871139

van der Zwaal, Peer; Pekelharing, Janneke F; Thomassen, Bregje J W; Swen, Jan-Willem A; van Arkel, Ewoud R A

2011-01-01

55

Vascularity and tendon pathology in the rotator cuff: a review of literature and implications for rehabilitation and surgery  

Microsoft Academic Search

ObjectiveTo compile histological and imaging research detailing the microvascularity of the rotator cuff and determine the clinical application of these findings for clinicians.MethodsA computer-assisted literature search of MEDLINE (1966 to September 2008) using keywords related to blood flow to the shoulder and limited to humans and English language. A hand search was also performed by three of the authors.ResultsNineteen studies

E. J. Hegedus; C. Cook; M. Brennan; D. Wyland; J. C. Garrison; D. Driesner

2010-01-01

56

Rapid Isolation of Human Stem Cells (Connective Tissue Progenitor Cells) From the Proximal Humerus During Arthroscopic Rotator Cuff Surgery  

Microsoft Academic Search

Background: Bone-to-tendon healing in the shoulder can be unpredictable. Biologic augmentation, through the implementation of adult mesenchymal stem cells, may improve this healing process.Purpose: The purpose of this study was to (1) arthroscopically obtain bone marrow aspirates from the proximal humerus during rotator cuff repair, (2) purify and concentrate the connective tissue progenitor cells (CTPs) in the operating room efficiently,

Augustus D. Mazzocca; Mary Beth R. McCarthy; David M. Chowaniec; Mark P. Cote; Robert A. Arciero; Hicham Drissi

2010-01-01

57

Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs  

Microsoft Academic Search

Background: Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome.Hypothesis: Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in

Steven Klepps; Julie Bishop; Jason Lin; Oren Cahlon; Alyssa Strauss; Patrick Hayes; Evan L. Flatow

2004-01-01

58

Mini-Open Rotator Cuff Repair  

Microsoft Academic Search

\\u000a Rotator cuff tears have long been recognized as a disabling problem of the upper extremity. Codman reportedly performed the\\u000a first open rotator cuff repair in 1911.1 However, it was not until 1972 when Neer reported the results of anterior acromioplasty in combination with cuff mobilization\\u000a and repair that results substantially improved.2 The surgical fundamentals detailed by Neer significantly improved the

Jason A. Schneider; Frances Cuomo

59

Arthroscopic Rotator Cuff Repairs Using Suture Anchors  

Microsoft Academic Search

Arthroscopic rotator cuff repairs using titanium-alloy suture anchors are a new treatment option for active patients with shoulder injuries. Shoulder arthroscopy and arthroscopic repair procedures are alternative treatments to traditional open surgical procedures for Bankart lesions and rotator cuff tears. Distinct advantages of arthroscopic repair techniques include decreased patient tissue trauma and morbidity rates and shortened recovery and rehabilitation periods.

Lee Anna Farrall

1995-01-01

60

Anatomy and dimensions of rotator cuff insertions  

Microsoft Academic Search

The purpose of this study was to devise and implement an accurate and reproducible method of measuring the area and dimensions of the rotator cuff tendon insertions and their distance from the articular surface. Twenty fresh-frozen cadaveric upper-extremity specimens were divided into 2 groups of 10. In group 1 the specimens were dissected, leaving only the most distal rotator cuff

Jeffrey R Dugas; Deirdre A Campbell; Russell F Warren; Bruce H Robie; Peter J Millett

2002-01-01

61

Rotator cuff injury: still a clinical controversy?  

Microsoft Academic Search

The rotator cuff mechanism is the primary stabiliser of the gleno-humeral joint and is vulnerable to considerable morbidity because of its anatomy and function. Both intrinsic and extrinsic factors are responsible for rotator cuff pathology, which is a disease spectrum ranging from inflammation to full thickness tears. The most notable extrinsic factors are impingement and demographic variables, whereas age-related degeneration

P. Hardy; S. Sanghavi

2009-01-01

62

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review  

Microsoft Academic Search

Background  Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator\\u000a cuffs may show improved healing when biologic factors are added during surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed\\u000a in tendon augmentation? (3) What approaches are being developed with the addition

Emilie V. Cheung; Luz Silverio; John W. Sperling

2010-01-01

63

Current biomechanical concepts for rotator cuff repair.  

PubMed

For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

Lee, Thay Q

2013-05-15

64

Rotator cuff repair in spinal cord injury patients  

Microsoft Academic Search

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on nonsurgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord–injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging underwent rotator cuff repair. Two of eight shoulders

Richard L Popowitz; John E Zvijac; John W Uribe; Keith S Hechtman; Matthias R Schürhoff; Jeremy B Green

2003-01-01

65

Rotator cuff repair in spinal cord injury patients  

Microsoft Academic Search

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on non- surgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord-injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imag- ing underwent rotator cuff repair. Two of

Richard L. Popowitz; John E. Zvijac; John W. Uribe; Keith S. Hechtman

66

Biologically enhanced healing of the rotator cuff.  

PubMed

Failure of rotator cuff repair is a well-documented problem. Successful repair is impeded by muscle atrophy, fat infiltration, devascularization, and scar tissue formation throughout the fibrocartilagenous transition zone. This case study exemplifies a technique to biologically augment rotator cuff healing. Clinically, pain and function improved. Postoperative magnetic resonance imaging evaluation confirmed construct integrity. Biological enhancement of the healing process and physiologically based alterations in rehabilitation protocols can successfully treat complicated rotator cuff tears. Prospective studies with larger sample sizes and continued follow-up are necessary to assess the definitive efficacy of this treatment modality. PMID:22691639

Gordon, Nicole M; Maxson, Scott; Hoffman, James K

2012-06-01

67

Conservative management of rotator cuff tear.  

PubMed

Ranking among the most prevalent of shoulder disorders, lesions involving shoulder rotator cuff strike million of patients in the United States at different points in their lives. Despite the fact that rotator cuff disease is a very common cause of pain and disability of the upper arm, a high proportion of patients is asymptomatic and unaware of performing daily living activities despite of a shoulder lesion. Given these drawbacks, surgeons are trying exploring whether conservative treatment is a viable option for the management of these injuries. This study presents a rationale to consider nonoperative treatment an effective option when dealing with patients with rotator cuff tears. PMID:22089284

Pegreffi, Francesco; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

2011-12-01

68

Arthroscopic Transosseous-Equivalent Rotator Cuff Repair  

PubMed Central

Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseous-equivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseous-equivalent rotator cuff repair technique with a focus on technical pearls.

Lavery, Kyle P.; Rasmussen, Jeffrey F.; Dhawan, Aman

2013-01-01

69

Clinical examination of the rotator cuff.  

PubMed

Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability and account for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing by using a goniometer, strength testing by using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can typically be completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time efficient for a busy clinical practice. It is useful in the diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology. PMID:23332909

Jain, Nitin B; Wilcox, Reg B; Katz, Jeffrey N; Higgins, Laurence D

2013-01-01

70

Occult interpositional rotator cuff - an extremely rare case of traumatic rotator cuff tear.  

PubMed

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed. PMID:22247643

Lin, Cheng-Li; Su, Wei-Ren; Jou, I-Ming; Chih, Wei-Hsing

2011-12-23

71

Medial Rotator Cuff Failure After Arthroscopic Double-Row Rotator Cuff Repair  

Microsoft Academic Search

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness.

John N. Trantalis; Richard S. Boorman; Kristie Pletsch; Ian K. Y. Lo

2008-01-01

72

Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear  

PubMed Central

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Lin, Cheng-Li; Su, Wei-Ren; Jou, I-Ming

2012-01-01

73

Association of Sonographically Detected Subacromial\\/Subdeltoid Bursal Effusion and Intraarticular Fluid with Rotator Cuff Tear  

Microsoft Academic Search

OBJECTIVE. Although an association between sonographically detected joint fluid and rotator cuff disease has been reported, the significance of sonographically detected subacromial\\/subdeitold bursal effusion has not been studied. We examined a group of patients who had shoulder sonography and surgery to determine the associa- tion between bursal and joint effusion and surgically proved tears of the rotator cuff. MATERIALS AND

Mary S. Hollister; Laurence A. Mack; Randall M. Patten; Thomas C. Winter; Fredrick A. Matsen; Ryan A. Veith

74

Fatty infiltration and rotator cuff atrophy.  

PubMed

Moderate to severe fatty infiltration and rotator cuff atrophy are commonly associated with poor clinical outcomes and failed rotator cuff repair. Numerous animal and human studies have attempted to elucidate the etiology of fatty infiltration and rotator cuff atrophy. Mechanical detachment of the tendon in rotator cuff tears is primarily responsible. Suprascapular nerve injury may also play a role. CT, MRI, and ultrasonography are used to evaluate severity. The Goutallier staging system is most commonly used to evaluate fatty infiltration, and rotator cuff atrophy is measured using multiple techniques. The presence and severity of fatty infiltration have been associated with increasing age, tear size, degree of tendon retraction, number of tendons involved (ie, massive tears), suprascapular neuropathy, and traumatic tears. Fatty infiltration is irreversible and progressive if left untreated. Slight reversal of muscle atrophy has been noted after repair in some studies. Novel therapies are currently being evaluated that may eventually allow clinicians to alter the natural history and improve patient outcomes. PMID:24084435

Kuzel, Bradley R; Grindel, Steven; Papandrea, Rick; Ziegler, Dean

2013-10-01

75

Tendon transfers for irreparable rotator cuff tears.  

PubMed

Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears. Although surgical indications are not clearly defined, the traditional thought is that the ideal candidate is young and lacks significant glenohumeral arthritis. The proposed benefits of tendon transfers are pain relief and potential increase in strength. The biomechanical rationale for the procedure is to restore the glenohumeral joint force couple and possibly to restore normal shoulder kinematics. The selection of donor tendon depends on the location of the rotator cuff deficiency. Transfers of latissimus dorsi and pectoralis major tendons have been shown to consistently improve pain; however, functional benefits are unpredictable. Trapezius tendon transfer may be an alternative in patients with massive posterosuperior rotator cuff tears, although longer-term follow-up is required. PMID:23908255

Omid, Reza; Lee, Brian

2013-08-01

76

Role of metalloproteinases in rotator cuff tear.  

PubMed

The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPS) in the pathophysiology of rotator cuff tears has not been established yet. Recent advances empathize about the role of MMPs and TIMPS in extracellular matrix (ECM) remodeling and degradation in rotator cuff tears pathogenesis and healing after surgical repair. An increase in MMPs synthesis and the resulting MMPs mediated alterations in the ECM of tendons have been implicated in the etiopathogenesis of tendinopathy, and there is an increase in the expression of MMPs and a decrease in TIMP messenger ribonucleic acid expression in tenocytes from degenerative or ruptured tendons. Importantly, MMPs are amenable to inhibition by cheap, safe, and widely available drugs such as the tetracycline antibiotics and bisphosphonates. A better understanding of relationship and activity of these molecules could provide better strategies to optimize outcomes of rotator cuff therapy. PMID:21822103

Garofalo, Raffaele; Cesari, Eugenio; Vinci, Enzo; Castagna, Alessandro

2011-09-01

77

Rotator Cuff Injuries - Multiple Languages: MedlinePlus  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Rotator Cuff Injuries - Multiple Languages Somali (af Soomaali) Spanish (español) Somali (af Soomaali) Rotator Cuff Exercises Jimicsiyada Muruqyada Wareegga ama Gulubida - af Soomaali ( ...

78

Rotator cuff tear measurement by arthropneumotomography  

SciTech Connect

Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size of the tear and the quality of the remaining cuff than did plain arthrograms.

Kilcoyne, R.F.; Matsen, F.A. III

1983-02-01

79

Arthroscopic Rotator Cuff Repair with Interval Release for Contracted Rotator Cuff Tears  

Microsoft Academic Search

As experience has been gained in the arthroscopic repair of small and moderate rotator cuff tears, there has been a natural\\u000a progression toward the repair of larger tears.1–3 There is now considerable experience in the arthroscopic repair of these larger tears. The most significant advantage of\\u000a an all-arthroscopic approach in the repair of large and massive rotator cuff tears is

Joseph C. Tauro

80

Biological strategies to enhance rotator cuff healing.  

PubMed

Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair. Growth factors are delivered to the repair site using tissue-engineered scaffolding, coated sutures, or dissolved in a fibrin sealant. Platelet-rich plasma is an autologous concentration of platelets and contains an high density of growth factors. There is some evidence that platelet-rich plasma may improve pain and recovery of function in a short time period, but it does not improve healing rates in rotator cuff. Thus the routine use of platelet-rich plasma in rotator cuff repair is not recommended. The addition of mesenchymal stem cells to scaffolds can lead to the production of a better quality healing tissue. Gene therapy is a gene transfer from a cell into another, in order to over-express the gene required. In this way, cultures of stem cells can over-express growth factors. Better understanding of the mechanisms of physiological tendon healing can promote the correct use of these new biological therapies for a better healing tissue. PMID:24059330

Longo, Umile Giuseppe; Rizzello, Giacomo; Berton, Alessandra; Maltese, Ludovica; Fumo, Caterina; Khan, Wasim S; Denaro, Vincenzo

2013-11-01

81

Partial-Thickness Rotator Cuff Tears  

PubMed Central

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.

2011-01-01

82

Physical Therapist's Guide to Rotator Cuff Tear  

MedlinePLUS

... bring with you to your health care provider. Longo UG, Franceschi F, Berton A, et al. Conservative treatment and rotator cuff tear progression. Med Sport Sci . 2012;57:90–99. Article Summary on PubMed . Düzgün I, Baltac? G, Atay OA. Comparison of slow and accelerated rehabilitation ...

83

Shoulder Impingement/Rotator Cuff Tendinitis  

MedlinePLUS

... x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special x-ray view, called an "outlet view," sometimes will show a small bone spur on the front edge of the acromion. (Left) Normal outlet view x-ray. (Right) Abnormal outlet view showing a large bone spur ...

84

Clinical and biological aspects of rotator cuff tears.  

PubMed

Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success. PMID:23888289

Via, Alessio Giai; De Cupis, Mauro; Spoliti, Marco; Oliva, Francesco

2013-07-09

85

Biologically based strategies to augment rotator cuff tears  

PubMed Central

Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

Schaer, M.; Schober, M.; Berger, S.; Boileau, P.; Zumstein, M. A.

2012-01-01

86

Natural Extracellular Matrix Grafts for Rotator Cuff Repair  

Microsoft Academic Search

The results of open or arthroscopic repair of the rotator cuff vary widely in the literature.1–15 The factors that have been shown to affect outcome relate to the technique of surgery,3,9,16–18 the size of the tear,9–11 the quality of the tissue and age of the patient,10,11,15 the chronicity of the tear,9–11,19,20 the degree of muscle atrophy, and the degree of

Joseph P. Iannotti; Michael J. DeFranco; Michael J. Codsi; Steven D. Maschke; Kathleen A. Derwin

87

[Symptomatic rotator cuff tear of the shoulder].  

PubMed

Rotator cuff tears of the shoulder are common in the middle age and elderly population and can cause chronic pain. The prevalence of rotator cuff tears in people in their 50s, 60s, 70s, and 80s is 12.8%, 25.6%, 45.8% and 50% respectively. Etiological theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tear. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. The symptoms are of gradual increase in shoulder pain and weakness, however, it can happen acutely due to an injury. Difficulties in overhead activities and night pain are common. Evaluation of shoulder muscle strength can imply on cuff tear. Shoulder radiograph is essential specifically to rule out other diagnosis. Imaging such as ultrasound and magnetic resonance can further define the tear, however they should be used only if they will affect the management of the condition. Common indications for surgical repair are acute tear in a relatively young and active patient or when the treatment of symptomatic patient with chronic tear had failed. Most repairs are currently performed in an all arthroscopic technique which is minimally invasive with easier rehabilitation and less pain. PMID:22741212

Haviv, Barak; Bronak, Shlomo; Thein, Rafael

2012-02-01

88

Experimental study on rotator cuff repair.  

PubMed

It was the purpose of the experimental study to use laboratory experience to verify the effectiveness of different methods used to repair the rotator cuff. The sheep was used as an animal model because its infraspinous tendon is the most similar to that in the human. Three static trials were conducted using Instron machines, comparing the repair systems used most by the same authors in their clinical work, the hold of the suturing wires with two different threading procedures in the bone tunnels and two types of knotting, and the breakage loading of the suturing wires in the two different miniplate systems. The authors conclude that tendinous anchoring must be entrusted to reinforced suturing systems (modified SCOI and Mason Allen), the threading of wires in pairs in a single bone tunnel makes surgery easier and shortens the amount of time required, with threading of wires similar to or better than threading with a single wire. There are no differences in breakage loading of the wire at the level of the holes in the two miniplates considered in this study. PMID:12056246

Rotini, R; Giardino, R; Veronesi, C A; Baleani, M; Shrader, S

89

Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis.  

PubMed Central

OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons (supraspinatus and subscapularis tendons, n = 53) were obtained during open shoulder surgery to repair shoulder lesions (age range 38-80 years). Glycosaminoglycans were extracted by papain digestion and analysed by cellulose acetate electrophoresis, the carbazole assay for uronic acid and the dimethylmethylene blue dye-binding assay for sulphated glycosaminoglycans. Some digests were analysed for keratan sulphate by 5D4 monoclonal antibody ELISA. Soluble proteoglycans were extracted in 4M guanidine hydrochloride and analysed by 4-15% SDS PAGE. RESULTS--The mean (SD) sulphated glycosaminoglycan (GAG) content of the normal cadaver supraspinatus tendon was 12.3 (4.3) micrograms/mg dry weight, between three and ten times greater than in the common biceps tendon [1.2 (0.6) micrograms/mg dry weight]. The major GAG was chondroitin sulphate [6.9 (2.6) micrograms/mg dry weight], with a smaller proportion of dermatan sulphate [2.5 (1.2) micrograms/mg dry weight]. In contrast, the common biceps tendon contained predominantly dermatan sulphate [0.8 (0.2) microgram/mg dry weight] with less chondroitin sulphate [0.2 (0.2) microgram/mg dry weight]. There was no difference in the concentration of hyaluronan in these tendons [9.3 (2.8) micrograms/mg dry weight and 10.8 (4.3) micrograms/mg dry weight respectively] and there was no significant change of hyaluronan with age. Keratan sulphate was a small but significant component of the supraspinatus tendon [0.43 (0.33) microgram/mg dry weight, n = 25], whereas there was little or none in the common biceps tendon [0.04 (0.05) microgram/mg dry weight, n = 8] and there was no significant change across the age range. In the supraspinatus tendon, there was a significant decrease in total glycosaminoglycan, chondroitin sulphate and dermatan sulphate with age (p < 0.001), whether expressed relative to the tendon dry weight or total collagen content, and no change in the relative proportion of the different GAG types. There was, however, a large degree of variation within the samples. Supraspinatus tendons from patients with chronic tendinitis had a significantly increased concentration of hyaluronan [30.4 (10.1) micrograms/mg dry weight, p < 0.001], chondroitin sulphate [8.4 (1.8) micrograms/mg dry weight, p < 0.05] and dermatan sulphate [3.8 (1.1) micrograms/mg dry weight, p < 0.001] compared with normal cadaver supraspinatus tendons, although the keratan sulphate content was not significantly different [0.18 (0.05) microgram/mg dry weight]. CONCLUSIONS--The normal supraspinatus tendon has the proteoglycan/glycosaminoglycan of tendon fibrocartilage, which it is suggested is an adaptation to mechanical forces (tension, compression and shear) which act on the rotator cuff tendons in the shoulder, although other factors such as reduced vascularity, low oxygen tension and the influence of local growth factors may also be important. This functional adaptation may have important consequences for the structural strength of the supraspinatus tendon and to influence the ability of the tendon to repair after injury. The glycosaminoglycan composition of tendon specimens from patients with chronic tendinitis is consistent with acute inflammation and new matrix proteoglycan synthesis, even in relatively old tendon specimens and after at least one injection of corticosteroid. Images

Riley, G P; Harrall, R L; Constant, C R; Chard, M D; Cawston, T E; Hazleman, B L

1994-01-01

90

Biological Augmentation of Rotator Cuff Tendon Repair  

Microsoft Academic Search

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due\\u000a to abnormal or insufficient gene expression and\\/or cell differentiation at the repair site. Techniques to manipulate the biologic\\u000a events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive\\u000a growth factors and BMP-12 on

David Kovacevic; Scott A. Rodeo

2008-01-01

91

Conservative treatment and rotator cuff tear progression.  

PubMed

There is no definite consensus on the best management for patients with rotator cuff tears. No randomized controlled studies have compared the outcome of surgical versus conservative treatment. The described successful rate of conservative treatment varies widely, from 33 to 92%. Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment of rotator cuff tears, non-operative management is often recommended in such patients. Prognostic factors seem to be clinical presentation, duration of symptoms and tear size. The best programme for conservative treatment is not defined. Physical therapy consists of stretching and strengthening exercises. The characteristics of exercise programmes are not standardized. In clinical practice, intra-articular injections are commonly used for treatment of shoulder pain. Systemic pharmacotherapy for patients with shoulder pain consists of non-steroidal anti-inflammatory drugs. Recently, cyclo-oxygenase-2-selective inhibitors have been introduced for management of shoulder pain. To date, few randomized controlled trials are available on conservative management of rotator cuff tears, and therefore further studies are required to clarify its role in such patients. PMID:21986048

Longo, Umile Giuseppe; Franceschi, Francesco; Berton, Alessandar; Maffulli, Nicola; Droena, Vincenzo

2011-10-04

92

Pulmonary Embolism after Arthroscopic Rotator Cuff Repair: A Case Report  

PubMed Central

Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively.

Yamamoto, Tadashi; Tamai, Kazuya; Akutsu, Miwa; Tomizawa, Kazuo; Sukegawa, Takuya; Nohara, Yutaka

2013-01-01

93

LactoSorb plates for rotator cuff repair  

Microsoft Academic Search

Purpose: We present our preliminary studies using LactoSorb plates (Lorenz\\/Biomet, Warsaw, IN) for rotator cuff repair in humans. The use and application of this plate are described as an adjunct to prevent hole migration in trough-tunnel repairs of rotator cuff tears. Methods: Fifty patients with rotator cuff tears documented by magnetic resonance imaging underwent arthroscopic subacromial decompression followed by a

Kevin J. Kessler; Amy E. Bullens-Borrow; Jesse Zisholtz

2002-01-01

94

Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: Magnetic resonance imaging findings and clinical significance  

Microsoft Academic Search

Cystic lesions that arise adjacent to the shoulder have been reported in association with labral tears or as an unusual manifestation of massive rotator cuff tears. The purpose of this study was to define the relationship between intramuscular cysts of the rotator cuff and tears of the rotator cuff. Thirteen cases of intramuscular cysts of the rotator cuff were identified

Timothy G. Sanders; Phillip F. J. Tirman; John F. Feller; Harry K. Genant

2000-01-01

95

Disability and satisfaction after Rotator Cuff decompression or repair: a sex and gender analysis  

PubMed Central

Background Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment. Results and Discussion One hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength. Conclusions The results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals.

2011-01-01

96

Anterior superior instability with rotator cuff tearing: SLAC lesion.  

PubMed

Anterosuperior instability of the shoulder may occur from a variety of pathologic lesions. We describe a specific entity, the SLAC (superior labrum, anterior cuff) lesion that involves an association of anterior-superior labral tear with a partial supraspinatus tear. We retrospectively isolated a group of 40 patients with this lesion. The presenting complaints, physical examination findings, surgical findings, and results were isolated. Overhead activities were the most common etiology; load and shift instability testing and whipple rotator cuff testing were the most common physical examination findings. Surgical repair was successful in 37 of the 40 patients. The SLAC lesion is a definable clinical entity with predictable history, examination, surgical pathology, and satisfactory results from surgery. PMID:11888140

Savoie, F H; Field, L D; Atchinson, S

2001-07-01

97

Role of biomechanics in rotator cuff pathology: North American perspective.  

PubMed

The biomechanical properties of, and mechanical environment surrounding, the rotator cuff continue to be a research area of great interest as injury and failure of these tendons are among the most common of shoulder pathologies, with incidence increasing in older populations. Recent literature has refined our knowledge of the anatomy, the role of the various tendons in movement and shoulder stability, and structural and material properties of the human rotator cuff. Furthermore, animal models have characterized the effects of mechanical loading on rotator cuff properties, the biomechanical interactions among cuff tendons in uninjured and deficient rotator cuffs have been described, and more recent imaging studies have provided novel insights into the function of the rotator cuff in vivo. Research to advance our understanding of the biomechanical factors contributing to rotator cuff disease is needed, as the etiology, prognostic indicators, and reasons for treatment failure are poorly understood. We summarize published biomechanical literature on the rotator cuff to provide a current perspective on potential mechanisms involved in cuff pathology. PMID:21986042

Karas, Vasili; Cole, Brian J; Wang, Vincent M

2011-10-04

98

Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?  

PubMed Central

Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

Yamaguchi, Hiroshi; Suenaga, Naoki; Oizumi, Naomi; Hosokawa, Yoshihiro; Kanaya, Fuminori

2012-01-01

99

Arthroscopic repair of anterosuperior (supraspinatus\\/subscapularis) rotator cuff tears  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate the outcome of patients who underwent arthroscopic repair of anterosuperior rotator cuff tears. The null hypothesis, that there was no difference between preoperative scores and postoperative scores, was tested statistically. Type of Study: A cohort study. Methods: The preoperative and postoperative status of patients with anterosuperior rotator cuff tears was analyzed

William F. Bennett

2003-01-01

100

Arthroscopic Rotator Cuff Repair: 4- to 10Year Results  

Microsoft Academic Search

Purpose: The purpose of this article is to report the 4- to 10-year results of arthroscopic repair of full- thickness rotator cuff tears. Type of Study: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. Methods: Retrospective chart reviews and telephone interviews were performed to

Eugene M. Wolf; William T. Pennington; Vivek Agrawal

2004-01-01

101

Management of Rotator Cuff and Impingement Injuries in the Athlete  

Microsoft Academic Search

Objective: To review current concepts of the pathophysiol- ogy, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regard- ing rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the

Gerald R. Williams; Martin Kelley

2000-01-01

102

Calcifying tendinitis of the rotator cuff with cortical bone erosion  

Microsoft Academic Search

Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and

Roxanne Chan; David H. Kim; Peter J. Millett; Barbara N. Weissman

2004-01-01

103

The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears  

Microsoft Academic Search

We measured the incidence of cuff retear and injury to the suprascapular nerve after mobilization and repair of a massive rotator cuff tear. Of one hundred four rotator cuff repairs performed over a 5-year period, 10 patients (7 men and 3 women, age range 22 to 68 years) had primary repairs of massive rotator cuff tears requiring cuff mobilization and

Robert M. Zanotti; James E. Carpenter; Ralph B. Blasier; Mary Lou V. H. Greenfield; Ronald S. Adler; Mark B. Bromberg

1997-01-01

104

Performance After Rotator Cuff Tear and Operative Treatment: A Case-Control Study of Major League Baseball Pitchers  

PubMed Central

Context: Little is known about pitching performance or lack of it among Major League Baseball (MLB) pitchers who undergo operative treatment of rotator cuff tears. Objective: To assess pitching performance outcomes in MLB players who needed operative treatment of rotator cuff tears and to compare performance in these athletes with that in a control group of MLB players. Design: Case-control study. Setting: Publicly available player profiles, press releases, and team injury reports. Patients or Other Participants: Thirty-three MLB pitchers with documented surgery to treat rotator cuff tears and 117 control pitchers who did not have documented rotator cuff tears were identified. Main Outcome Measure(s): Major League Baseball pitching attrition and performance variables. Results: Players who underwent rotator cuff surgery were no more likely not to play than control players. Performance variables of players who underwent surgery improved after surgery but never returned to baseline preoperative status. Players who needed rotator cuff surgery typically were more experienced and had better earned run averages than control players. Conclusions: Pitchers who had symptomatic rotator cuff tears that necessitated operative treatment tended to decline gradually in performance leading up to their operations and to improve gradually over the next 3 seasons. In contrast to what we expected, they did not have a greater attrition rate than their control counterparts; however, their performances did not return to preoperative levels over the course of the study.

Namdari, Surena; Baldwin, Keith; Ahn, Albert; Huffman, G. Russell; Sennett, Brian J.

2011-01-01

105

Outcomes after arthroscopic rotator cuff repairs.  

PubMed

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic. PMID:17011216

Lee, Edward; Bishop, Julie Y; Braman, Jonathan P; Langford, Joshua; Gelber, Jonathan; Flatow, Evan L

2006-09-29

106

Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy.  

PubMed

Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24-48 months), and the average age was 71 years (range, 57-84 years). Of these 14 patients, 9 were men and 5 women. None of these patients had undergone previous shoulder surgery, and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Preoperatively, the average active forward flexion was 30 degrees, active external rotation was 10 degrees, and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperatively, the average active forward flexion improved to 88 degrees, active external rotation increased to 37 degrees, and the ASES score improved to 80 points. Of the 14 patients, 12 stated that they had no pain with activities of daily living. Two patients continued to have moderate pain in everyday activity. PMID:12629606

Sarris, Ioannis K; Papadimitriou, Nicholas G; Sotereanos, Dean G

2003-02-01

107

When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears  

Microsoft Academic Search

Background: Despite advances in arthroscopic repair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to

Bruce S. Miller; Brian K. Downie; Robert B. Kohen; Theresa Kijek; Bryson Lesniak; Jon A. Jacobson; Richard E. Hughes; James E. Carpenter

2011-01-01

108

Post-operative rehabilitation after surgical repair of the rotator cuff  

Microsoft Academic Search

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions\\u000a of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different\\u000a kinds of sports, and who have widely different expectations in terms of recovery of functions and pain

Marco Conti; Raffaele Garofalo; Giacomo Delle Rose; Giuseppe Massazza; Enzo Vinci; Mario Randelli; Alessandro Castagna

2009-01-01

109

Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement.  

PubMed

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. PMID:23401583

Nazarian, Levon N; Jacobson, Jon A; Benson, Carol B; Bancroft, Laura W; Bedi, Asheesh; McShane, John M; Miller, Theodore T; Parker, Laurence; Smith, Jay; Steinbach, Lynne S; Teefey, Sharlene A; Thiele, Ralf G; Tuite, Michael J; Wise, James N; Yamaguchi, Ken

2013-02-11

110

Rotator cuff injuries in baseball. Prevention and rehabilitation.  

PubMed

Rotator cuff and ligamentous capsule injuries are common in the young baseball player. In order to understand these injuries, it is important to first appreciate the delicate balance between shoulder mobility and stability as well as the biomechanics of throwing. This background information makes it easy to see how shoulder injuries are really part of a progressive continuum beginning with instability leading to subluxation, and later impingement which can result in a rotator cuff tear. A detailed and precise history and physical is crucial in determining where a patient might be on the continuum. An accurate evaluation will also help appropriately place a patient in one of the following 4 groups: pure impingement, anterior instability due to trauma with secondary impingement, anterior stability due to a hyperelasticity with secondary impingement, and pure anterior instability. A kinesiological repair is the initial treatment of choice. It is the best preventative or early treatment available, and consists of a specific strengthening programme. If this fails (as in only 5 to 10% of the cases), an anatomical repair is instituted. There are 4 basic guidelines when doing this surgery: (a) maintain muscle attachments and proprioceptive fibres; (b) do not shorten the capsule significantly; (c) build up the anterior labrum; and (d) regain full range of motion quickly through abduction splinting and rehabilitation. A postoperative rehabilitation programme is then diligently adhered to, as it is at least as important as the surgery itself. PMID:3231953

Jobe, F W; Bradley, J P

1988-12-01

111

Calcific Tendinitis of the Rotator Cuff: A Review  

PubMed Central

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences.

Kachewar, Sushil G; Kulkarni, Devidas S

2013-01-01

112

Calcific tendinitis of the rotator cuff: a review.  

PubMed

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non - operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non - steroidal anti - inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non - operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short - wave, and radiation therapy. Rest, immobilization with a sling, and oral non - steroidal and steroid anti - inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102

Kachewar, Sushil G; Kulkarni, Devidas S

2013-07-01

113

Differential Suture Loading in an Experimental Rotator Cuff Repair  

Microsoft Academic Search

Background: Repairs of large rotator cuff tears often fail to heal. A possible factor in these failures is excessive tension in the repair sutures, causing them to pull through the tendon.Hypothesis: Arm positions encountered during early rehabilitation after cuff repair can dramatically increase the relative tension in the different sutures of the cuff repair.Study Design: Controlled laboratory study.Methods: In a

Christopher Howe; Philippe Huber; Fredric M. Wolf; Frederick Matsen

2009-01-01

114

Strength after surgical repair of the rotator cuff.  

PubMed

Forty-two consecutive patients (20 men and 22 women, age range 39 to 78 years) with full-thickness rotator cuff tears underwent a comprehensive isokinetic strength assessment before and at 3-month intervals for 1 year after surgery. All patients underwent acromioplasty and rotator cuff repair and were treated with a standardized postoperative rehabilitation program. Isokinetic strength testing was performed in flexion/extension, abduction/adduction, and external/internal rotation at 60 degrees/sec. The unaffected contralateral shoulder was tested for comparison. Clinical outcomes were assessed with the University of California Los Angeles Shoulder Rating Scale (maximum = 35 points). The average University of California Los Angeles score was 31.2 by 1 year after operation. Patients with small and medium tears had an average rating of 33.5, whereas those with large and massive tears had an average score of 28.3. Strength increased gradually during the first postoperative year. The preoperative mean peak torque was 54%, 45%, and 64% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively; after operation it increased to 78%, 80%, and 79% by 6 months and 84%, 90%, and 91% by 12 months. The greatest improvement in strength consistently occurred during the first 6 months after surgery. Patients also showed marked increases in both work and power. By 12 months after operation mean work had increased to 70% in flexion and abduction and 90% in external rotation of the uninvolved shoulder. Similarly, mean power had increased to 68%, 79%, and 90% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively, by 12 months after operation. Recovery of strength correlated primarily with the size of the tear: for small and medium tears recovery of strength was almost complete during the first year, and for large and massive tears it was much slower and less consistent. By using isokinetic strength evaluation we found that recovery of strength after rotator cuff repair requires at least 1 year of rehabilitation. PMID:8919437

Rokito, A S; Zuckerman, J D; Gallagher, M A; Cuomo, F

115

Management of Rotator Cuff and Impingement Injuries in the Athlete  

PubMed Central

Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.

Williams, Gerald R.; Kelley, Martin

2000-01-01

116

Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears  

Microsoft Academic Search

Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires

Shane J. Nho; Demetris Delos; Hemang Yadav; Michael Pensak; Anthony A. Romeo; Russell F. Warren; John D. MacGillivray

2010-01-01

117

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease  

Microsoft Academic Search

Background  Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat\\u000a a variety of problems. Although its use has expanded substantially since the FDA’s approval in 2004, the appropriateness in\\u000a patients with rotator cuff disease is unclear.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We review the use of RTSA in patients with rotator cuff disease to (1) describe

Gregory N. Drake; Daniel P. O’Connor; T. Bradley Edwards

2010-01-01

118

TREATMENT OPTIONS IN FULL THICKNESS ROTATOR CUFF TEARS  

Microsoft Academic Search

Increasing interest in shoulder pathology during the last decades has considerably diversified the possible treatment options of full thickness rotator cuff tears. This review of the recent literature combined with information gathered during recent European shoul- der meetings attempts to summarize present trends. Every full thickness cuff tear, except for the acute traumatic tear in younger patients, should always benefit

F. W. J. HANDELBERG

2001-01-01

119

Rotator Cuff Damage: Reexamining the Causes and Treatments.  

ERIC Educational Resources Information Center

|Sports medicine specialists are beginning to reexamine the causes and treatments of rotator cuff problems, questioning the role of primary impingement in a deficient or torn cuff and trying new surgical procedures as alternatives to the traditional open acromioplasty. (Author/CB)|

Nash, Heyward L.

1988-01-01

120

Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

Microsoft Academic Search

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup.\\u000a We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three\\u000a cohorts of patients had repair of a symptomatic

Neal L. Millar; Xiao Wu; Robyn Tantau; Elizabeth Silverstone; George A. C. Murrell

2009-01-01

121

Patterns of Vascular and Anatomical Response After Rotator Cuff Repair  

Microsoft Academic Search

Background: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion.Purpose: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded

Stephen Fealy; Ronald S. Adler; Mark C. Drakos; Anne M. Kelly; Answorth A. Allen; Frank A. Cordasco; Russell F. Warren; Stephen J. OBrien

2006-01-01

122

Current evidence for effectiveness of interventions to treat rotator cuff tears.  

PubMed

In this systematic review we assessed effectiveness of non-surgical and (post)surgical interventions for symptomatic rotator cuff tears (RotCuffTear). The Cochrane Library, PubMed, Embase, Cinahl, and Pedro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently selected relevant studies, extracted data and assessed the methodological quality. Three Cochrane reviews (7 RCTs) and 14 RCTs were included (3 non-surgery, 10 surgery, 8 post-surgery). For small or medium RotCufftears, moderate evidence was found in favour of surgery versus physiotherapy in mid- and long-term. In surgery, tendon-to-bone fixation with one metal suture anchor loaded with double sutures (TB) was more effective (moderate evidence) than a side-to-side repair with permanent sutures (SS) in the mid- and long-term; limited evidence for effectiveness was found in favour of debridement versus anchor replacement and suture repair of the type II SLAP tear in the long-term. Further, no evidence was found in favour of any non-surgical, surgical or post-surgical intervention. In conclusion, although surgery seems to give better results compared to non-surgery and TB is more effective than SS in rotator cuff repair (RCR), it remains hard to draw firm evidence-based conclusions for effectiveness of non-surgical or (post)surgical interventions to treat RotCuffTears. More research is clearly needed. PMID:21146445

Huisstede, Bionka M A; Koes, Bart W; Gebremariam, Lukas; Keijsers, Ellen; Verhaar, Jan A N

2010-12-10

123

Massive Rotator Cuff Tear in an Adolescent Athlete  

PubMed Central

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia (“stinger” or “burner”). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.

Turman, Kimberly A.; Anderson, Mark W.; Miller, Mark D.

2010-01-01

124

Rotator cuff repair with periosteum for enhancing tendon–bone healing: a biomechanical and histological study in rabbits  

Microsoft Academic Search

During rotator cuff repair surgery, fixation and incorporation of ruptured rotator cuff tendon into the bone is a major concern.\\u000a The repair usually fails at the tendon–bone interface, especially in cases where the tear is massive. The periosteum contains\\u000a multipotent stem cells that have the potential to differentiate into osteogenic and chondrogenic tissues, which may restore\\u000a the original structure at

Chih-Hsiang Chang; Chih-Hwa Chen; Chun-Yi Su; Hsien-Tao Liu; Chung-Ming Yu

2009-01-01

125

Cup arthroplasty for rotator cuff tear arthropathy.  

PubMed

Cup arthroplasty is a conservative bone-sparing option for resurfacing of the humeral head. Earlier reports have shown its effectiveness in appropriately selected patients with osteoarthritis, osteonecrosis, and severe rheumatoid arthritis. Patients with cuff tear arthropathy may also benefit from a modified cup arthroplasty technique. The purpose of this article is to describe the surgical technique involved in humeral cup arthroplasty in cuff tear arthropathy patients. We will review the indications, contraindications, complications, and postoperative rehabilitation. PMID:21358516

Mariscalco, Michael W; Patterson, Ryan W; Seitz, William H

2011-03-01

126

Subdeltoid lipoma arborescens combined with rotator cuff tears.  

PubMed

Lipoma arborescens, a rare benign intra-articular lesion, is characterized by lipomatous proliferation of the synovium in which the subsynovial tissue is replaced by mature adipocytes. Subdeltoid bursa is a rare location for lipoma arborescens, and only a few cases have been reported in the literature. This article reports 2 cases of subdeltoid lipoma arborescens combined with rotator cuff tears, and the possible relationships between subdeltoid lipoma arborescens and rotator cuff tears are discussed. The intra-articular villous proliferations on fat-suppressed T2-weighted magnetic resonance imaging appeared as yellowish-white lipomatous villous proliferations on arthroscopy, and finger-like lipomatous proliferation of the synovium, where the subsynovial connective tissue is replaced by mature adipocytes, on histology. Although further evidence would be necessary, the bony proliferations, in addition to bone-to-bone abrasion and inflammatory processes, may contribute to the relationship between subdeltoid lipoma arborescens and rotator cuff tears. Because this is a rare disease in a rare location, no established treatment guidelines are available for lipoma arborescens in subdeltoid bursa. For the current patients, arthroscopic excision of the lipoma arborescens and concomitant rotator cuff repair were prescribed after more than 6 months of conservative management. All patients had symptom relief and were satisfied with their results. Paying special attention to the radiologic and arthroscopic characteristics of the lipoma arborescens will help physicians and surgeons to achieve a more accurate diagnosis and effective treatment strategy, especially in patients with concomitant rotator cuff tears. PMID:23937762

Kim, Min-Hyung; Chung, Seok Won; Yoon, Jong Pil; Kim, Sae Hoon; Oh, Joo Han

2013-08-01

127

Rotator Cuff Tear Pain and Tear Size and Scapulohumeral Rhythm  

PubMed Central

Context: The body of knowledge concerning shoulder kinematics in patients with rotator cuff tears is increasing. However, the level of understanding regarding how pain and tear size affect these kinematic patterns is minimal. Objective: To identify relationships between pain associated with a full-thickness rotator cuff tear, tear size, and scapulohumeral rhythm (SHR) and to determine whether pain and tear size serve as predictors of SHR. Design: A test-retest design was used to quantify pain and SHR before and after a subacromial lidocaine injection. Correlation and multivariate analyses were used to identify relationships among pain, tear size, and SHR. Setting: Orthopaedic biomechanics research laboratory. Patients or Other Participants: Fifteen patients (age range, 40–75 years) with diagnosed full-thickness rotator cuff tears participated. They were experiencing pain at the time of testing. Intervention(s): Shoulder kinematic data were collected with an electromagnetic tracking system before and after the patient received a lidocaine injection. Main Outcome Measure(s): Pain was rated using a visual analog scale. Three-dimensional scapular kinematics and glenohumeral elevation were assessed. Scapular kinematics included anterior-posterior tilt, medial-lateral tilt, and upward-downward rotation. A regression model was used to calculate SHR (scapular kinematics to glenohumeral elevation) for phases of humeral elevation and lowering. Results: Linear relationships were identified between initial pain scores and SHR and between tear size and SHR, representing an increased reliance on scapular motion with increasing pain and tear size. Pain was identified as an independent predictor of SHR, whereas significant findings for the effect of tear size on SHR and the interaction between pain and tear size were limited. Conclusions: We noted an increased reliance on scapular contributions to overall humeral elevation with increasing levels of pain and rotator cuff tear size. Pain associated with a rotator cuff tear serves as a primary contributor to the kinematic patterns exhibited in patients with rotator cuff tears.

Scibek, Jason S; Carpenter, James E; Hughes, Richard E

2009-01-01

128

Development of Fatty Atrophy After Neurologic and Rotator Cuff Injuries in an Animal Model of Rotator Cuff Pathology  

PubMed Central

Background: Detachment of a tendon from its osseous insertion, as can be the case with severe rotator cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a rotator cuff injury model in the rabbit and to test the hypothesis that tenotomy of a rotator cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle. Methods: New Zealand white rabbits were divided into three groups: (1) partial rotator cuff tear without retraction of the muscle, (2) complete rotator cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury. Results: At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury. Conclusions: This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with rotator cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic rotator cuff tears may induce a neurologic injury. Clinical Relevance: Chronic rotator cuff injuries are associated with neuronal injury of the affected muscle. As such, neuronal injury may explain the histopathologic changes that have been observed following chronic rotator cuff tears.

Rowshan, Kasra; Hadley, Scott; Pham, Khoa; Caiozzo, Vince; Lee, Thay Q.; Gupta, Ranjan

2010-01-01

129

Evaluation of cartilage degeneration in a rat model of rotator cuff tear arthropathy.  

PubMed

BACKGROUND AND HYPOTHESIS: Rotator cuff tears are the most common injury seen by shoulder surgeons. Glenohumeral osteoarthritis develops in many late-stage rotator cuff tear patients as a result of torn cuff tendons, termed "cuff tear arthropathy." However, the mechanisms of cuff tear arthropathy have not been fully established. It has been hypothesized that a combination of synovial and mechanical factors contribute equally to the development of cuff tear arthropathy. The goal of this study was to assess the utility of this model in investigating cuff tear arthropathy. MATERIALS AND METHODS: We used a rat model that accurately reflects rotator cuff muscle degradation after massive rotator cuff tears through either infraspinatus and supraspinatus tenotomy or suprascapular nerve transection. Using a modified Mankin scoring system, we found significant glenohumeral cartilage damage after both rotator cuff tenotomy and suprascapular nerve transection after only 12 weeks. RESULTS: Cartilage degeneration was similar between groups and was present on both the humeral head and the glenoid. Denervation of the supraspinatus and infraspinatus muscles without opening the joint capsule caused cartilage degeneration similar to that found in the tendon transection group. CONCLUSIONS: Our results suggest that altered mechanical loading after rotator cuff tears is the primary factor in cartilage degeneration after rotator cuff tears. Clinically, understanding the process of cartilage degeneration after rotator cuff injury will help guide treatment decisions in the setting of rotator cuff tears. PMID:23664745

Kramer, Erik J; Bodendorfer, Blake M; Laron, Dominique; Wong, Jason; Kim, Hubert T; Liu, Xuhui; Feeley, Brian T

2013-05-01

130

Normal isometric strength of rotator cuff muscles in adults  

PubMed Central

Objectives The most prevalent disorders of the shoulder are related to the muscles of rotator cuff. In order to develop a mechanical method for the evaluation of the rotator cuff muscles, we created a database of isometric force generation by the rotator cuff muscles in normal adult population. We hypothesised the existence of variations according to age, gender and dominancy of limb. Methods A total of 400 healthy adult volunteers were tested, classified into groups of 50 men and women for each decade of life. Maximal isometric force was measured at standardised positions for supraspinatus, infraspinatus and subscapularis muscles in both shoulders in every person. Torque of the force was calculated and normalised to lean body mass. The profiles of mean torque-time curves for each age and gender group were compared. Results Our data showed that men gradually gained maximal strength in the fifth decade, and showed decreased strength in the sixth. In women the maximal strength was gained in the fourth decade with gradual decline to the sixth decade of life. The dominant arm was stronger in most of the tested groups. The torque profiles of the rotator cuff muscles in men at all ages were significantly higher than that in women. Conclusions We found previously unrecognised variations of rotator cuff muscles’ isometric strength according to age, gender and dominancy in a normal population. The presented data may serve as a basis for the future studies for identification of the abnormal patterns of muscle isometric strength in patients with pathology of the rotator cuff muscles. Cite this article: Bone Joint Res 2013;2:214–19.

Chezar, A.; Berkovitch, Y.; Haddad, M.; Keren, Y.; Soudry, M.; Rosenberg, N.

2013-01-01

131

Arthroscopic technique for patch augmentation of rotator cuff repairs.  

PubMed

The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears. PMID:17027416

Labbé, Marc R

2006-10-01

132

Degenerative rotator cuff tear in an elderly athlete: a case report  

Microsoft Academic Search

The incidence of rotator cuff tear increases with age. Degenerative rotator cuff tears are commonly seen in athletes above 40 years. These athletes are commonly involved in overhead activities. Repetitive microtrauma is a more important factor in rotator cuff degeneration than acute trauma. Conservative treatment is the mainstay treatment for these injuries. A case report of an elderly athlete who

Mohsen Kazemi

1999-01-01

133

Operative repair of anterior instability and rotator cuff tears in athletes  

Microsoft Academic Search

Rotator cuff tears in individuals under age 40 are uncommon; especially rare is the younger patient with acombination of full thickness rotator cuff tear and a Bankart lesion. Operative management of this challenging patient must provide for a “stable” repair of both lesions to allow for optimal rehabilitation. Our surgical preference includes arthroscopic subacromial decompression, rotator cuff repair, and a

Kenneth Brislin; David Rubenstein; Merrick Wetzler; Christian Subbio

2002-01-01

134

A Biomechanical Analysis of Rotator Cuff Deficiency in a Cadaveric Model  

Microsoft Academic Search

We conducted this cadaveric study to define a biome chanical rationale for rotator cuff function in several deficiency states. A dynamic shoulder testing appara tus was used to examine change in middle deltoid muscle force and humeral translation associated with simulated rotator cuff tendon paralyses and various sizes of rotator cuff tears. Supraspinatus paralysis re sulted in a significant increase

William O. Thompson; Richard E. Debski; N. Douglas Boardman; Emin Taskiran; Jon J. P. Warner; Freddie H. Fu; Savio L.-Y. Woo

1996-01-01

135

Validation of the western ontario rotator cuff index in patients with arthroscopic rotator cuff repair: A study protocol  

Microsoft Academic Search

Background  Arthroscopic rotator cuff repair is described as being a successful procedure. These results are often derived from clinical\\u000a general shoulder examinations, which are then classified as 'excellent', 'good', 'fair' or 'poor'. However, the cut-off points\\u000a for these classifications vary and sometimes modified scores are used.\\u000a \\u000a \\u000a Arthroscopic rotator cuff repair is performed to improve quality of life. Therefore, disease specific health-related

Ronald N Wessel; Tjoan E Lim; Henk van Mameren; Rob A de Bie

2011-01-01

136

Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology.  

PubMed

We sought to determine the accuracy of ultrasound for the preoperative evaluation of shoulder impingement syndrome, rotator cuff tear, and abnormalities of the long head of the biceps tendon. The findings in 42 consecutive surgical cases were compared with the preoperative sonographic readings. Ultrasound detected all of the 10 full-thickness cuff tears identified at surgery (sensitivity 1.0, specificity 0.97) but detected only 6 of 13 partial-thickness cuff tears (sensitivity 0.46, specificity 0.97). A full-thickness tear was falsely diagnosed in one case of severe cuff abrasion. Dynamic scan criteria correctly diagnosed impingement in 27 of 34 cases (sensitivity 0.79, positive predictive value 0.96). Abnormalities of the long head of the biceps were accurately diagnosed with the exception of low-grade tendinitis and the superior labral tear, anterior to posterior, lesion. We concluded that ultrasound is a sensitive and accurate method of identifying patients with full-thickness tears of the rotator cuff, extracapsular biceps tendon pathology, or both. Dynamic ultrasound can help confirm, but not exclude, a clinical diagnosis of impingement. PMID:9658352

Read, J W; Perko, M

137

Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature.  

PubMed

Full-thickness rotator cuff tears are common. When symptomatic, they can affect quality of life. Surgical repair might improve patients' overall health. We systematically reviewed postoperative outcomes in 10 studies comparing mini-open repair and all-arthroscopic repair techniques. Data regarding patient demographics, rotator cuff pathology, postoperative rehabilitation protocols, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, pain scores, and incidence of recurrent defects were extracted. There were no statistically significant differences between groups within each study in terms of these data points. One study found decreased pain 6 months after surgery in the all-arthroscopic group versus the miniopen repair group. This systematic literature review indicates there is no statistically significant difference in postoperative ASES, UCLA, or pain scores or incidence of recurrent rotator cuff tears in rotator cuffs repaired all-arthroscopically versus using the mini-open technique. However, there might be decreased short-term pain in patients who undergo arthroscopic repairs. PMID:21720577

Lindley, Kenneth; Jones, Grant L

2010-12-01

138

Do Outcomes Differ after Rotator Cuff Repair for Patients Receiving Workers' Compensation?  

PubMed Central

Comparisons of outcomes after rotator cuff repair between Worker’s Compensation Board (WCB) recipients and nonrecipients generally do not consider patient, injury, and shoulder characteristics. We compared preoperative differences between WCB recipients and nonrecipients and determined the impact on their 6-month postoperative outcome. We evaluated a prospective cohort of 141 patients with full-thickness rotator cuff tears, 36 of whom (26%) were WCB recipients, preoperatively and 3 and 6 months after rotator cuff repair. Their mean age was 54.0 ± 10.4 years (standard deviation) and 102 (72%) patients were male. Shoulder range of motion, Western Ontario Rotator Cuff (WORC) index, and American Shoulder and Elbow Surgeons’ score were used to evaluate outcomes. We performed regression analyses to control for baseline differences in age, baseline scores, smoking status, symptom duration, injury type, and associated biceps disorder between WCB recipients and nonrecipients. WCB recipients were younger and more likely to smoke, have a traumatic injury, and undergo surgery within 6 months of injury. WCB recipients had lower recovery for all outcomes when these differences were not considered but when differences were accounted for, only 6-month WORC scores were lower in WCB recipients. Clinicians should consider preoperative characteristics before concluding WCB recipients experience less recovery after surgical repair. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Balyk, R.; Luciak-Corea, C.; Otto, D.; Baysal, D.

2008-01-01

139

Open techniques for repair of largeand massive rotator cuff tears  

Microsoft Academic Search

Rotator cuff tears can be a significant source of shoulder pain and weakness. Repair of full-thickness tears canimprove patient satisfaction and functional outcome. Several repair techniques have been described in the literature; these include arthroscopic and open approaches. Although arthroscopic repair has been popularized in the recent literature, it may not be optimal for some cases of large or massive

Bernard C. Ong; Jon K. Sekiya; Mark W. Rodosky

2002-01-01

140

The influence of acromioclavicular joint morphology on rotator cuff tears  

Microsoft Academic Search

A detailed anatomic study of 123 shoulders was performed to define the location of the acromioclavicular (AC) joint within the supraspinatus outlet and to determine the correlation of AC joint morphologic characteristics with the presence of full-thickness rotator cuff tears (RCTs). The presence, location, and extent of RCTs were first documented for each shoulder, and 2 anatomic landmarks consisting of

Frances Cuomo; Frederick J. Kummer; Joseph D. Zuckerman; Thomas Lyon; Benjamin Blair; Todd Olsen

1998-01-01

141

Conservative management of rotator cuff tears: literature review and proposal for a prognostic. Prediction Score  

PubMed Central

Summary Rotator cuff tears are a common cause of pain and shoulder dysfunction. The prevalence of the rotator cuff tears increases with the age reaching the 80% in patients aged more than 80 year. Symptomatic shoulders usually are initially treated conservatively and then, in case of poor outcomes, with surgery. Different parameters are still used to decide between the conservative or surgical treatment in patients with rotator cuff tears. Aim of the current study is to characterize the various features used in decision making and to validate a “Prediction Score” that let us know which patients could have a good and stable outcome with non operative treatment. We enrolled 60 patients (mean age 52 years) with symptomatic rotator cuff tears who were assigned to conservative treatment and were evaluated at 6,9 and 12 months follow-up. We developed a score based on 18 clinical and radiographic parameters. 27 patients (“non conservative”) (45%) with a mean prediction score of 16.1 ± 1.7 interrupted the conservative treatment, while 33 patients (“conservative”) (55%) with an average prediction score of 11.3 ± 1.8 remained conservatively treated at last follow-up. The conservative patients were 14 years older than non conservative patients. According to the results of this study we identified a value of 13 points as a “cut-off” score to predict good results by conservative management of rotator cuff tear. These outcomes support the assumption that a predictive prognostic score may guarantee a rational approach in the management of subjects with RC tears, especially in elderly who continue to have the higher rate of recurrence and therefore could be well treated with standard conservative therapies.

Merolla, Giovanni; Paladini, Paolo; Saporito, Marco; Porcellini, Giuseppe

2011-01-01

142

Latissimus dorsi transfer for treatment of irreparable rotator cuff tears.  

PubMed

Massive rotator cuff tendon ruptures are not uncommon in older patients. We propose the transfer of the latissimus dorsi muscle for treatment of irreparable ruptures associated with functional impairment and chronic pain. Five women and 11 men were so treated and reviewed with an average follow-up of 26 months. The mean age was 60 years. Four patients also had subscapularis deficiency. Results were assessed with the Constant score and the Oxford shoulder score. Humeral head position was analysed. Statistical analysis was performed by the Wilcoxon non-parametrical test. The Constant score increased by 24.2% (p?=?0.001) with all parameters showing improvement. Nine patients showed improved humeral head positioning in internal rotation. Three of four patients with a deficient subscapularis had unfavourable results. Latissimus dorsi transfer for the treatment of irreparable massive rotator cuff tears leads to a substantial clinical improvement. An intact subscapularis tendon is mandatory. PMID:20155494

Weening, Alexander A; Willems, W Jaap

2010-02-16

143

Arthroscopic Versus Mini-open Rotator Cuff RepairA Comprehensive Review and Meta-analysis  

Microsoft Academic Search

Background: Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs.Hypothesis: There is no difference between the clinical results obtained from all arthroscopic rotator

Kenneth Morse; A. David Davis; Robert Afra; Elizabeth Krall Kaye; Anthony Schepsis; Ilya Voloshin

2008-01-01

144

Fatty Infiltration and Atrophy of the Rotator Cuff Do Not Improve After Rotator Cuff Repair and Correlate With Poor Functional Outcome  

Microsoft Academic Search

Background: The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood. In addition, the reversibility of these changes with repair of the tendons is questionable.Hypothesis: Poorer preoperative muscle quality negatively affects outcome, and a successful outcome (in terms of a

James N. Gladstone; Julie Y. Bishop; Ian K. Y. Lo; Evan L. Flatow

2007-01-01

145

Chronic rotator cuff impingement in the throwing athlete.  

PubMed

Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability. PMID:64122

Jackson, D W

146

Arthroscopic management of recalcitrant stiffness following rotator cuff repair: A retrospective analysis  

PubMed Central

Background: Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair. Materials and Methods: Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24?70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2?36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1?43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test. Results: Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110?180° SD 22.3°), and ERS improved to 58.9°, (range 15?90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion. Conclusion: Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair.

Bhatia, Sanjeev; Mather, Richard C; Hsu, Andrew R; Ferry, Amon T; Romeo, Anthony A; Nicholson, Gregory P; Cole, Brian J; Verma, Nikhil N

2013-01-01

147

Rotator Cuff and Shoulder Conditioning Program  

MedlinePLUS

... your back or lock your knees. 2. Crossover Arm Stretch _____________________________________________________________ Main muscles worked: Posterior deltoid You should ... together as you pull. 7. External Rotation With Arm Abducted 90° ___________________________________________ Main muscles worked: Infraspinatus and teres ...

148

Rotator Cuff Tears: Surgical Treatment Options  

MedlinePLUS

... program will help you regain shoulder strength and motion. Immobilization After surgery, therapy progresses in stages. At ... you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist ...

149

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures  

PubMed Central

Background Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff (WORC) index, in relation to one another and to other joint and limb specific measures in the same population of the patients suffering from rotator cuff pathology. Methods Participants enrolled were consecutive patients who received physical therapy for management of impingement syndrome or received treatment following rotator cuff repair, acromioplasty or decompression surgeries. All subjects received physical therapy treatment and completed four outcome measures at 3 single points (initial, interim, and final). Cross-sectional convergent validity was assessed at each of the 3 time-points by correlating the WORC and RC-QOL's scores to each other and to two alternative scales; a joint-specific scale, the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and a limb-specific measure, the Upper Extremity Functional Index (UEFI). Non-parametric statistics (Spearman's rho and Wilcoxon-Mann-Whitney tests) examined the construct validity. The standardized response mean (SRM) was used to examine sensitivity to change. Results Forty-one participants entered the study and their scores were compared at 3 cross sectional single points. The correlation coefficients among the 4 measures varied from 0.60 to 0.91. Correlation between corresponding domains of the WORC and RC-QOL varied from 0.45 to 0.85. The known group validity was not significantly different among individual sub-scores and total scores. The final SRMs were (1.42), (1.43), (1.44), and (1.54) for the ASES, RCQOL, WORC, and UEFI respectively. Conclusion The WORC and RC-QOL exhibit similar cross-sectional convergent validity in patients suffering from rotator cuff pathology. The sensitivity to change was very close among all scores, with the UEFI having the highest sensitivity. Further research is needed to examine the extent to which each physical or emotional domain contributes to prognostic or therapeutic decision-making.

Razmjou, Helen; Bean, Andrea; van Osnabrugge, Varda; MacDermid, Joy C; Holtby, Richard

2006-01-01

150

The derotation sign for perioperative diagnosis of significant partial-thickness rotator cuff tears  

Microsoft Academic Search

Purpose: To describe and evaluate a simple perioperative test (the derotation sign) that differentiates significant (grade 3) partial-thickness and small full-thickness rotator cuff tears from insignificant (grades 1 and 2) partial-thickness rotator cuff tears and intact rotator cuffs. Type of Study: Sensitivity and specificity study. Methods: A study was conducted of 123 patients who underwent shoulder arthroscopy for chronic symptomatic

David E. Attarian

2002-01-01

151

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation  

Microsoft Academic Search

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness\\u000a and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including\\u000a a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically\\u000a intact rotator cuff tendons were

S. Waldt; M. Bruegel; D. Mueller; K. Holzapfel; A. B. Imhoff; E. J. Rummeny; K. Woertler

2007-01-01

152

Repair of Full-Thickness Rotator Cuff Tears in Professional Baseball Players  

Microsoft Academic Search

Background: Despite the relative frequency of partial-thickness rotator cuff tears seen in baseball players, full-thickness rotator cuff tears in baseball players are uncommon.Hypothesis: Return to competitive baseball is difficult after surgical treatment of a full-thickness rotator cuff tear.Study Design: Case series; Level of evidence, 4.Methods: We evaluated the results of 16 professional baseball players after a mini-open repair of a

Christopher G. Mazoué; James R. Andrews

2006-01-01

153

Arthroscopic Single-Row Versus Double-Row Suture Anchor Rotator Cuff Repair  

Microsoft Academic Search

Background: Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair.Purpose: To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques.Hypothesis: Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to

Augustus D. Mazzocca; Peter J. Millett; Carlos A. Guanche; Stephen A. Santangelo; Robert A. Arciero

2005-01-01

154

Nonarthroplasty options for the management of massive and irreparable rotator cuff tears.  

PubMed

Massive, irreparable rotator cuff tears remain a clinical challenge. In low-demand patients, debridement of the tear may relieve pain. Partial repair using the technique of margin convergence decreases the size of the tear gap and reduces strain. Biceps tenotomy or tenodesis has a role in providing pain relief in massive rotator cuff tears. Tendon transfers offer good results in patients with massive, irreparable rotator cuff tears. The treatment modality specifically chosen for the massive, irreparable rotator cuff tear must be tailored to the individual patient, their needs and expectations, and their ability to comply with intensive rehabilitation. PMID:23040556

Delaney, Ruth A; Lin, Albert; Warner, Jon J P

2012-10-01

155

Clinical and radiographic factors influencing the results of revision rotator cuff repair  

PubMed Central

Purpose: Historically, results of open revision of rotator cuff repair have been mixed and often poor. We reviewed the outcomes of revision rotator cuff repair with a detailed analysis of clinical and radiographic risk factors in order to improve patient selection for this type of surgery. Materials and Methods: Thirty-six patients (37 shoulders) underwent first-time, open revision rotator cuff repair between 1995 and 2005. Average follow-up was 7.0 years (range 1-14.9 years). The tear size was small in 1 shoulder, medium in 8, large in 22 and massive in 6. Associations of 29 clinical and radiographic factors with the outcomes of pain, motion, and function were assessed. Results: Satisfactory outcome occurred in 22 shoulders (59%): An excellent result in 2, a good result in 7, and a fair result in 13. Unsatisfactory, poor results occurred in 15. Pain was substantially reduced in 25 (68%). Median pain scores decreased to five from a pre-operative eight (P = 0.002). Median motion did not change from pre-operative to post-operative. The chance of a satisfactory outcome and improved post-operative motion were associated with males, greater pre-operative motion, increased acromial humeral distance, the absence of glenohumeral arthritis, or a degenerative re-tear. Conclusions: Revision rotator cuff repair, although a safe operation, with a low re-operative rate, has very mixed overall results. By knowing the factors associated with success, surgeons can better counsel patients and with this increased knowledge, consider alternative treatment choices.

Hartzler, Robert U.; Sperling, John W.; Schleck, Cathy D.; Cofield, Robert H.

2013-01-01

156

Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?  

Microsoft Academic Search

Background  One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm\\u000a in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical\\u000a examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion.

Xiaofeng Jia; Jong Hun Ji; Vinodhkumar Pannirselvam; Steve A. Petersen; Edward G. McFarland

2011-01-01

157

Interrater reproducibility of clinical tests for rotator cuff lesions  

PubMed Central

Background: Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use. Objective: To study interrater reproducibility of standard tests for shoulder evaluation among a rheumatology specialist, rheumatology trainee, and research nurse. Methods: 136 patients were reviewed over 12 months at a major teaching hospital. The three assessors examined each patient in random order and were unaware of each other's evaluation. Each shoulder was examined in a standard manner by recognised tests for specific lesions and a diagnostic algorithm was used. Between-observer agreement was determined by calculating Cohen's ? coefficients (measuring agreement beyond that expected by chance). Results: Fair to substantial agreement was obtained for the observations of tenderness, painful arc, and external rotation. Tests for supraspinatus and subscapularis also showed at least fair agreement between observers. 40/55 (73%) ? coefficient assessments were rated at >0.2, indicating at least fair concordance between observers; 21/55 (38%) were rated at >0.4, indicating at least moderate concordance between observers. Conclusion: The reproducibility of certain tests, employed by observers of varying experience, in the assessment of the rotator cuff and general shoulder disease was determined. This has implications for delegation of shoulder assessment to nurse specialists, the development of a simplified evaluation schedule for general practitioners, and uniformity in epidemiological research studies.

Ostor, A; Richards, C; Prevost, A; Hazleman, B; Speed, C

2004-01-01

158

Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview  

PubMed Central

It is now over a decade since the features defining a contractile dysfunction of the shoulder were first reported. Since this time, some progress has been made to better understand this mechanical syndrome. In response to these developments, this narrative review will explore current understanding in relation to pathology, diagnosis, treatment, and prognosis of this syndrome with reference to literature specifically relating to contractile dysfunction but also literature relating to rotator cuff tendinopathy where necessary. The review not only identifies the strengths of the mechanical diagnosis and therapy approach with reference to a contractile dysfunction of the shoulder but also identifies where further progress needs to be made.

Littlewood, Chris

2012-01-01

159

The role of the biceps tendon in massive rotator cuff tears.  

PubMed

Tendinopathy of the long head of the biceps (LHB) tendon commonly occurs in patients with rotator cuff tears, and the inflammation of one head tends to lead to inflammation of the other. Many theories have been proposed regarding the function of the LHB tendon; however, its exact purpose is poorly understood. It has been described as an important stabilizer of the glenohumeral joint, a depressor of the humeral head, and as a vestigial structure. The LHB tendon can be a significant source of pain in patients with rotator cuff tears. The appropriate treatment depends on the patient's age, comorbidities, activity level, extent of disability, the presence of rotator cuff arthropathy, and the quality of the rotator cuff tissue. Conservative treatment is usually attempted first, with modalities such as nonsteroidal anti-inflammatory drugs, corticosteroid injections, physical therapy, and activity modification. If symptoms persist, biceps tenotomy or tenodesis may be combined with rotator cuff repair, depending on the quality of the rotator cuff tissue, the severity of rotator cuff arthropathy, and the willingness of the patient to comply with postoperative immobilization and rehabilitation. Even when rotator cuff repair is not possible, isolated tenotomy or tenodesis of the LHB tendon can provide substantial pain relief. PMID:22301226

Pill, Stephan G; Walch, Gilles; Hawkins, Richard J; Kissenberth, Michael J

2012-01-01

160

Simultaneous rupture of bilateral quadriceps tendon and rotator cuff tear: a case report.  

PubMed

This is a case report of a patient who sustained both a bilateral quadriceps tendon rupture and a complete rotator cuff tear. Overuse is a known risk factor for rotator cuff tears, but this case suggests that it can also be a risk factor for quadriceps tendon rupture. PMID:23155972

Chen, H T

2012-03-01

161

Dermal Tissue Allograft for the Repair of Massive Irreparable Rotator Cuff Tears  

Microsoft Academic Search

Background: Massive irreparable rotator cuff tears in patients without advanced glenohumeral arthritis can pose a challenge to surgeons. Numerous management strategies have been utilized, and studies have shown varied results with regard to shoulder pain, range of motion, strength, and overall function.Hypothesis: Patients undergoing repair of massive irreparable rotator cuff tears through a mini-open approach with the use of human

Anil K. Gupta; Kevin Hug; David J. Berkoff; Blake R. Boggess; Molly Gavigan; Paul C. Malley; Alison P. Toth

2012-01-01

162

Rotator cuff tendinopathy: a model for the continuum of pathology and related management  

Microsoft Academic Search

BackgroundPathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are extremely common and are a principal cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the

Jeremy S Lewis

2010-01-01

163

Rotator cuff repair with bioabsorbable screws: An in vivo and ex vivo investigation  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate in vivo the clinical outcomes of rotator cuff repairs with bioabsorbable screws compared with metal suture anchors, and to compare the ex vivo initial load to failure of rotator cuff repairs using 3 different bioabsorbable screws, suture anchors, and transosseous sutures. Type of Study: In vivo clinical outcomes investigation, and ex

Craig A. Cummins; Sabrina Strickland; Richard C. Appleyard; Zoltan L. Szomor; Jeanette Marshall; George A. C. Murrell

2003-01-01

164

Cyclic loading of transosseous rotator cuff repairs: Tension overload as a possible cause of failure  

Microsoft Academic Search

Previous experimental studies of failure of rotator cuff repair have involved a single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 cm × 2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with transosseous simple sutures, and cyclically loaded the repairs by a servohydraulic

Stephen S. Burkhart; Todd C. Johnson; Michael A. Wirth; Kyriacos A. Athanasiou

1997-01-01

165

The Outcome and Repair Integrity of Completely Arthroscopically Repaired Large and Massive Rotator Cuff Tears  

Microsoft Academic Search

Background: The impact of a recurrent defect on the outcome after rotator cuff repair has been controversial. The purpose of this study was to evaluate the functional and anatomic results after arthroscopic repair of large and mas- sive rotator cuff tears with use of ultrasound as an imaging modality to determine the postoperative integrity of the repair. Methods: Eighteen patients

LEESA M. GALATZ; CRAIG M. BALL; SHARLENE A. TEEFEY; WILLIAM D. MIDDLETON; KEN YAMAGUCHI

166

The coracoacromial ligament: anatomical and biomechanical properties with respect to age and rotator cuff disease  

Microsoft Academic Search

The coracoacromial ligament (CAL) plays an important role in the pathoetiology of the subacromial impingement syndrome especially in those patients who do not have bony abnormalities. A total of 40 shoulders were dissected to determine the anatomical and biomechanical properties of the CAL in shoulders with either intact rotator cuffs or rotator cuff disease, taken from cadavers of persons who

R. Fremerey; L. Bastian; W. E. Siebert

2000-01-01

167

Age-related prevalence of rotator cuff tears in asymptomatic shoulders  

Microsoft Academic Search

To determine the prevalence of rotator cuff tears in asymptomatic shoulders we conducted a prospective clinical and ultrasonographic study of 411 volunteers. We anticipated an age-dependent outcome and divided the patients into 4 age-groups. Overall, we found evidence of a rotator cuff tear in 23% of the patients. In group 1 (aged 50 to 59 years), 13% (22 of 167)

Siegbert Tempelhof; Stefan Rupp; Romain Seil

1999-01-01

168

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture  

Microsoft Academic Search

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of

J. M. Mellado; J. Calmet; M. Olona; J. Ballabriga; A. Camins; L. Pérez del Palomar; J. Giné

2006-01-01

169

From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts  

Microsoft Academic Search

High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of

M. J. C. M. Rutten; G. J. Jager; J. G. Blickman

2006-01-01

170

Neovascularization Prevalence in the Supraspinatus of Patients With Rotator Cuff Tendinopathy.  

PubMed

OBJECTIVE:: A high prevalence of neovascularity in lower extremity tendinopathies has been reported. Neovascularity in those with rotator cuff tendinopathy exclusively has not been examined. The objective was to determine the prevalence of neovascularization in patients with rotator cuff tendinopathy compared with asymptomatic controls. DESIGN:: Single-blind cross-sectional study. SETTING:: Research laboratory. PARTICIPANTS:: Participants (n = 40; age = 44.9 years, 23-62 years; 20 females) with rotator cuff tendinopathy (n = 20) but without full-thickness rotator cuff tears, and asymptomatic controls that were age, gender, and hand dominance matched (n = 20) to the patients. INTERVENTIONS:: The participants laying in supine had their shoulder positioned in internal rotation and extension. Ultrasound images were collected of the supraspinatus tendon and subacromial bursae in the transverse and longitudinal planes using a linear transducer in color Doppler mode. MAIN OUTCOME MEASURES:: Images were assessed for neovascularization by 2 trained raters who were blinded to group (rotator cuff tendinopathy or asymptomatic group). RESULTS:: No statistically significant difference in neovascularization was identified between participants with and without rotator cuff tendinopathy (? = 0.13, df = 1, P = 0.72). Neovascularization was identified in 6 of 20 patients with rotator cuff tendinopathy (30%) and 5 of 20 asymptomatic control participants (25%). CONCLUSIONS:: The authors found no differences in neovascularization rate in patients with rotator cuff tendinopathy (30%) and asymptomatic controls (25%). The study indicates that neovascularization is not related to presence of symptomatic tendinopathy in those with rotator cuff tendinopathy. Neovascularization may not be a relevant sonographic finding to aid the clinical assessment of those with rotator cuff tendinopathy. PMID:23732364

Kardouni, Joseph R; Seitz, Amee L; Walsworth, Matthew K; Michener, Lori A

2013-05-31

171

Surgical treatment of tears of the rotator cuff in athletes.  

PubMed

Forty-five athletes with either a partial or a complete tear of the rotator cuff were treated with anterior acromioplasty and repair of the tear. The minimum duration of follow-up was twenty-four months (average, forty-two months). Thirty patients had an incomplete tear and fifteen had a complete tear. Postoperatively, thirty-nine (87 per cent) of the patients stated that they were improved compared with their preoperative status, although only thirty-four patients (76 per cent) felt that they had a significant reduction of pain postoperatively. Objectively, twenty-five (56 per cent) of the patients were rated as having a good result, which allowed them to return to their former competitive level without significant pain. Twelve (41 per cent) of the twenty-nine athletes who had been involved in pitching and throwing returned to their former competitive status. Seven (32 per cent) of the twenty-two pitchers and throwers who had been active at a professional or collegiate level returned to the same competitive level. In our experience, a repair of the rotator cuff combined with an acromioplasty in a young athletic population provides satisfactory relief of pain but does not guarantee that the patient will be able to return to his or her former competitive status in all sports. PMID:3733777

Tibone, J E; Elrod, B; Jobe, F W; Kerlan, R K; Carter, V S; Shields, C L; Lombardo, S J; Yocum, L

1986-07-01

172

Effect of rotator cuff pathology on shoulder rhythm.  

PubMed

The purpose of this study was to test the hypothesis that shoulder rhythm is affected by rotator cuff pathology during arm elevation. We divided 42 subjects into 3 groups: those with full-thickness rotator cuff tears (RCTs) (n = 14), those with tendinopathy (n = 13), and control subjects (n = 15). Shoulder kinematics was recorded while subjects performed elevation in the sagittal and scapular planes. Euler angles were computed for scapular and humeral elevation. Data were divided into 3 equal phases. Lines were fit and the slope determined for each phase. Significant differences in slopes ( P < .05) were found between experimental groups for both motions. The RCT group had higher slopes in the initial and middle phases for sagittal elevation and in the middle phase for scapular abduction. The scapula was elevated more in the RCT group in the initial two thirds of movement. This motion may change the length of remaining muscles so that they operate on a more effective part of their length-tension curve. PMID:15726088

Mell, Amy G; LaScalza, Suzanne; Guffey, Patrick; Ray, Jennifer; Maciejewski, Mike; Carpenter, James E; Hughes, Richard E

173

Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare!  

Microsoft Academic Search

An avulsion fracture of the greater tuberosity of the humerus with associated rotator cuff tear is rare. The authors describe the unusual case of a shoulder injury with an isolated, displaced greater tuberosity fracture associated with a massive rotator cuff tear. Due to the rotator cuff dysfunction, this patient presented with significant functional loss.

Amr Fahmy; Nick Antonakopoulos; Amer Khan

2011-01-01

174

Using your shoulder after surgery  

MedlinePLUS

... tells you it is okay. If you had rotator cuff surgery, or other ligament or labral surgery, you ... EV, Lippitt SB, Wirth MA, Rockwood Jr. CA. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth ...

175

Results of the repair of acute rotator cuff tears is not influenced by tear retraction  

PubMed Central

Purpose: This study evaluated retraction in the setting of acute rotator cuff tears and determined its effects on patient outcomes and tendon repair integrity. Materials and Methods: A total of 22 patients had surgery within 6 weeks or less from the time of injury. Fifteen of these patients were prospectively followed at a minimum of 2 years; average 40.5 months (range 24-69). Pre-operative objective and subjective outcomes were compared. Tendon repair integrity was assessed with ultrasound at a minimum of 1 year from surgery. The population was stratified into Group 1 (8 patients) with minimal intra-operative medial tendon retraction to the mid-line level of the humeral head and Group 2 (7 patients) with a large medial tendon retraction to the glenohumeral joint or greater. Results: The average time to surgery from the onset of symptoms was 27 days (range, 6-42). Post-operative motion increased significantly for external rotation and forward elevation, 77% of patients were pain free, 80% were completely satisfied, and 100% would have the surgery again. Group 1 (small retraction) versus Group 2 (large retraction) showed that post-operative pain levels, satisfaction, range of motion, strength, subjective shoulder value (95.4% vs. 92.3%), Constant Score (80.8 vs. 78.1), and American Society of Shoulder and Elbow Surgeons (96.2 vs. 93.5) scores were not statistically different. Ultrasound showed a tendon repair integrity rate of 87%. 2 patients who did have a re-tear were in Group 2, yet had comparative outcomes. Conclusion: In acute rotator cuff tears, equal patient satisfaction, pain scores, range of motion, strength, and outcome measures should be expected with surgical repair despite the level of retraction. Level of Evidence: Therapeutic level IV

Butler, Bryan R.; Byrne, Abigail N.; Higgins, Laurence D.; Shah, Anup; Fowler, Rachel L.

2013-01-01

176

Metal markers for radiographic visualization of rotator cuff margins: A new technique for radiographic assessment of cuff repair integrity  

PubMed Central

Surgically repaired rotator cuff repairs may re-tear in the post-operative follow-up phase, and periodic imaging is useful for early detection. The authors describe a simple surgical technique that provides a visible clue to the tendon edge on an anteroposterior radiograph of the shoulder. The technique involves arthroscopic or mini-open radio-opaque tagging of the tendon edge using a metal marker, and followed by a double-row rotator cuff repair using suture anchors. Serial post-operative radiographs may then be used to monitor the position of the marker. Progressive or marked displacement of the marker suggests a failure of cuff repair integrity and should be evaluated further.

Bhatia, Deepak N.; De Beer, Joe F.

2013-01-01

177

Epidemiology, natural history, and indications for treatment of rotator cuff tears.  

PubMed

The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma and macrotrauma. The incidence of rotator cuff tears increases with aging with more than half of individuals in their 80s having a rotator cuff tear. Smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing. Substantial full-thickness rotator cuff tears, in general, progress and enlarge with time. Pain, or worsening pain, usually signals tear progression in both asymptomatic and symptomatic tears and should warrant further investigation if the tear is treated conservatively. Larger (>1-1.5 cm) symptomatic full-thickness cuff tears have a high rate of tear progression and, therefore, should be considered for earlier surgical repair in younger patients if the tear is reparable and there is limited muscle degeneration to avoid irreversible changes to the cuff, including tear enlargement and degenerative muscle changes. Smaller symptomatic full-thickness tears have been shown to have a slower rate of progression, similar to partial-thickness tears, and can be considered for initial nonoperative treatment due to the limited risk for rapid tear progression. In both small full-thickness tears and partial-thickness tears, increasing pain should alert physicians to obtain further imaging as it can signal tear progression. Natural history data, along with information on factors affecting healing after rotator cuff repair, can help guide surgeons in making appropriate decisions regarding the treatment of rotator cuff tears. The management of rotator cuff tears should be considered in the context of the risks and benefits of operative versus nonoperative treatment. Tear size and acuity, the presence of irreparable changes to the rotator cuff or glenohumeral joint, and patient age should all be considered in making this decision. Initial nonoperative care can be safely undertaken in older patients (>70 years old) with chronic tears; in patients with irreparable rotator cuff tears with irreversible changes, including significant atrophy and fatty infiltration, humeral head migration, and arthritis; in patients of any age with small (<1 cm) full-thickness tears; or in patients without a full-thickness tear. Early surgical treatment can be considered in significant (>1 cm-1.5 cm) acute tears or young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes. PMID:23040548

Tashjian, Robert Z

2012-08-30

178

Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing  

Microsoft Academic Search

The goals of this study were to define biplanar glenohumeral kinematics and glenohumeral-scapulothoracic motion relationships in normal patients with a two-plane radiograph series and then in patients with anterior shoulder instability or rotator cuff tear both before surgery and after surgical repair and postoperative rehabilitation. A two-plane radiographic series of x-ray films in the scapular and horizontal (axillary) planes was

George A Paletta; Jon J. P Warner; Russell F Warren; Allen Deutsch; David W Altchek

1997-01-01

179

Factors that impact rehabilitation strategies after rotator cuff repair.  

PubMed

Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes. PMID:23306420

Mulligan, Edward P; Devanna, Raymond R; Huang, Mu; Middleton, Emily F; Khazzam, Michael

2012-11-01

180

The role of platelet-rich plasma in rotator cuff repair.  

PubMed

The shoulder is a common source of disability resulting from traumatic and degenerate tears of the rotator cuff, subacromial impingement, and osteoarthritis. Nonoperative management has focused on treatment of the predisposing factors, the use of analgesics and anti-inflammatory medication usually in association with local anesthetic and steroid injections. Surgical intervention allows debridement of the degenerate cuff and partial thickness cuff tears, subacromial bursitis, impinging bone spurs and osteophytes together with rotator cuff repairs. Repairs of degenerate and torn tissue are often prone to failure due to many intrinsic and extrinsic factors. It is assumed that some biological therapies might improve clinical, mechanical, and histologic outcomes. Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears. PMID:21822108

Mei-Dan, Omer; Carmont, Michael R

2011-09-01

181

[Contribution of MRI to the preoperative evaluation of rotator cuff tears].  

PubMed

The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was completed with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning. PMID:1812516

Gagey, N; Desmoineaux, P; Gagey, O; Idy-Peretti, I; Mazas, F

1991-01-01

182

[MRI in the pre-operative evaluation of lesions of the rotator cuff].  

PubMed

The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was complete with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning. PMID:8483150

Gagey, N; Desmoineaux, P; Gagey, O; Idy-Peretti, I; Mazas, F

1993-01-01

183

Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft  

PubMed Central

Purpose: This study presents a retrospective case series of the clinical and structural outcomes (1.5 T MRI) of arthroscopic rotator cuff repair with acellular human dermal graft reinforcement performed by a single surgeon in patients with large, massive, and previously repaired rotator cuff tears. Materials and Methods: Fourteen patients with mean anterior to posterior tear size 3.87 ± 0.99 cm (median 4 cm, range 2.5–6 cm) were enrolled in the study and were evaluated for structural integrity using a high-field (1.5 T) MRI at an average of 16.8 months after surgery. The Constant-Murley scores, the Flexilevel Scale of Shoulder Function (Flex SF), scapular plane abduction, and strength were analyzed. Results: MRI results showed that the rotator cuff repair was intact in 85.7% (12/14) of the patients studied. Two patients had a Sugaya Type IV recurrent tear (2 of 14; 14.3%), which were both less than 1 cm. The Constant score increased from a preoperative mean of 49.72 (range 13–74) to a postoperative mean of 81.07 (range 45–92) (P value = 0.009). Flexilevel Scale of Shoulder Function (Flex SF) Score normalized to a 100-point scale improved from a preoperative mean of 53.69 to a postoperative mean of 79.71 (P value = 0.003). The Pain Score improved from a preoperative mean of 7.73 to a postoperative mean of 13.57 (P value = 0.008). Scapular plane abduction improved from a preoperative mean of 113.64° to a postoperative mean of 166.43° (P value = 0.010). The strength subset score improved from a preoperative mean of 1.73 kg to a postoperative mean of 7.52 kg (P value = 0.006). Conclusions: This study presents a safe and effective technique that may help improve the healing rates of large, massive, and revision rotator cuff tears with the use of an acellular human dermal allograft. This technique demonstrated favorable structural healing rates and statistically improved functional outcomes in the near term. Level of Evidence: 4. Retrospective case series.

Agrawal, Vivek

2012-01-01

184

[Evidence-Based Treatment of Combined Rotator Cuff and SLAP Lesions].  

PubMed

Purpose: In the face of improved radiological and arthroscopic techniques the diagnosis and treatment of SLAP lesions has recently gained much interest. Originally described as an (isolated) injury of the overhead athlete, it was only recently that the association of SLAP and rotator cuff defects was described in up to 40 % of cases. This study addresses the question of the evidence-based treatment of such frequent, combined lesions. Methods: Based on a systematic review of the online databases PubMed, EMBASE, CINAHL and Cochrane Library we identified clinical studies on the treatment of combined SLAP and rotator cuff lesions. Study quality was assessed using levels of evidence and a modified Jadad score. Clinical outcome was assessed through scores and range of motion assessments. Results: We included 7 studies of 374 patients with a mean age of 53 ± 11 years followed for 35 ± 13 months. Combined lesions have a significant negative effect on isolated rotator cuff or SLAP repair. Patients older than 45 years of age had a significantly better clinical result after biceps tenotomy than SLAP repair with concomitant rotator cuff repair. Biceps tenotomy plus rotator cuff repair showed significantly better range of motion for flexion and rotation than SLAP plus rotator cuff repair. Conclusion: The frequent combination of SLAP and rotator cuff injury should be considered during assessment and informed consent of shoulder patients. While young patients and isolated SLAP lesions show excellent clinical results after elective repair, combined lesions should be treated with biceps tenotomy and/or debridement plus rotator cuff repair in patients older than 45 years. PMID:24129723

Vavken, P; Wimmer, M D; Smirnov, E; Quidde, J; Speth, B; Müller, A M; Valderrabano, V

2013-10-15

185

Management of degenerative rotator cuff tears: a review and treatment strategy  

PubMed Central

The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence. Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction. The management of these tears is controversial, as to whether they should be managed non-operatively or operatively. In addition when operative intervention is undertaken, there is question as to what technique of repair should be used. This review describes the epidemiology and natural history of degenerative rotator cuff tears. The management options, and the evidence to support these, are reviewed. We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.

2012-01-01

186

Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears  

Microsoft Academic Search

The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable\\u000a anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either\\u000a the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the\\u000a rotator cuff that does

Iosif Gavriilidis; Jörn Kircher; Petra Magosch; Sven Lichtenberg; Peter Habermeyer

2010-01-01

187

The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears  

Microsoft Academic Search

To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major

Gary M. Gartsman; Ettore Taverna

1997-01-01

188

Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?  

Microsoft Academic Search

Background: Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality.Purpose: To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: One hundred

Yang-Soo Kim; Seok Won Chung; Joon Yub Kim; Ji-Hoon Ok; Joo Han Oh

2012-01-01

189

Humeral head cysts and rotator cuff tears: an MR arthrographic study  

Microsoft Academic Search

Objective  Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age.Design and patients  Shoulder MR arthrograms were reviewed in 120 consecutive patients—83 males (mean

Martin Williams; Robert G. W. Lambert; Gian S. Jhangri; Michael Grace; Jay Zelaso; Ben Wong; Sukhvinder S. Dhillon

2006-01-01

190

RC-QOL score for rotator cuff pathology: adaptation to Italian  

Microsoft Academic Search

We translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability\\u000a and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was\\u000a translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed\\u000a by another bilingual orthopaedic

Rocco Papalia; Leonardo Osti; Francesco Leonardi; Vincenzo Denaro; Nicola Maffulli

2010-01-01

191

Subacromial internal spacer for rotator cuff tendon repair: "the balloon technique".  

PubMed

Lateral reattachment of the rotator cuff and the more recent introduction of the double-row rotator cuff repair technique require adequate visualization to define the rotator cuff footprint and the greater tuberosity. In many cases extensive debridement in this area is required to remove the overlying subdeltoid bursa, which can impair visualization laterally on the proximal humerus. Inadequate visualization laterally may lead to improper placement of the lateral row of fixation, compromising the reduction and fixation of the repaired rotator cuff tendon. We describe a surgical technique used to improve lateral visualization of the proximal humerus for placement of lateral anchors during arthroscopic rotator cuff repair using a Foley catheter. The end of a 14F-diameter Foley catheter is cut just proximal to the balloon end. One to three catheters are introduced in the subacromial space through small anterolateral or posterolateral portals and inflated with 15 mL of air. Adequate distension of the subacromial space allows better visualization, triangulation of the arthroscopic instruments, and anatomic repair of the rotator cuff tendon. PMID:19664512

Kilinc, Alexandre S; Ebrahimzadeh, Mohammad H; Lafosse, Laurent

2009-08-01

192

Evidence for an Inherited Predisposition Contributing to the Risk for Rotator Cuff Disease  

PubMed Central

Background: A genetic predisposition has been suggested to contribute to the risk for development of rotator cuff disease on the basis of observed family clusters of close relatives. We used a population-based resource combining genealogical data for Utah with clinical diagnosis data from a large Utah hospital to test the hypothesis of excess familial clustering for rotator cuff disease. Methods: The Utah Population Database contains combined health and genealogical data on over two million Utah residents. Current Procedural Terminology, Fourth Revision, codes (29827, 23412, 23410, and 23420) and International Classification of Diseases, Ninth Revision, codes (726.1, 727.61, and 840.4) entered in patient records were used to identify patients with rotator cuff disease. We tested the hypothesis of excess familial clustering using two well-established methods (the Genealogical Index of Familiality test and the estimation of relative risks in relatives) in the overall study group (3091 patients) and a subgroup of the study group diagnosed before the age of forty years (652 patients). Results: The Genealogical Index of Familiality test in patients diagnosed before the age of forty years showed significant excess relatedness for individuals with rotator cuff disease in close and distant relationships (as distant as third cousins) (p = 0.001). The relative risk of rotator cuff disease in the relatives of patients diagnosed before the age of forty years was significantly elevated for second degree (relative risk = 3.66, p = 0.0076) and third degree (relative risk = 1.81, p = 0.0479) relatives. Conclusions: We analyzed a set of patients with diagnosed rotator cuff disease and a known genealogy to describe the familial clustering of affected individuals. The observations of significant excess relatedness of patients and the significantly elevated risks to both close and distant relatives of patients strongly support a heritable predisposition to rotator cuff disease. Clinical Relevance: A better understanding of the familial risk of rotator cuff disease could lead to the identification of candidate genes predisposing individuals to rotator cuff disease. Gene identification will possibly allow the development of improved treatments, including biologic augmentations of rotator cuff repairs, which may improve tendon healing and repair outcomes. Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

Tashjian, Robert Z.; Farnham, James M.; Albright, Frederick S.; Teerlink, Craig C.; Cannon-Albright, Lisa A.

2009-01-01

193

Post-operative rehabilitation after surgical repair of the rotator cuff.  

PubMed

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilitation protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biological factors while the patient's work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist's choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biological tissue healing, surgical technique and focused rehabilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabiliser reinforcement, are done. Phase three consists of progressive active arm mobilisation dry or in water integrated with proprioceptive exercise and "core" stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilitation protocol for each patient. PMID:19711171

Conti, Marco; Garofalo, Raffaele; Delle Rose, Giacomo; Massazza, Giuseppe; Vinci, Enzo; Randelli, Mario; Castagna, Alessandro

2009-04-01

194

Setting patients' expectations for range of motion after arthroscopic rotator cuff repair.  

PubMed

Arthroscopic rotator cuff repair is a reliable option for symptomatic patients who have failed conservative treatments. Limited evidence exists regarding early rehabilitation time points (less than 1 year) and the influence of tear size. The authors sought to determine whether a difference exists in pre- and postoperative range of motion among small, medium, and large isolated rotator cuff tears treated arthroscopically. Patient- and tear-specific demographics were analyzed in a retrospective series of patients who had undergone arthroscopic rotator cuff repair. Two hundred seventy-four patients (153 [56%] men and 121 [44%] women; mean age, 53 years) were analyzed. Small tears (n=158 [58%]) were more common than medium (n=70 [25%]) and large (n=46 [17%]) tears. Shoulder range of motion was measured preoperatively and at 2 and 6 weeks, 3 and 6 months, and 1 year postoperatively. At nearly all time points pre- and postoperatively, large tears were significantly stiffer than small tears in external rotation and forward elevation (P<.05). It takes 1 year to fully regain external rotation after small and medium tears, whereas mild residual stiffness remains after large tears. Full forward elevation is restored by 3 months for small tears vs 6 months for medium and large tears. Significant tear size-dependent differences exist in shoulder range of motion after arthroscopic repair of isolated rotator cuff tears. These data can be used to manage patients' expectations for range of motion after arthroscopic rotator cuff repair to improve patient satisfaction. PMID:23380011

Harris, Joshua D; Ravindra, Amy; Jones, Grant L; Butler, R Bryan; Bishop, Julie Y

2013-02-01

195

Initial Fixation Strength of Transosseous-Equivalent Suture Bridge Rotator Cuff Repair Is Comparable With Transosseous Repair  

Microsoft Academic Search

Background: The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength.Purpose: To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a

Steve B. Behrens; Benjamin Bruce; Alan J. Zonno; David Paller; Andrew Green

2012-01-01

196

Rotator cuff muscles perform different functional roles during shoulder external rotation exercises.  

PubMed

The aim of this study was to compare activity in shoulder muscles during an external rotation task under conditions of increasing arm support to investigate whether changing support requirements would influence muscle recruitment levels, particularly in the rotator cuff (RC) muscles. Electromyographic recordings were collected from seven shoulder muscles using surface and indwelling electrodes. The dominant shoulder of 14 healthy participants were examined during dynamic shoulder external rotation performed at 90° abduction with the arm fully supported, partially supported, and unsupported. Linear regressions between arm support load and the averaged muscle activity across participants for each muscle showed infraspinatus predominantly contributing to rotating the shoulder whilst supraspinatus, deltoid, upper trapezius, and serratus anterior were predominantly functioning in support/stabilization roles. During dynamic shoulder external rotation in mid-range abduction, the RC muscles perform different functional roles. Infraspinatus is responsible for producing external rotation torque, supraspinatus is playing a larger joint stabilizer role, and subscapularis is contributing minimally to joint stability. The results also indicate that increasing support load requirements during an external rotation task may be a functionally specific way to retrain the stabilization function of axioscapular muscles. Manipulating joint stabilization requirements while maintaining constant rotational load is a novel method of investigating the differential contribution of muscles to joint movement and stabilization during a given task. PMID:22836526

Tardo, Daniel T; Halaki, Mark; Cathers, Ian; Ginn, Karen A

2012-07-26

197

Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study  

Microsoft Academic Search

Objective  To evaluate the impact of abduction and external rotation (ABER) positioning performed before image acquisition on the assessment\\u000a of rotator cuff tears.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty-seven consecutive patients with clinically suspected rotator cuff tears underwent an initial CT arthrogram of the shoulder\\u000a in neutral position, immediately followed by temporary ABER positioning, before a second CT acquisition in neutral position.\\u000a Two observers blinded to

Hubert Cochet; Stephane Couderc; Eric Pelé; Nicolas Amoretti; Marie-Hélène Moreau-Durieux; Olivier Hauger

2010-01-01

198

Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players.  

PubMed

Internal impingement is a primary cause of shoulder pain in throwers; however, instability, internal rotation deficit, scapula muscle dysfunction, and core muscle dysfunction are also important elements of the internal impingement process. Articular surface rotator cuff tears, posterior superior labrum tears, SLAP lesions, anterior capsular ligament attenuation, and posterior capsular ligament contracture are commonly seen in throwers. Each of these conditions must be recognized and appropriately treated to ensure the best possible outcome. There is little potential for spontaneous healing of rotator cuff tears and SLAP lesions after debridement. PMID:11888139

Conway, J E

2001-07-01

199

Principles of arthroscopic repair of large and massive rotator cuff tears.  

PubMed

Minimally invasive arthroscopic techniques for rotator cuff tears have been greatly advanced during the past decade. It is important to review the clinical presentation and common physical findings of a large or massive rotator cuff tear, essential preoperative imaging, and the principles and technical aspects of all-arthroscopic repair. An anatomic repair of the footprint must begin with an understanding of the three-dimensional morphology of the rotator cuff tear and an accurate reduction of the tear. A contracted, immobile massive rotator cuff tear is challenging. Advanced arthroscopic mobilization techniques and margin convergence principles may allow repair of an otherwise irreparable tear. Failure of tendon healing is common but can be minimized by using dual-row, transosseous-equivalent techniques. A relatively slow rehabilitation program is paramount to protect the repair. The result of using arthroscopic techniques for a large or massive rotator cuff tear is comparable to that of a traditional open repair. Pain relief has been a far more reliable result than gains in function or strength. PMID:20415385

MacDonald, Peter B; Altamimi, Sahal

2010-01-01

200

Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears  

PubMed Central

Background Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair. Purposes To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera. Results During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05). Conclusion RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides.

2011-01-01

201

Glenoid cartilage mechanical properties decrease after rotator cuff tears in a rat model.  

PubMed

Rotator cuff repairs are commonly performed to reduce pain and restore function. Tears are also treated successfully without surgical intervention; however, the effect that a torn tendon has on the glenohumeral cartilage remains unknown. Clinically, a correlation between massive rotator cuff tears and glenohumeral arthritis has often been observed. This may be due to a disruption in the balance of forces at the shoulder, resulting in migration of the humeral head and subsequently, abnormal loading of the glenoid. Our lab previously demonstrated changes in ambulation and intact tendon mechanical properties following supraspinatus and infraspinatus rotator cuff tendon tears in a rat model. Therefore, the purpose of this study was to investigate the effects of supraspinatus and infraspinatus rotator cuff tears on the glenoid cartilage. Nine rats underwent unilateral detachment of the supraspinatus and infraspinatus tendons and were sacrificed after 4 weeks. Cartilage thickness significantly decreased in the antero-inferior region of injured shoulders. In addition, equilibrium elastic modulus significantly decreased in the center, antero-superior, antero-inferior, and superior regions. These results suggest that altered loading after rotator cuff injury may lead to damage to the joint with significant pain and dysfunction. Clinically, understanding the mechanical processes involved with joint damage will allow physicians to better advise patients. PMID:22407524

Reuther, Katherine E; Sarver, Joseph J; Schultz, Susan M; Lee, Chang Soo; Sehgal, Chandra M; Glaser, David L; Soslowsky, Louis J

2012-03-09

202

Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease  

Microsoft Academic Search

BACKGROUND: Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator

Ole M Ekeberg; Erik Bautz-Holter; Niels G Juel; Kaia Engebretsen; Synnøve Kvalheim; Jens I Brox

2010-01-01

203

Long-term outcome and structural integrity following open repair of massive rotator cuff tears  

PubMed Central

Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years. Level of evidence: Level IV

Bartl, Christoph; Kouloumentas, Pannos; Holzapfel, Konstantin; Eichhorn, Stefan; Wortler, Klaus; Imhoff, Andreas; Salzmann, Gian M

2012-01-01

204

Proximal Humeral Migration in Shoulders with Symptomatic and Asymptomatic Rotator Cuff Tears  

PubMed Central

Background: Proximal humeral migration is commonly seen in rotator-cuff-deficient shoulders. The specific effects of the size of the rotator cuff tear and of pain on glenohumeral kinematics have been poorly defined. The purpose of this study was to examine the influences of cuff tear size and pain, separately, on humeral migration in a series of patients with symptomatic and asymptomatic rotator cuff tears. Methods: Ninety-eight asymptomatic and sixty-two symptomatic shoulders were identified from a cohort of patients with unilateral shoulder pain related to rotator cuff disease. All shoulders underwent ultrasonographic evaluation of the rotator cuff and standardized radiographic evaluation. Humeral migration was measured by three observers using software-enhanced radiographic analysis. Results: There was no significant difference in rotator cuff tear size between the asymptomatic and symptomatic shoulders, although more tears involved the infraspinatus in the symptomatic group (p = 0.01). Proximal humeral migration was greater in the shoulders with a symptomatic tear than it was in those with an asymptomatic tear (p = 0.03). Tears that involved the infraspinatus resulted in more migration than did isolated supraspinatus tears in both the symptomatic (p = 0.01) and the asymptomatic shoulders (p = 0.03). When the symptomatic tears of ?175 mm2 were analyzed separately, the size of the tear was found to correlate strongly with humeral migration (p = 0.01). However, when the symptomatic tears that were <175 mm2 were analyzed, neither tear size nor pain was found to have a significant relationship with migration. When the analysis was limited to full-thickness symptomatic tears of ?175 mm2, both pain (p = 0.002) and tear area (p = 0.0002) were found to have a significant effect on migration. Multivariate analysis showed that tear size (p = 0.01) was the strongest predictor of migration in symptomatic shoulders. Conclusions: Proximal humeral migration correlates with rotator cuff tear size. Tears extending into the infraspinatus tendon are associated with greater humeral migration than is seen with isolated supraspinatus tears. Humeral migration resulting from symptomatic rotator cuff tears is greater than that resulting from asymptomatic tears. Additionally, there is a critical size for tendon tears resulting in humeral migration in painful shoulders. Although both pain and tear size influence glenohumeral kinematics in symptomatic shoulders, only tear size is an independent predictor of humeral migration. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Keener, Jay D.; Wei, Anthony S.; Kim, H. Mike; Steger-May, Karen; Yamaguchi, Ken

2009-01-01

205

Correlation of acromial morphology with impingement syndrome and rotator cuff tears  

PubMed Central

Background and purpose Indications for acromioplasty are based on clinical symptoms and are generally supported by typical changes in acromial morphology on standard radiographs. We evaluated 5 commonly used radiographic parameters of acromial morphology and assessed the association between different radiographic characteristics on the one hand and subacromial impingement or rotator cuff tears on the other. Patients and methods We measured acromial type (Bigliani), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), and acromion index (AI) on standard radiographs from 50 patients with full-thickness supraspinatus tendon tears, 50 patients with subacromial impingement, and 50 controls without subacromial pathology. Results The acromial type according to Bigliani was not associated with any particular cuff lesion. A statistically significant difference between controls and impingement patients was found for AS. AT of controls was significantly smaller than that of impingement patients and cuff-tear patients. LAA of cuff-tear patients differed significantly from that of controls and impingement patients, but LAA of controls was not significantly different from that of impingement patients. Differences between impingement patients and cuff-tear patients were also significant. AI of controls was significantly lower than of impingement patients and of cuff-tear patients. A good correlation was found between acromial type and AS. Interpretation A low lateral acromial angle and a large lateral extension of the acromion were associated with a higher prevalence of impingement and rotator cuff tears. An extremely hooked anterior acromion with a slope of more than 43° and an LAA of less than 70° only occurred in patients with rotator cuff tears.

2013-01-01

206

Suture passing needle breakage during arthroscopic rotator cuff repair: a complication report.  

PubMed

Arthroscopic rotator cuff repair is a well established surgical technique. Passing sutures through the rotator cuff is a critical-and at times, time-consuming-portion of the procedure. Suture-passing devices have been developed that combine a nitinol needle for pushing sutures through the tissue with a tissue grasper. These devices eliminate multiple steps in the repair process and improve the efficiency of the operation. However, as with any innovation, there is the potential for complications. It is vital that these technical complications be appreciated so that they can be avoided in the future. We report a case in which the needle tip of a suture-passing device broke during arthroscopic rotator cuff repair. The breakage was not recognized until after the operation. The patient was observed for 2 years without migration of the foreign body. To our knowledge, this is the first reported complication associated with the use of this type of suturing device. PMID:19038716

Song, Hyun Seok; Ramsey, Matthew L

2008-01-07

207

Operatively treated traumatic versus non-traumatic rotator cuff ruptures: A registry study  

PubMed Central

Backround Operative treatment of traumatic rotator cuff ruptures, i.e. ruptures with a predisposing traumatic event, is reported to yield superior results compared to operative treatment of non-traumatic, degenerative ruptures. Aim The purpose of this study was to evaluate the difference of outcome, peroperative findings, and demographics after operative treatment of traumatic versus non-traumatic rotator cuff rupture. Methods A total of 306 consecutive shoulders with an operated rotator cuff rupture (124 traumatic and 182 non-traumatic) were followed up. Constant and Murley score, size of the rupture, and age of the patients were used as an outcome measure. Results A total of 112 traumatic and 167 non-traumatic rotator cuff rupture shoulders were available for 1-year follow-up (91%). Mean Constant and Murley score was preoperatively lower in the traumatic group (46 versus 52, P = 0.01). At 3 months postoperatively, Constant and Murley scores were 61 and 60 (P = 0.72) and at 1 year 73 and 77 (P = 0.03), respectively. Altogether 91% of the patients in the traumatic and 93% in the non-traumatic group were satisfied with the final outcome (P = 0.45). In 94% of traumatic and 95% of a non-traumatic cases the rupture involved the supraspinatus tendon. In the traumatic group the rupture was larger and involved more frequently the whole supraspinatus insertion area (41% versus 17%, P < 0.0001). Mean age of patients was 58 and 57 years, respectively. Conclusion Operative treatment of both traumatic and non-traumatic rotator cuff ruptures gives essentially good results. In our cohort, patients' recollection of predisposing trauma reflects the size of the rotator cuff rupture, but does not reflect the age of the patients.

Joukainen, Antti; Itala, Ari; Aarimaa, Ville

2013-01-01

208

Arthroscopic repair of massive rotator cuff tears: A prospective cohort with 2- to 4-year follow-up  

Microsoft Academic Search

Purpose: The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. Type of Study: Prospective cohort study. Methods: Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow

William F. Bennett

2003-01-01

209

Comparison of ultrasound versus fluorcoscopic guided rotator cuff interval approach for MR arthrography.  

PubMed

Our purpose is to compare ultrasound and fluoroscopic-guided approaches to the glenohumeral joint at the rotator cuff interval for magnetic resonance (MR) arthrography of the shoulder. Forty consecutive patients were prospectively studied. 20 patients underwent ultrasound-guided and 20 patients underwent fluoroscopic guided injection. Successful rate of ultrasound guidance is 95%. No significant difference in pain score and duration of injection between two methods (P>.05). Ultrasound-guided rotator cuff interval injection of the glenohumeral joint for MR arthrography is comparable with fluoroscopic-guided injection. Ultrasound is the preferred method as there is no ionizing radiation. PMID:23601770

Ng, Alex W H; Hung, Esther H Y; Griffith, James F; Tong, Cina S L; Cho, Carman C M

2012-09-13

210

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells  

Microsoft Academic Search

Purpose  To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone\\u000a marrow mononuclear cells (BMMC).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Fourteen consecutive patients (9 women, 5 men, mean age of 59.2 years) with complete rotator cuff tears (mean preoperative\\u000a UCLA score of 12 ± 3.0) were fixed by transosseous stitches through mini-open incision, with subsequent injection of BMMC\\u000a into the

João L. Ellera Gomes; Ricardo Canquerini da Silva; Lúcia M. R. Silla; Marcelo R. Abreu; Roberto Pellanda

211

Arthroscopically assisted mini-open rotator cuff repairs. Functional outcome at 2- to 7-year follow-up.  

PubMed

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N = 19) were satisfied with the results of surgery and 95% (N = 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living. PMID:10843119

Hersch, J C; Sgaglione, N A

212

Isokinetic torque imbalances in the rotator cuff of the elite water polo player.  

PubMed

The specific repetitive activity of water polo, like baseball pitching, emphasizes adduction and internal rotation. This study used the Cybex II to evaluate the isokinetic strength of the rotator cuff in elite water polo players and in a group of control subjects. The water polo players were significantly stronger than the controls. Of greater importance was the confirmation of imbalances in the rotator cuff force couples of adduction/abduction and external/internal rotation. These changes are similar to those reported for pitchers. The adductors in the water polo group had gained in relative strength resulting in an increase in the adduction/abduction ratio to about 2:1. The internal rotators had gained in relative strength resulting in a decrease in the external/internal ratio to about 0.6:1. For both force couples the differences are more apparent at a slow speed. Side-to-side differences were not significant. PMID:2008934

McMaster, W C; Long, S C; Caiozzo, V J

213

Suprascapular nerve rotator cuff compression syndrome in volleyball players.  

PubMed

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinaglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome. PMID:9814933

Sandow, M J; Ilic, J

214

Reverse total shoulder arthroplasty for irreparable rotator cuff tears and cuff tear arthropathy.  

PubMed

Based on the available literature, we believe that reverse shoulder arthroplasty is a reasonable treatment modality in patients with CTA and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. There are still a high number of complications related to this procedure; however, with stringent patient selection criteria and meticulous technique, high patient satisfaction scores are typically achieved in these patients, at least in the short term. Further studies are required to evaluate the efficacy these devices in the long term. PMID:23040557

Ramirez, Miguel A; Ramirez, Jose; Murthi, Anand M

2012-10-01

215

Arthroplasty of the shoulder in rheumatoid arthritis with rotator cuff dysfunction  

Microsoft Academic Search

We carried out a retrospective analysis of 17 total shoulder replacements using the reversed Delta III prosthesis in patients with rheumatoid arthritis of the glenohumeral joint complicated by rotator cuff dysfunction. Outcome was assessed using the Constant-Murley scoring system. In addition, general health status was assessed with the Short Form Health Survey and radiographical analysis of the prostheses undertaken. Mean

M. J. Woodruff; A. P. Cohen; J. G. Bradley

2003-01-01

216

Arthroscopic rotator cuff repair: suture anchor properties, modes of failure and technical considerations.  

PubMed

Rotator cuff injury and tears are a common source of shoulder pain, particularly among the elderly. Arthroscopic repair has now become the mainstay in the treatment of significant injuries that have failed conservative therapy. Compared with the traditional open technique, arthroscopic repair offers patients smaller incisions and less soft-tissue trauma, which result in improved postoperative pain and rehabilitation. The advances that have made arthroscopic repairs a reality includes improvement in arthroscopic rotator cuff instrumentation, particularly suture anchors. Suture anchors are used to reattach the torn rotator cuff tissue back onto the bone. Current rotator cuff anchors vary by design, anchor composition and suture materials. A treating physician should be aware of the advantages and limitations of these implants, which may influence the choice of one anchor over another. In addition to anchor variables, other factors that may affect the success of the repair include the local environment and surgical technique. In this article, various aspects of anchor design will be discussed. In addition, a concise review of technical considerations will also be discussed. PMID:21542709

Ma, Richard; Chow, Robert; Choi, Luke; Diduch, David

2011-05-01

217

Incidence and Treatment of Postoperative Stiffness Following Arthroscopic Rotator Cuff Repair  

Microsoft Academic Search

Purpose: The purpose of this study was to determine the incidence of clinically significant postoperative stiffness following arthroscopic rotator cuff repair. This study also sought to determine the clinical and surgical factors that were associated with higher rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic lysis of adhesions and capsular release for treatment of patients who developed

David P. Huberty; John D. Schoolfield; Paul C. Brady; Antonio P. Vadala; Paolo Arrigoni; Stephen S. Burkhart

2009-01-01

218

The relevance of long head biceps degeneration in the presence of rotator cuff tears  

Microsoft Academic Search

BACKGROUND: Long head biceps (LHB) degeneration in combination with rotator cuff tears can be a source of chronic shoulder pain. LHB tenotomy is an approved surgical procedure for pain reduction and improvement of joint function, however, the pathophysiology of LHB degeneration is not fully understood. In the literature, neoangiogenesis in tendon tissue has previously been shown to be associated with

Stefan Lakemeier; Johannes JA Reichelt; Nina Timmesfeld; Susanne Fuchs-Winkelmann; Juergen RJ Paletta; Markus D Schofer

2010-01-01

219

Débridement of small partial-thickness rotator cuff tears in elite overhead throwers.  

PubMed

Elite overhead throwing athletes with rotator cuff tears represent a unique group of patients with an ultimate goal of returning to their previous level of competition. We hypothesized débridement of small partial-thickness rotator cuff tears would return the majority of elite overhead throwing athletes to their previous level of competition. Preoperative and intraoperative findings on 82 professional pitchers who had undergone débridement of partial-thickness rotator cuff tears were evaluated using our database. We obtained return to play data on 67 of the 82 players (82%); 51 (76%) were able to return to competitive pitching at the professional level and 37 (55%) were able to return to the same or higher level of competition. Of the 67 patients, 34 pitchers returned a questionnaire with a minimum followup of 18 months (mean 38 months; range 18 to 59 months). SF-12 scores were above average with a mean PSF-12 and MSF-12 of 55.04 and 56.49 respectively. An Athletic Shoulder Outcome Rating Scale score of greater than 60 was found in 76.5% of pitchers. Débridement of small partial-thickness rotator cuff tears allowed a majority of elite overhead throwing athletes to return to competitive pitching, however, returning to their previous level of competition remains a challenge for many of these players. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18264849

Reynolds, Scott B; Dugas, Jeffrey R; Cain, E Lyle; McMichael, Christopher S; Andrews, James R

2008-02-10

220

Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders  

Microsoft Academic Search

Background: The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with

KA Sinnott; P Milburn; H McNaughton

2000-01-01

221

Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease  

PubMed Central

Background Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator cuff disease. Methods We performed analyses of data from 104 patients who had participated in a randomized controlled study. Socio-demographic, clinical and radiographic baseline factors were assessed for association with outcome at six-weeks follow-up evaluated by Shoulder Pain and Disability Index (SPADI) and patient perceived outcome. Factors with significant univariate association were entered into multivariate linear and logistic regression analyses. Results In the multivariate analyses; a high SPADI score indicating pain and disability at follow-up was associated with decreasing age, male gender, high baseline pain and disability, being on sick-leave, and using regular pain medication. A successful patient perceived outcome was associated with not being on sick-leave, high active abduction, local corticosteroid injection and previous cortisone injections. Structural findings of rotator cuff tendon pathology on MRI and bursal exudation or thickening on ultrasonography did not contribute to the predictive model. Conclusions Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. Sick-leave was the best predictor of poor short-term outcome. Trial registration: Clinical trials NCT00640575

2010-01-01

222

Isokinetic torque imbalances in the rotator cuff of the elite water polo player  

Microsoft Academic Search

The specific repetitive activity of water polo, like base ball pitching, emphasizes adduction and internal rota tion. This study used the Cybex II to evaluate the isokinetic strength of the rotator cuff in elite water polo players and in a group of control subjects. The water polo players were significantly stronger than the con trols. Of greater importance was the

William C. McMaster; Susan C. Long; Vincent J. Caiozzo

1991-01-01

223

Arthroscopic findings in the overhand throwing athlete: Evidence for posterior internal impingement of the rotator cuff  

Microsoft Academic Search

The purpose of this article is to describe the outcome of an arthroscopic examination and the pathology in symptomatic shoulders of 41 professional overhand throwing athletes. With the arm in the position of the relocation test, 100% of the subjects had either contact between the rotator cuff undersurface and the posterosuperior glenoid rim or osteochondral lesions. Other key findings included

Kevin J. Paley; Frank W. Jobe; Marilyn M. Pink; Ronald S. Kvitne; Neal S. ElAttrache

2000-01-01

224

A Multicenter Study of 210 Rotator Cuff Tears Treated by Arthroscopic Acromioplasty  

Microsoft Academic Search

Summary: We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was

Jean-François Kempf; Pascal Gleyze; François Bonnomet; Gilles Walch; Daniel Mole; André Frank; Philippe Beaufils; Christophe Levigne; Bruno Rio; André Jaffe

1999-01-01

225

Synthetic and degradable patches: an emerging solution for rotator cuff repair.  

PubMed

The use of rotator cuff augmentation has increased dramatically over the last 10 years in response to the high rate of failure observed after non-augmented surgery. However, although augmentations have been shown to reduce shoulder pain, there is no consensus or clear guideline as to what is the safest or most efficacious material. Current augmentations, either available commercially or in development, can be classified into three categories: non-degradable structures, extra cellular matrix (ECM)-based patches and degradable synthetic scaffolds. Non-degradable structures have excellent mechanical properties, but can cause problems of infection and loss of integrity in the long-term. ECM-based patches usually demonstrate excellent biological properties in vitro, but studies have highlighted complications in vivo due to poor mechanical support and to infection or inflammation. Degradable synthetic scaffolds represent the new generation of implants. It is proposed that a combination of good mechanical properties, active promotion of biological healing, low infection risk and bio-absorption are the ideal characteristics of an augmentation material. Among the materials with these features, those processed by electrospinning have shown great promis. However, their clinical effectiveness has yet to be proven and well conducted clinical trials are urgently required. PMID:23837794

Hakimi, Osnat; Mouthuy, Pierre-Alexis; Carr, Andrew

2013-08-01

226

Outcome of nonoperative management of full-thickness rotator cuff tears.  

PubMed

The study documented the functional outcome in a consecutive series of 46 patients from an individual practice meeting the inclusion criteria of (1) a full-thickness rotator cuff tear seen by ultrasonography, arthrogram, or magnetic resonance imaging, (2) absence of a Workers' Compensation claim or previous surgery, (3) followup of at least 1 year, and (4) election of nonoperative management by the patient. Twenty-six of the tears involved only the supraspinatus, two involved the supraspinatus and infraspinatus, and two involved the supraspinatus, infraspinatus, and subscapularis (16 reports did not specify the size of the tear). Treatment consisted only of patient education and a home program of gentle stretching and strengthening. Patients completed the Simple Shoulder Test at the initial visit and sequentially at 6-month intervals thereafter. At an average followup of 2.5+/-1.6 years, 27 (59%) patients experienced improvement with nonoperative treatment, 14 (30%) patients experienced worsening, and five (11%) patients remained unchanged. The average number of Simple Shoulder Test functions the patients could perform initially was 5.6+/-3.2. At the latest followup, the average number of Simple Shoulder Test functions the patients could perform improved to 7.0 +/-3.8. The ability to sleep on the affected side and the ability to place the hand behind the head were significantly improved. PMID:11154011

Goldberg, B A; Nowinski, R J; Matsen, F A

2001-01-01

227

Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results  

PubMed Central

Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3?years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. Results The mean follow-up was 40?months in the SR group and 38.9?months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case–control study.

2013-01-01

228

A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty With Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff TearsDisease-Specific Quality of Life Outcome at an Average 2Year Follow-Up  

Microsoft Academic Search

Background: Rotator cuff tears affect patients' quality of life. The evolution toward less invasive operative techniques for rotator cuff repair requires appropriate comparisons with the standard open procedure, using validated outcomes in a randomized fashion.Hypothesis: There is no difference in disease-specific quality of life outcomes at 2 years between an open surgical repair (open) versus an arthroscopic acromioplasty with mini-open

Nicholas G. Mohtadi; Robert M. Hollinshead; Treny M. Sasyniuk; Jennifer A. Fletcher; Denise S. Chan; Feng X. Li

2008-01-01

229

Rotator cuff muscle function and its relation to scapular morphology in apes.  

PubMed

It is widely held that many differences among primate species in scapular morphology can be functionally related to differing demands on the shoulder associated with particular locomotor habits. This perspective is largely based on broad scale studies, while more narrow comparisons of scapular form often fail to follow predictions based on inferred differences in shoulder function. For example, the ratio of supraspinous fossa/infraspinous fossa size in apes is commonly viewed as an indicator of the importance of overhead use of the forelimb, yet paradoxically, the African apes, the most terrestrial of the great apes, have higher scapular fossa ratios than the more suspensory orangutan. The recent discovery of several nearly complete early hominin scapular specimens, and their apparent morphological affinities to scapulae of orangutans and gorillas rather than chimpanzees, has led to renewed interest in the comparative analysis of human and extant ape scapular form. To facilitate the functional interpretation of differences in ape scapulae, particularly in regard to relative scapular fossa size, we used electromyography (EMG) to document the activity patterns in all four rotator cuff muscles in orangutans and gibbons, comparing the results with previously published data for chimpanzees. The EMG results indicate that the distinctive contributions of each cuff muscle to locomotion are the same in the three ape species, failing to support inferences of differences in rotator cuff function based on relative scapular fossa size comparisons. It is also shown that relative scapular fossa size is not in fact a good predictor of either the relative masses or cross-sectional areas of the rotator cuff muscles in apes, and relative fossa size gives a false impression of the importance of individual cuff muscles to locomotor differences among apes. A possible explanation for the disparity between fossa and muscle size relates to the underappreciated role of the scapular spine in structural reinforcement of the blade. PMID:23968682

Larson, Susan G; Stern, Jack T

2013-08-19

230

Rotator Cuff Contusions of the Shoulder in Professional Football PlayersEpidemiology and Magnetic Resonance Imaging Findings  

Microsoft Academic Search

Background: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players.Purpose: To determine a single professional football team’s incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder.Study Design: Case series; Level of evidence, 4.Methods: From 1999 to 2005, a

Steven B. Cohen; Jeffrey D. Towers; James P. Bradley

2007-01-01

231

Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial  

Microsoft Academic Search

Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease.Design Randomised, participant and single assessor blinded, placebo controlled trial.Setting Metropolitan region of Melbourne, Victoria, Australia.Participants 120 participants with chronic (>3 months) rotator cuff disease recruited through medical practitioners and from the community.Interventions

Kim Bennell; Elin Wee; Sally Coburn; Sally Green; Anthony Harris; Margaret Staples; Andrew Forbes; Rachelle Buchbinder

2010-01-01

232

Relationship of Radiographic Acromial Characteristics and Rotator Cuff Disease: A Prospective Investigation of Clinical, Radiographic, and Sonographic Findings  

PubMed Central

Background Many studies have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Therefore, the purpose of this study was to determine the relationship between rotator cuff disease and development of symptoms with different radiographic acromial characteristics including shape, index, and presence of a spur. Materials and Methods The records of 216 patients enrolled in an ongoing prospective, longitudinal study investigating asymptomatic rotator cuff tears were reviewed. All patients underwent standardized radiographic evaluation, clinical evaluation, and shoulder ultrasonography at regularly scheduled surveillance visits. Three blinded observers reviewed all radiographs to determine the acromial morphology, presence and size of an acromial spur, and acromial index. These findings were analyzed to determine an association with the presence of a full-thickness rotator cuff tear. Results The three observers demonstrated poor agreement for acromial morphology, substantial agreement for the presence of an acromial spur, and excellent agreement for acromial index (kappa= 0.41, 0.65, and 0.86 respectively). The presence of an acromial spur was highly associated with the presence of a full-thickness rotator cuff tear (p=0.003) even after adjusting for age. No association was found between acromial index and rotator cuff disease (p=0.92). Conclusion The presence of an acromial spur is highly associated with the presence of a full-thickness rotator cuff tear in both the symptomatic and asymptomatic patient. The acromial morphology classification system is an unreliable method to assess the acromion. The acromial index shows no association with the presence of rotator cuff disease.

Hamid, Nady; Omid, Reza; Yamaguchi, Ken; Steger-May, Karen; Stobbs, Georgia; Keener, Jay D

2013-01-01

233

Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions.  

PubMed

Limited evidence exists regarding the validity of clinical examination for the detection of shoulder pathology. We therefore wished to establish the sensitivity, specificity, positive predictive value and negative predictive value of clinical tests and magnetic resonance imaging (MRI) in the diagnosis of rotator cuff disorders against findings at arthroscopy. Using recognised tests for specific shoulder lesions, 117 patients with shoulder symptoms awaiting surgery were examined in a standard manner. The diagnoses were categorised and compared with abnormalities found on MRI and at surgery. Results were cross-tabulated to determine the above parameters. Ninety-four patients formed the study group with a mean age of 51 years. The median duration of symptoms was 45 weeks. For clinical examination, sensitivity and specificity to detect a tear or rupture of supraspinatus were 30 % (16/54) and 38 % (15/40) and, for the detection of any pathology, were 94 % (67/71) and 22 % (5/23), respectively, compared with arthroscopy. Correspondingly, the sensitivity of MRI compared with arthroscopy to detect a tear or rupture of supraspinatus was 90 % (28/31) with a specificity of 70 % (46/53), whereas for the detection of any abnormality, the sensitivity was 92 % (65/71) with a specificity of 48 % (11/23). The sensitivity of detecting any rotator cuff abnormality is high when examination and MRI is compared with arthroscopy with the specificity being greater with MRI than examination. In patients with shoulder symptoms severe enough to consider surgery, clinical assessment followed by specific imaging may help define the pathology in order to direct appropriate management. PMID:23636792

Ostör, Andrew J K; Richards, Christine A; Tytherleigh-Strong, Graham; Bearcroft, Philip W; Prevost, A Toby; Speed, Cathy A; Hazleman, Brian L

2013-05-02

234

New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial "Biodegradable Spacer"  

PubMed Central

Massive, irreparable rotator cuff tears are a source of pain and disability. Although most rotator cuff tears can be completely repaired, a significant number are considered massive and irreparable. Numerous operative techniques have been described for the treatment of these kinds of tears including arthroscopic debridement, biceps tenotomy, tendon transfer, grafting, and reverse arthroplasty. We describe a surgical technique using a biodegradable subacromial balloon spacer (InSpace; OrthoSpace, Kfar Saba, Israel) implanted between the humeral head and acromion that permits smooth, frictionless gliding, restoring the shoulder biomechanics. The technique is easy to perform and is less invasive than the conventional surgical techniques available, and it may potentially serve as a bridging option in patients with massive, irreparable tears who are normally candidates for reverse arthroplasty.

Savarese, Eugenio; Romeo, Rocco

2012-01-01

235

A load-sharing rip-stop fixation construct for arthroscopic rotator cuff repair.  

PubMed

Despite advancements in arthroscopic rotator cuff repair techniques, achieving tendon-to-bone healing can be difficult in the setting of poor-quality tendon. Moreover, medial tendon tears or tears with lateral tendon loss may preclude standard techniques. Rip-stop suture configurations have been shown to improve load to failure compared with simple or mattress stitch patterns and may be particularly valuable in these settings. The purpose of this report is to describe a technical modification of a rip-stop rotator cuff repair that combines the advantages of a rip-stop suture (by providing resistance to tissue cutout) and a double row of load-sharing suture anchors (minimizing the load per anchor and therefore the load per suture within each anchor). PMID:23766972

Denard, Patrick J; Burkhart, Stephen S

2012-03-15

236

Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears  

PubMed Central

Summary Purpose: simple tenotomy in the treatment of long head biceps (LHB) lesion offers good results, as well as tenotomy/tenodesis. Materials and methods: we prospectively evaluated 252 patients, divided into 3 groups, treated with rotator cuff repair associated with LHB tenotomy or 2 different types of tenodesis in cases where there had been a partial lesion of the LHB or instability of the bicipital groove. We ascertained whether there was residual pain and the presence of the “Popeye sign” in the post-operative stage. Results: patients who underwent tenotomy alone achieved an improvement on the Visual Analogue Scale (VAS), Simple Shoulder Test (SST) and modified UCLA shoulder rating compared to patients who underwent LHB tenodesis. A positive Popeye sign is poorly perceived by patients. Conclusion: we considered the LHB tenotomy as treatment of choice for the rotator cuff surgical repair when there was an evident LHB lesion.

Biz, Carlo; Vinanti, Giovanni Battista; Rossato, Alberto; Arnaldi, Enrico; Aldegheri, Roberto

2012-01-01

237

Current concepts: rotator cuff pathology in athletes - a source of pain or adaptive pathology?  

PubMed

Magnetic resonance imaging (MRI) findings are common in patients and athletes with shoulder pain. Historically these anatomic derangements have been thought to be the source of the patient's symptoms, and approaches have been focused on restoring the anatomy. This manuscript will address three objectives: 1) suggest that the approach to rotator cuff disease should be based on the patient's history and physical examination, and not necessarily on the anatomic disorders apparent on imaging; 2) review the data that supports the contention that rotator cuff disease is not the source of pain in the symptomatic shoulder, and 3) describe the concept of adaptive pathology. The findings on the MRI in the thrower's painful shoulder may be adaptive, and these alterations may be required to allow performance at high levels in sport. PMID:24030304

Kuhn, John E

238

Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.  

PubMed

We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes. PMID:11734490

Nakagawa, S; Yoneda, M; Hayashida, K; Wakitani, S; Okamura, K

239

Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair  

Microsoft Academic Search

Relatively large calcific materials on radiographs of shoulders with persistent symptoms after extended periods of conservative\\u000a treatment are candidates for operative treatment. But complete removal of calcific materials sometimes leaves a large defect\\u000a in the rotator cuff tendon, and tendon repair might be essential if defects are large. We evaluated the clinical results of\\u000a complete removal of calcific deposits with

Jae Chul Yoo; Won Hah Park; Kyoung Hwan Koh; Sang Min Kim

2010-01-01

240

Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age  

Microsoft Academic Search

We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group:\\u000a median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years).\\u000a The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but\\u000a different in age. After

Leonardo OstiRocco; Rocco Papalia; Angelo Del Buono; Vincenzo Denaro; Nicola Maffulli

2010-01-01

241

Long Head of the Biceps Pathology Combined with Rotator Cuff Tears  

PubMed Central

The long head of the biceps tendon (LHBT) is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT) tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies.

Ditsios, Konstantinos; Agathangelidis, Filon; Boutsiadis, Achilleas; Karataglis, Dimitrios; Papadopoulos, Pericles

2012-01-01

242

Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap  

Microsoft Academic Search

Periosteal augmentation of tendons in the course of refixation to bone has been shown to be a suitable method for early primarily\\u000a stable osteofibroblastic integration. The aim of this study was to evaluate the clinical and radiological results of open\\u000a rotator cuff reconstruction using an autologous periosteal flap augmentation technique. The research was performed as a prospective\\u000a cohort study. Twenty-three

Markus Scheibel; Anna Brown; Klaus Woertler; Andreas B. Imhoff

2007-01-01

243

New perspectives in rotator cuff tendon regeneration: review of tissue engineered therapies  

Microsoft Academic Search

Tissue engineering may play a major role in the treatment of rotator cuff tendon lesions through replacement of an injured\\u000a tendon segment. Tendons have very poor spontaneous regenerative capabilities, and despite intensive remodelling, complete\\u000a regeneration is never achieved and the strength of tendon and ligaments remains as much as 30% lower than normal even months\\u000a or years following an acute

Roberto Rotini; Milena Fini; Gianluca Giavaresi; Alessandro Marinelli; Enrico Guerra; Diego Antonioli; Alessandro Castagna; Roberto Giardino

2008-01-01

244

The effect of unloading on gene expression of healthy and injured rotator cuffs.  

PubMed

Tendon unloading following rupture of one of the rotator cuff tendons can induce alterations in muscle physiology and tendon structure, which can subsequently affect reparability and healing potential. Yet little is known about the effects of muscle and tendon unloading on the molecular response of the rotator cuff. We determined the effect of mechanical unloading on gene expression and morphology of healthy supraspinatus tendons and muscles, and the same muscles after acute injury and repair. Mechanical unloading was achieved by tenotomy and/or botulinum toxin A (BTX) chemical denervation in a rat rotator cuff model of injury and repair. Gene expression profiles varied across regions of the muscle, with the greatest changes seen in the distal aspect of the muscle for most genes. Myogenic and adipogenic genes were upregulated in muscle when unloaded (tenotomy and BTX). Tendon injury, with and without repair, resulted in upregulation of fibrosis- and tendon-specific gene expression. The expression of scleraxis, a transcription factor necessary for tendon development, was upregulated in response to injury and repair. In summary, tendon detachment and repair had the greatest effect on tendon gene expression, while unloading had the greatest effect on muscle gene expression. PMID:23508698

Killian, M L; Lim, C T; Thomopoulos, S; Charlton, N; Kim, H M; Galatz, L M

2013-03-18

245

Rotator Cuff Tendinitis and Tear (Beyond the Basics)  

MedlinePLUS

... Shoulder strength PI PICTURES Posterior shoulder capsule stretch Sleeper stretch Scapular squeeze PI Outward rotation PI Inward ... You can do this regularly throughout the day. Sleeper stretch – Lie on your back and extend both ...

246

Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears  

PubMed Central

Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing.

Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.

2010-01-01

247

The use of split deltoid-flap in the treatment of massive rotator cuff defects: a retrospective study of 61 patients  

Microsoft Academic Search

Massive and irreparable rotator cuff tears are a challenge for the orthopaedic surgeon. The purpose of this study was to report\\u000a our experience with the treatment of massive and irreparable defects of the rotator cuff with a modified deltoid split transfer.\\u000a Between 1996 and 2004, for all patients suffering from full-thickness tears of the rotator cuff (>5 cm tears in diameter,

Panayiotis T. Hadjicostas; Panayotis N. Soucacos; Markus Theissen; Friedrich W. Thielemann

2008-01-01

248

Functional Outcome and Health-Related Quality of Life After Surgical Repair of Full-Thickness Rotator Cuff Tear Using a Mini-Open Technique  

Microsoft Academic Search

Background: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss.Hypothesis: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life.Study Design: Cohort study. Level of evidence, 2.Methods: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1)

Deniz Baysal; Robert Balyk; David Otto; Charlene Luciak-Corea; Lauren Beaupre

2005-01-01

249

Suprascapular nerve rotator cuff compression syndrome in volleyball players  

Microsoft Academic Search

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous

Michael J Sandow; James Ilic

1998-01-01

250

Major ruptures of the rotator cuff. The results of surgical repair in 89 patients.  

PubMed

Major ruptures of the rotator cuff were repaired in 89 patients over a six-year period, using an approach through the split deltoid muscle and the bed of the excised outer centimetre of the clavicle. Review of these patients showed that poor results were associated with larger cuff defects, with more pre-operative steroid injections and with pre-operative weakness of the deltoid muscle. A randomised prospective study showed that repair followed by splinting in abduction gave no better results than repair followed by resting the arm at the side. Excision of the coraco-acromial ligament was associated with worse results than leaving its divided halves in situ. Follow-up showed that the results continued to improve for two years after operation; their quality was maintained in patients less than 60 years old, but in those over 60 there was deterioration with time. PMID:4030862

Watson, M

1985-08-01

251

Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears  

PubMed Central

The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.

Gille, Justus; Suehwold, Joerg; Schulz, Arndt-Peter; Kienast, Benjamin; Unger, Andreas; Jurgens, Christian

2009-01-01

252

Rotator cuff healing after continuous subacromial bupivacaine infusion: an in vivo rabbit study  

PubMed Central

Background The objective of this study was to evaluate the effects of continuous subacromial bupivacaine infusion on supraspinatus muscle and rotator cuff tendon healing via gross, biomechanical, and histologic analyses. Methods Thirty-three New Zealand White rabbits underwent unilateral supraspinatus transection and rotator cuff repair (RCR). Rabbits were assigned to 1 of 3 groups: (1)RCR only, (2)RCR with continuous saline infusion for 48 hours, or (3)RCR with continuous 0.25% bupivacaine with epinephrine (1:200,000) infusion for 48 hours. Rabbits were sacrificed at either 2 (for histologic assessment) or 8 weeks post-operatively (for biomechanical and histologic assessment). Results Tensile testing showed significantly higher load to failure in intact tendons compared to repaired tendons (p<0.01); however, no statistical differences were detected among RCR only, RCR Saline, and RCR Bupivacaine groups. Histologically, the enthesis of repaired tendons showed increased cellularity and disorganized collagen fibers compared to intact tendons, with no differences between treatment groups. Muscle histology demonstrated scattered degenerative muscle fibers at 2 weeks in both RCR Saline and RCR Bupivacaine, but no degeneration was noted at 8 weeks. Conclusions The healing supraspinatus tendons exposed to bupivacaine infusion showed similar histologic and biomechanical characteristics compared to untreated and saline infused RCR groups. Muscle histology showed fiber damage at 2 weeks for both the saline and bupivacaine treated groups, with no apparent disruption at 8 weeks, suggesting a recovery process. Therefore, subacromial bupivacaine infusion in this rabbit rotator cuff model does not appear to impair muscle or tendon following acute injury and repair. Level Of Evidence Basic science study

FRIEL, NICOLE A.; WANG, VINCENT M.; SLABAUGH, MARK A.; WANG, FANCHIA; CHUBINSKAYA, SUSAN; COLE, BRIAN J.

2013-01-01

253

Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial  

Microsoft Academic Search

BACKGROUND: Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other

Jennifer A Coghlan; Andrew Forbes; Simon N Bell; Rachelle Buchbinder

2008-01-01

254

Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair  

Microsoft Academic Search

Background  The surgical treatment of massive rotator cuff tears (RCT) is still controversial and can be based on a variety of different\\u000a surgical repair methods. This study investigated the effectiveness of arthroscopic debridement or arthroscopic partial repair\\u000a in patients with massive RCT.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  This prospective, randomized study involved forty-two patients with massive RCT (fatty infiltration stage 3 or 4) treated\\u000a with

Alexander Berth; Wolfram Neumann; Friedemann Awiszus; Géza Pap

2010-01-01

255

Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective randomized comparison study  

Microsoft Academic Search

Hypothesis  Arthroscopic acromioclavicular joint (ACJ) resection for asymptomatic ACJ arthritis combined with rotator cuff repair leads\\u000a to more satisfactory pain relief and decrease reoperation rate when inferiorly directed osteophytes present at the undersurface\\u000a of ACJ.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Between January 2006 and May 2008, a total of 83 patients (83 shoulders), 40 males and 43 females, who were planned to have\\u000a arthroscopic

Jaehwa Kim; Juhwan Chung; Hyunsoo Ok

2011-01-01

256

Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks.  

PubMed

Rotator cuff calcific tendinitis is a very common disease and may result in a very painful shoulder. Aetiology of this disease is still poorly understood. When symptoms are mild, this disease may be treated conservatively. Several treatment options have been proposed. Among them, ultrasound-guided procedures have been recently described. All procedures use one or two needles to inject a fluid, to dissolve calcium and to aspirate it. In the present article, we review some tips and tricks that may be useful to improve performance of an ultrasound-guided double-needle procedure. PMID:22710923

Sconfienza, Luca Maria; Viganò, Sara; Martini, Chiara; Aliprandi, Alberto; Randelli, Pietro; Serafini, Giovanni; Sardanelli, Francesco

2012-06-19

257

Fast MR arthrography using VIBE sequences to evaluate the rotator cuff  

Microsoft Academic Search

Purpose  The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be\\u000a used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography\\u000a to diagnose rotator cuff tears.\\u000a \\u000a \\u000a \\u000a Materials and methods  Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS

Jan E. Vandevenne; Filip Vanhoenacker; Jestinah M. Mahachie John; Geert Gelin; Paul M. Parizel

2009-01-01

258

Avaliação da microcirculação das bordas do tendão do supra-espinal nas lesões do manguito rotador* Microvascular evaluation of the supraspinatus tendon borders in rotator cuff lesions  

Microsoft Academic Search

Objectives: To evaluate microvasculature in the borders of the supraspinatus tendon in rotator cuff lesions in order to determine the need to debrid the borders when surgical repair is performed. Methods: From June to December 224, samples were evaluated from 31 patients with full lesion of the supraspinatus tendon that had been submitted to arthroscopic rotator cuff lesion treatment. They

Ikemoto RY; Murachovsky J; Nascimento LGP; Bueno RS; Ueno FH; Akita Júnior J; ROBERTO YUKIO IKEMOTO; LUIS GUSTAVO; PRATA NASCIMENTO; ROGÉRIO SERPONE BUENO; FABRÍCIO HIDETOSHI UENO; JORGE AKITA JÚNIOR

259

Cyclic loading of anchor-based rotator cuff repairs: Confirmation of the tension overload phenomenon and comparison of suture anchor fixation with transosseous fixation  

Microsoft Academic Search

Previous experimental studies of failure of rotator cuff repair have involved single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 ×2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with three MitekRC suture anchors (Mitek Surgical Products, Inc, Westwood, MA) using simple sutures of

Stephen S. Burkhart; Jose L. Diaz Pagàn; Michael A. Wirth; K. A. Athanasiou

1997-01-01

260

Shoulder muscle activation and coordination in patients with a massive rotator cuff tear: an electromyographic study.  

PubMed

Adaptive muscle activation strategies following a massive rotator cuff tear (MRCT) are inadequately understood, and the relationship among muscles during everyday activities has not been considered. Thirteen healthy subjects comprised the control group, and 11 subjects with a MRCT the patient group. Upper limb function was assessed using the Functional Impairment test-hand, neck, shoulder, and arm (FIT-HaNSA). Electromyography (EMG) was recorded from 13 shoulder muscles, comprising five muscle groups, during a shelf-lifting task. Mean FIT-HaNSA scores were significantly lower in MRCT patients (p?0.001), reflecting a severe functional deficit. In MRCT patients, EMG signal amplitude was significantly higher for the biceps brachii-brachioradialis (p?rotator cuff. Re-education towards an alternate neuromuscular control strategy appears necessary to restore function. PMID:22213234

Hawkes, David H; Alizadehkhaiyat, Omid; Kemp, Graham J; Fisher, Anthony C; Roebuck, Margaret M; Frostick, Simon P

2011-12-30

261

Early postoperative outcomes between arthroscopic and mini-open repair for rotator cuff tears.  

PubMed

The purpose of this study was to compare early postoperative outcomes between arthroscopic and mini-open repair for rotator cuff tears smaller than 3 cm to determine whether arthroscopic repair causes less postoperative pain and allows for faster recovery of range of motion. Sixty patients scheduled for rotator cuff repair were randomized to either an arthroscopic repair group (30 patients) or a mini-open repair group (30 patients). Pain level, range of motion, shoulder stiffness, and complications were compared between the 2 groups from immediately postoperatively to 6 months postoperatively. Although no statistically significant difference was found in mean visual analog scale pain scores between the 2 groups during the 6 months postoperatively, mean visual analog scale pain score was significantly lower in the arthroscopic repair group compared with the mini-open repair group at postoperative days 1 and 2 (P=.02 and P=.04, respectively). No significant difference existed in postoperative range of motion, duration of rehabilitation, shoulder stiffness, or complications between the 2 groups; however, the use of additional analgesics in the arthroscopic repair group was significantly lower than in the mini-open repair group (P=.03). Arthroscopic and mini-open repair had equivalent clinical outcomes in the early postoperative period. The hypothesis that arthroscopic repair would cause less postoperative pain and allow faster recovery of range of motion in the early postoperative period compared with mini-open repair was not supported. PMID:22955400

Cho, Chul-Hyun; Song, Kwang-Soon; Jung, Gu-Hee; Lee, Young-Kuk; Shin, Hong-Kwan

2012-09-01

262

Simultaneous acute rotator cuff tear and distal biceps rupture in a strongman competitor.  

PubMed

Acute rotator cuff tear is commonly associated with tearing of the proximal biceps tendon, but has never been reported to occur simultaneously with a distal biceps tendon rupture. A 38-year-old right-hand-dominant strongman competitor attempted a 300-pound overhead axle press and experienced immediate pain in the right shoulder and elbow. He had no known systemic risk factors for tendon ruptures including hyperparathyroidism, hemodialysis, alcoholism, rheumatoid arthritis, statin medications, fluoroquinolones, and steroid use.Right shoulder magnetic resonance imaging (MRI) showed a full-thickness supraspinatus tear with 3 cm of retraction. There was minimal fatty infiltration of the supraspinatus on the sagittal cuts consistent with acute rupture. The subscapularis was intact. The long head of the biceps tendon had mild medial subluxation but was completely within the bicipital groove. Right elbow MRI showed a complete distal biceps tendon rupture. Thirteen days after his injury, the patient underwent arthroscopic supraspinatus repair and proximal biceps tenodesis. Distal biceps tendon repair was performed using the modified 2-incision muscle-splitting technique. At 24-month follow-up, the patient was pain free and had returned to full activity including weightlifting but had not returned to strongman competition.This is the first report of simultaneous acute full thickness ruptures of the rotator cuff and distal biceps tendon. This case report underscores the importance of a complete physical examination and a high index of suspicion for additional concomitant injuries, particularly in athletes with unusually high stresses to the body. PMID:20415310

George, Michael S

2010-04-16

263

[Comparative arthrographic and echographic study of degenerative lesions of the rotator cuff of the shoulder].  

PubMed

Sonography is a simple technique which is currently employed in the study of rotator cuff lesions in the shoulder. A comparative US and arthrographic study was carried out on 52 patients with a "painful shoulder", to evaluate US yield in this pathologic condition. Arthrography was positive for a rotator cuff lesion in 31/52 cases (25 full-thickness and 6 incomplete lesions) and demonstrated associated conditions (capsulitis, chondral lesions, lesions of the long head of biceps, capsulo-ligamentous hypotonia, effusions) in 11 case. Arthrographic findings were negative in 10 cases. US demonstrated a lesion in 25/31 of positive arthrographic cases, and it was negative in 3/6 incomplete lesions. In 7/11 patients US yielded additional information as to associated conditions. US false-positives were 3/10, while in the extant 7/10 cases US was negative too. Thanks to its high sensitivity and specificity (80% and 70%, respectively, in our series), US appears as a valuable diagnostic complement to arthrography; the former may even replace the latter in those cases where conservative treatment is expected. PMID:2267376

Gatti, G; Tabasso, M D

1990-11-01

264

Operative management of partial- and full-thickness rotator cuff tears.  

PubMed

Repair of rotator cuff tears (RCT) is challenging. In RC tears, a partial (PTRCTs) or full (RCTs) discontinuation of one or more of the muscles or tendons and may occur as a result of traumatic injury or degeneration over a period of years. Many factors seem to contribute to the final outcome and a considerable number of variations during the decision-making process of patients with RCTs exist. Accurate diagnosis is fundamental to guide correct management, and the tear pattern should be carefully evaluated to plan the appropriate repair. Both non-operative and operative treatments are used to relieve pain and restore movement and function of the shoulder. Different surgical options are available. The present review describes the current evidence about diagnosis and management of partial and complete rotator tears. PMID:21986049

Franceschi, Francesco; Papalia, Rocco; Palumbo, Alessio; Del Buono, Angelo; Maffulli, Nicola; Denaro, Vincenzo

2011-10-04

265

Arm adductor with arm abduction in rotator cuff tear patients vs. healthy--design of a new measuring instrument.  

PubMed

The incidence of (a)symptomatic rotator cuff tears is high, but etiologic mechanisms are unclear and treatment outcomes vary. A practical tool providing objective outcome measures and insight into etiology and potential patient subgroups is desirable. Symptomatic cuff tears coincide with humerus cranialization. Adductor co-activation during active arm abduction has been reported to reduce subacromial narrowing and pain in cuff patients. We present an easy-to-use method to evaluate adductor co-activation. Twenty healthy controls and twenty full-thickness cuff tear patients exerted EMG-recorded isometric arm abduction and adduction tasks. Ab- and adductor EMG's were expressed using the "Activation Ratio (AR)" (-1 ? AR ? 1), where lower values express more co-activation. Mean control AR's ranged from .7 to .9 with moderate to good test-retest reliability (ICC: .60-.74). Patients showed significantly more adductor co-activation during abduction, with adductor AR's ranging between .3 (teres major) and .5 (latissimus dorsi). In conclusion, the introduced method discriminates symptomatic cuff tear patients from healthy controls, quantifies adductor co-activation in an interpretable measure, and provides the opportunity to study correlations between muscle activation and humerus cranialization in a straightforward manner. It has potential as an objective outcome measure, for distinguishing symptomatic from asymptomatic cuff tears and as a tool for surgical or therapeutic decision-making. PMID:22341875

de Witte, P B; van der Zwaal, P; Visch, W; Schut, J; Nagels, J; Nelissen, R G H H; de Groot, J H

2012-02-15

266

PARot - assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial  

PubMed Central

Background Platelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171–1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies. Methods/Design PARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP. The study will run for 3 years and aims to randomize 40 patients. Recruitment will be for 24 months with final follow-up at 1 year post surgery. The third year will also involve collation and analysis of the data. This study will be funded through the NIHR Biomedical Research Unit at the Oxford University Hospitals NHS Trust. Trial registration Current Controlled Trials: ISRCTN10464365

2013-01-01

267

The effect of head rotation on efficiency of ventilation and cuff pressure using the PLMA in pediatric patients  

PubMed Central

Background This study examined whether changing the head position from neutral to side can affect expiratory tidal volume (TV) and cuff pressure when the appropriate sizes of a Proseal™ Laryngeal Mask Airway (PLMA)-depending on the body weight -are used in pediatric patients during pressure controlled ventilation (PCV). Methods Seventy-seven children (5-30 kg) were divided into three groups according to their body weight, PLMA#1.5 (group I, n = 24), #2 (group II, n = 26), and #2.5 (group III, n = 27). After anesthesia induction, a PLMA was placed with a cuff-pressure of 60 cmH2O. The TV and existence of leakage at the peak inspiratory pressure (PIP) of 20 cmH2O, and the appropriate PIP for TV 10 ml/kg were examined. Upon head rotation to the left side, the TV, PIP, cuff pressure changes, and the appropriate PIP to achieve a TV 10 ml/kg were evaluated. Results Head rotation of 45 degrees to the left side during PCV caused a significant increase in cuff pressure and a decrease in TV, and there was no definite leakage. Changes in PIP and TV were similar in the three groups. The cuff pressure increased but there was no significant difference between the three groups. Conclusions Although cuff pressure and TV of the PLMA were changed significantly after turning the head from the neutral position to the side, a re-adjustment of the cuff pressure and PIP to maintain a TV of 10 ml/kg can make the placed PLMA useful and successful in pediatric patients under general anesthesia.

Park, Hahck Soo; Kim, Youn Jin

2011-01-01

268

Double-contrast arthrotomography of the shoulder: correlation of radiological and surgical findings in complete rotator cuff tears.  

PubMed

Double-contrast arthrotomography of the shoulder appears extremely valuable; we have verified its accuracy in measurements of complete rotator cuff tears. The first 31 patients so investigated and explored surgically have been retrospectively evaluated. Accurate measurements were found in 85% of the coronal diameters and in 69% of the sagittal ones. PMID:4044611

Vézina, J A; Des Marchais, J E; Beauregard, C G

1985-09-01

269

Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors.  

PubMed

Over 2.6 million breast cancer survivors currently reside in the United States. While improvements in the medical management of women diagnosed with breast cancer have resulted in a 5-year survival rate of 89%, curative treatments are associated with a high prevalence of shoulder and arm morbidity, which, in turn, can negatively impact a woman's quality of life. Breast cancer survivors frequently experience shoulder and arm pain, decreased range of motion, muscle weakness, and lymphedema. These symptoms can lead to difficulties with daily activities ranging from overhead reaching and carrying objects to caring for family and returning to work. Despite health care professionals awareness of these problems, a significant number of breast cancer survivors are confronted with long-term, restricted use of their affected shoulder and upper extremity. This problem may partially be explained by: (1) an incomplete understanding of relevant impairments and diagnoses associated with shoulder/arm pain and limited upper extremity use, and (2) the limited effectiveness of current rehabilitation interventions for managing shoulder pain and decreased upper extremity function in breast cancer survivors. Because breast cancer treatment directly involves the neuromusculoskeletal tissues of the shoulder girdle, it is understandable why breast cancer survivors are likely to develop shoulder girdle muscle weakness and fatigue, decreased shoulder motion, altered shoulder girdle alignment, and lymphedema. These impairments can be associated with diagnoses such as post-mastectomy syndrome, adhesive capsulitis, myofascial dysfunction, and brachial plexopathy, all of which have been reported among breast cancer survivors. It is our belief that these impairments also put women at risk for developing symptomatic rotator cuff disease. In this paper we set forth the rationale for our belief that breast cancer treatments and subsequent impairments of shoulder girdle neuromusculoskeletal tissues place breast cancer survivors at risk for developing symptomatic rotator cuff disease. Additionally, we identify knowledge gaps related to the current understanding of relevant shoulder girdle impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Ultimately, information from studies designed to meet these gaps will provide a scientific basis for the development of new, or refinement of existing, examination, intervention, and prevention techniques, which should lead to improved clinical outcomes in this population. PMID:21764521

Ebaugh, David; Spinelli, Bryan; Schmitz, Kathryn H

2011-07-18

270

Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: A Modified Technique Using Arthroscopy  

PubMed Central

Latissimus dorsi transfer is a well-established method for the treatment of posterosuperior massive irreparable rotator cuff tears. We propose using an arthroscopically assisted technique that avoids insult to the deltoid. With the patient in the lateral decubitus position, an L-shaped incision is made along the anterior belly of the latissimus muscle and then along the posterior axillary line. The latissimus and teres major are identified and separated. The tendon insertion of the latissimus is isolated, and a FiberWire traction suture (Arthrex, Naples, FL) is placed, facilitating dissection of the muscle to the thoracodorsal neurovascular pedicle and subsequent mobilization. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the lateral aspect of the infraspinatus and supraspinatus footprints by multiple suture anchors.

Villacis, Diego; Merriman, Jarrad; Wong, Karlton; Rick Hatch, George F.

2013-01-01

271

Footprint reconstruction in a rotator cuff tear associated cyst of the greater tuberosity: augmented anchorage.  

PubMed

Tears of the rotator cuff (RC) complicated by bone cysts at the footprint might represent a challenge for the shoulder surgeon. This might be additionally aggravated in elderly patients with inferior bone quality due to osteopenia or osteoporosis. In this report we present a technique for open repair of RC tears by augmenting the cystic lesion at the greater tuberosity using bone void filler in combination with a double row anchor reconstruction technique. Despite disadvantageous position and size of the cyst, using this technique the footprint can be restored by obtaining an anatomical position of the supraspinatus tendon. The application range of this technique is not limited to defined bony defects and presents a promising novel surgical approach. Level of evidence V. PMID:23070221

Postl, L K; Braunstein, V; von Eisenhart-Rothe, R; Kirchhoff, C

2012-10-16

272

Medium term results of reverse total shoulder replacement in patients with rotator cuff arthropathy  

Microsoft Academic Search

Background  The Delta III total shoulder replacement is a reversed, semi-constrained prosthesis and is recommended for the management\\u000a of rotator cuff arthropathy.\\u000a \\u000a \\u000a \\u000a Methods  We performed a retrospective mid-term review of the Delta shoulder replacements performed during 2000–2005 with a minimum\\u000a 18-month follow-up. We recorded the pre-operative and post-operative constant scores.\\u000a \\u000a \\u000a \\u000a Results  The Constant’s score improved from a pre-operative mean of 14.8 (95% CI

M. K. Sayana; G. Kakarala; S. Bandi; C. Wynn-Jones

2009-01-01

273

Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods  

PubMed Central

Background: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances. Objective: To determine the most effective training for altering strength ratios in the shoulder rotator cuff. Methods: Forty eight physical education students were randomly assigned to four groups (12 per group): (a) experimental group who carried out multijoint dynamic resistance training for shoulder internal and external rotation movement (pull ups or lat pull downs, overhead press, reverse pull ups, push ups) (MJDR group); (b) experimental group who exercised the same muscle group using dumbbells weighing 2 kg (isolated group); (c) experimental group who followed an isokinetic strengthening programme for the rotator cuff muscle group (isokinetic group); (d) control group who had no strength training. Testing was performed in the supine position with the glenohumeral joint in 90° of abduction in the coronal plane, with a range of motion of 0–90° of external rotation and 0–65° of internal rotation at angular velocities of 60, 120, and 180°/s. The test procedure was performed before and after the exercise period of six weeks. Results: One way analysis of variance found no differences between the groups for the initial tests. Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement. Conclusions: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle.

Malliou, P; Giannakopoulos, K; Beneka, A; Gioftsidou, A; Godolias, G

2004-01-01

274

Biceps tendon properties worsen initially but improve over time following rotator cuff tears in a rat model  

PubMed Central

Damage to the biceps tendon is often seen in conjunction with rotator cuff tears. However, controversy exists regarding its role in the shoulder and its optimal treatment. A previous study determined that biceps tendons were detrimentally affected in the presence of rotator cuff tears in the rat model and this damage worsened over time. However, whether this damage progresses at later time points to provide a chronic model is unknown. The objective of this study was to determine the changes in the biceps tendon in the presence of a cuff tear over time. Our hypothesis was that histological, compositional, organizational and mechanical properties would worsen with time. We detached the supraspinatus and infraspinatus tendons of 48 rats and evaluated these properties at 1, 4, 8 and 16 weeks post detachment. Properties worsened through 8 weeks, but improved between 8 and 16 weeks. We therefore conclude that biceps tendon changes in this model are not truly chronic. Additionally, it has been shown that infraspinatus properties in this model return to normal by 16 weeks, when biceps properties improve, indicating that earlier repair of one or more of the rotator cuff tendons may lead to resolved pathology of the long head of the biceps tendon.

Peltz, Cathryn D.; Hsu, Jason E.; Zgonis, Miltiadis H.; Trasolini, Nicholas A.; Glaser, David L.; Soslowsky, Louis J.

2012-01-01

275

Classification of the degenerative grade of lesions of supraspinatus rotator cuff tendons by FT-Raman spectroscopy  

NASA Astrophysics Data System (ADS)

FT-Raman spectroscopy was employed to access the biochemical alterations occurring on the degenerative process of the rotator cuff supraspinatus tendons. The spectral characteristic variations in the 351 spectra of samples of 39 patients were identified with the help of Principal Components Analysis. The main variations occurred in the 840-911; 1022- 1218; 1257; 1270; 1300; 1452; 1663; and 1751 cm-1 regions corresponding to the vibrational bands of proline, hydroxiproline, lipids, nucleic acids, carbohydrates, collagen, and elastin. These alterations are compatible with the pathology alterations reported on the literature. Scattering plots of PC 4 vs PC 2 and PC 3 vs PC 2 contrasted with histopathological analysis has enabled the spectral classification of the data into normal and degenerated groups of tendons. By depicting empiric lines the estimated sensibility and specificity were 39,6 % and 97,8 %, respectively for PC 4 vs PC 2 and 36,0 % and 100 %, respectively for PC 3 vs PC 2. These results indicate that Raman spectroscopy can be used to probe the general tendon quality and could be applied as co adjuvant element in the usual arthroscopy surgery apparatus to guide the procedure and possibly infer about the probability of rerupture.

Palma Fogazza, Bianca; da Silva Carvalho, Carolina; Godoy Penteado, Sergio; Meneses, Cláudio S.; Abrahão Martin, Airton; da Silva Martinho, Herculano

2007-03-01

276

Single-Row or Double-Row Fixation Technique for Full-Thickness Rotator Cuff Tears: A Meta-Analysis  

PubMed Central

Background The single-row and double-row fixation techniques have been widely used for rotator cuff tears. However, whether the double-row technique produces superior clinical or anatomic outcomes is still considered controversial. This study aims to use meta-analysis to compare the clinical and anatomical outcomes between the two techniques. Methods The Pubmed, Embase, and Cochrane library databases were searched for relevant studies published before November 1, 2012. Studies clearly reporting a comparison of the single-row and double-row techniques were selected. The Constant, ASES, and UCLA scale systems and the rotator cuff integrity rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects or random-effects model. Results Eight studies were included in this meta-analysis. The weighted mean differences of the ASES (?0.84; P?=?0.04; I2?=?0%) and UCLA (?0.75; P?=?0.007; I2?=?0%) scales were significantly low in the single-row group for full-thickness rotator cuff tears. For tear sizes smaller than 3 cm, no significant difference was found between the groups no matter in Constant (P?=?0.95; I2?=?0%), ASES (P?=?0.77; I2?=?0%), or UCLA (P?=?0.24; I2?=?13%) scales. For tear sizes larger than 3 cm, the ASES (?1.95; P?=?0.001; I2?=?49%) and UCLA (?1.17; P?=?0.006; I2?=?0%) scales were markedly lower in the single-row group. The integrity of the rotator cuff (0.81; P?=?0.0004; I2?=?10%) was greater and the partial thickness retear rate (1.93; P?=?0.007; I2?=?10%) was less in the double-row group. Full-thickness retears showed no difference between the groups (P?=?0.15; I2?=?0%). Conclusion The meta-analysis suggests that the double-row fixation technique increases post-operative rotator cuff integrity and improves the clinical outcomes, especially for full-thickness rotator cuff tears larger than 3 cm. For tear sizes smaller than 3 cm, there was no difference in the clinical outcomes between the two techniques. Level of Evidence Level I.

Zhou, Jiaojiao; Yuan, Chaoqun; Chen, Kai; Cheng, Biao

2013-01-01

277

Effects of one-month continuous passive motion after arthroscopic rotator cuff repair: results at 1-year follow-up of a prospective randomized study  

Microsoft Academic Search

The study included 100 patients who underwent an arthroscopic rotator cuff repair. All patients suffered about a rotator cuff\\u000a tear that was repaired arthroscopically with a suture anchor technique. Immediately postoperatively, patients were randomly\\u000a allocated to one of two different postoperative physiotherapy regimens: passive self-assisted range of motion exercise (controls:\\u000a 46 patients) versus passive self-assisted range of motion exercise associated

Raffaele Garofalo; Marco Conti; Angela Notarnicola; Leonardo Maradei; Antonio Giardella; Alessandro Castagna

2010-01-01

278

Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder  

Microsoft Academic Search

The usefulness of ultrasound measurements in the diagnosis of the subacromial impingement syndrome of the shoulder was evaluated.\\u000a Fifty-seven patients with unilateral symptoms of the impingement syndrome underwent ultrasound examination of both shoulder\\u000a joints, which included assessment of rotator cuff integrity, measurement of rotator cuff thickness and the distance between\\u000a the infero-lateral edge of acromion and the apex of the

Jerzy J. Cholewinski; Damian J. Kusz; Piotr Wojciechowski; Lukasz S. Cielinski; Miroslaw P. Zoladz

2008-01-01

279

Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete.  

PubMed

Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12 months of increasing pain during gymnastics being unable to perform most skills. At 1 year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3 T MRI. The patient was able to return to national-level competition. PMID:23314880

Wang, Allan W; Bauer, Stefan; Goonatillake, Matthew; Breidahl, William; Zheng, Ming-Hao

2013-01-11

280

A new approach to the subacromial space. Technique and 2-year results in 28 rotator-cuff repair cases.  

PubMed

We present a new approach to the subacromial space, consisting essentially of an osseous detachment of the deltoid muscle from the anterior and lateral rim of the acromion including the osseous origin of the coraco-acromial ligament. After acromioplasty and an eventual reconstruction of a torn rotator cuff, Kessler-sutures provide stable transosseous repair of the deltoid muscle. This method generally allows immediate active shoulder motion. 25 of 28 patients with rotator cuff ruptures alone or in combination with an impingement syndrome had good results according to the UCLA-score 2 years postoperatively. No serious complications regarding the function of the deltoid muscle or any failure of the accompanying acromioplasty occurred. PMID:8451960

Habernek, H; Weinstabl, R; Schabus, R; Schmid, L

1993-02-01

281

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement.  

PubMed

OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients. PMID:20411160

Phadke, V; Camargo, Pr; Ludewig, Pm

2009-02-01

282

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement  

PubMed Central

Objective The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. Results The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. Conclusion These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.

Phadke, V; Camargo, PR; Ludewig, PM

2009-01-01

283

Arthroscopically Assisted Mini-Open Rotator Cuff RepairsFunctional Outcome at 2- to 7Year Follow-up  

Microsoft Academic Search

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients

Jonathan C. Hersch; Nicholas A. Sgaglione

2000-01-01

284

Delayed diagnosis of concomitant rotator cuff tear and brachial plexopathy in a patient with traumatic brain injury: A case report  

Microsoft Academic Search

Mukand JA, Blackinton DD, VanDyck WR. Delayed diagnosis of concomitant rotator cuff tear and brachial plexopathy in a patient with traumatic brain injury: a case report. Arch Phys Med Rehabil 2001;82:1729-32. Traumatic brain injury (TBI) is often accompanied by additional trauma that can be obscured by cognitive dysfunction or multiple injuries in the same region of the body. This report

Jon A. Mukand; Dilshad D. Blackinton; Walter R. VanDyck

2001-01-01

285

Midterm results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears  

Microsoft Academic Search

IntroductionThe objective of this study was to compare the postoperative range of motion (ROM) and patient satisfaction after surgical reconstruction of traumatic and non-traumatic rotator cuff tears.Materials and methodsThe cases of 46 consecutive patients who underwent the same standardised surgical reconstruction and postoperative rehabilitation protocol between 1993 and 1998 were reviewed. Traumatic (group I, n=20, average age 34.2 years, range 15–49 years)

Carsten Braune; Ruediger von Eisenhart-Rothe; Frederic Welsch; Matthias Teufel; Alwin Jaeger

2003-01-01

286

Evaluation of BioCorkscrew and Bioknotless RC suture anchor rotator cuff repair fixation: an in vitro biomechanical study  

Microsoft Academic Search

This in vitro biomechanical study used cadaveric specimens to compare the rotator cuff repair fixation provided by BioCorkscrew\\u000a and Bioknotless RC suture anchors. Three cm wide by 1-cm long full-thickness supraspinatus defects were repaired using either\\u000a two BioCorkscrew suture anchors with combined vertical and horizontal mattress sutures (n = 7) or three Bioknotless RC suture anchors with simple sutures (n = 7). Therefore, the

Jennifer Tucker Ammon; John Nyland; Haw Chong Chang; Robert Burden; David N. M. Caborn

2007-01-01

287

Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction  

Microsoft Academic Search

Introduction  Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( ? 5 cm2) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements.Patients and methods  Of 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have

J. Keen; J. Nyland; Y. Kocabey; A. Malkani

2006-01-01

288

MR Evaluation of Rotator Cuff Pathology Using T2Weighted Fast Spin-Echo Technique with and Without Fat Suppression  

Microsoft Academic Search

OBJECTIVE. This study was designed to compare MR imaging findings from T2- weighted fast spin-echo images with and without fat suppression and then to com- pare surgical results with those MR imaging interpretations in the evaluation of rotator cuff disease. SUBJECTS AND METHODS. 12-weighted fast spin-echo images-with and without fat suppression-of 177 shoulder MR imaging studies were reviewed separately in

Rolando D. Singson; Tuyen Hoang; Sol Dan; Marvin Friedman

289

Ultrasonographic rotator-cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings  

Microsoft Academic Search

The aim of this study was to correlate sonographic abnormalities of the rotator cuff with clinical findings in veteran tennis players. One hundred fifty individuals playing competition-level tennis, aged from 35 to 77 years (mean age 55 years), underwent physical and US examinations of their shoulders. The US abnormalities found in the dominant shoulder were compared with those observed in the non-dominant

Jean-Louis Brasseur; Olivier Lucidarme; Marc Tardieu; Muriel Tordeur; Bernard Montalvan; Jacques Parier; Patrick Le Goux; Anne Gires; Philippe Grenier

2004-01-01

290

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects  

Microsoft Academic Search

Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images\\u000a after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings.\\u000a \\u000a \\u000a Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27–53 months (mean 39\\u000a months) after open transosseous reinsertion of

Marco Zanetti; Bernhard Jost; Juerg Hodler; Christian Gerber

2000-01-01

291

Intra-articular Partial-Thickness Rotator Cuff TearsAnalysis of Injured and Repaired Strain Behavior  

Microsoft Academic Search

Background: There are few biomechanical studies regarding partial-thickness rotator cuff tears and subsequent repair.Hypothesis: Partial-thickness intra-articular supraspinatus tendon tears increase articular-sided tendon strain as they increase in size. Repair of these tears will return strain to the intact state.Study Design: Controlled laboratory study.Methods: Twenty fresh-frozen human cadaveric shoulders were prepared by dissecting to the supraspinatus tendon and leaving the native

Augustus D. Mazzocca; Lina M. Rincon; Robert W. OConnor; Elifho Obopilwe; Matthew Andersen; Lauren Geaney; Robert A. Arciero

2008-01-01

292

Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report.  

PubMed

Thirty-six patients with partial tears of the supraspinatus portion of the rotator cuff underwent arthroscopic examination and debridement of the lesion. All patients, whose average age was 22 years, were involved in competitive athletics; 64% were baseball pitchers. The average duration of symptoms prior to arthroscopy was 12 months. The most common presenting complaint was pain felt in the shoulder during overhead activities. Associated pathology included tears of the glenoid labrum and partial tearing or tendinitis of the long head of the biceps tendon. Of the 34 patients available for follow-up, 26 (76%) had excellent results, three (9%) had good results, and five (15%) had poor results. Eighty-five percent of the patients returned satisfactorily to their preoperative athletic activity. Our preliminary experience with arthroscopy of the shoulder in the management of patients with partial rotator cuff tears is encouraging. Not only can a partial rotator cuff tear be debrided to initiate a healing response, but a definitive diagnosis can also be made and associated pathology identified, permitting the establishment of an appropriate rehabilitation program. PMID:4091915

Andrews, J R; Broussard, T S; Carson, W G

1985-01-01

293

Isolation of mesenchymal stem cells from shoulder rotator cuff: a potential source for muscle and tendon repair.  

PubMed

The self-healing potential of each tissue belongs to endogenous stem cells residing in the tissue; however, there are currently no reports mentioned for the isolation of human rotator cuff-derived mesenchymal stem cells (RC-MSCs) since. To isolate RC-MSCs, minced rotator cuff samples were first digested with enzymes and the single cell suspensions were seeded in plastic culture dishes. Twenty-four hours later, nonadherent cells were removed and the adherent cells were further cultured. The RC-MSCs had fibroblast-like morphology and were positive for the putative surface markers of MSCs, such as CD44, CD73, CD90, CD105, and CD166, and negative for the putative markers of hematopoietic cells, such as CD34, CD45, and CD133. Similar to BM-MSCs, RC-MSCs were demonstrated to have the potential to undergo osteogenic, adipogenic, and chondrogenic differentiation. Upon induction in the defined media, RC-MSCs also expressed lineage-specific genes, such as Runx 2 and osteocalcin in osteogenic induction, PPAR-? and LPL in adipogenic differentiation, and aggrecan and Col2a1 in chondrogenic differentiation. The multipotent feature of RC-MSCs in the myogenic injury model was further strengthened by the increase in myogenic potential both in vitro and in vivo when compared with BM-MSCs. These results demonstrate the successful isolation of MSCs from human rotator cuffs and encourage the application of RC-MSCs in myogenic regeneration. PMID:23006509

Tsai, Chih-Chien; Huang, Tung-Fu; Ma, Hsiao-Li; Chiang, En-Rung; Hung, Shih-Chieh

2012-09-21

294

The Use of an Intra-Articular Depth Guide in the Measurement of Partial Thickness Rotator Cuff Tears  

PubMed Central

Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears.

Carroll, Michael J.; More, Kristie D.; Sohmer, Stephen; Nelson, Atiba A.; Sciore, Paul; Boorman, Richard; Hollinshead, Robert; Lo, Ian K. Y.

2013-01-01

295

Magnetic resonance imaging appearance of the shoulder after subacromial injection with corticosteroids can mimic a rotator cuff tear.  

PubMed

Subacromial injections have been used to treat rotator cuff problems. Previous studies have noted the difficulty in performing accurate injections into this area. In addition, one must also question the effects that misplaced corticosteroids could have on the surrounding tissues. In this case, a 51-year-old woman presented with several weeks of left shoulder pain and was diagnosed with rotator cuff tendonitis. After a subacromial injection with betamethasone and lidocaine, the patient noted 3 weeks of near complete pain relief, followed by a return of her symptoms. A magnetic resonance imaging scan obtained 7 weeks after the injection showed a full-thickness tear of the supraspinatus tendon. Five weeks later, the patient underwent arthroscopic evaluation of the shoulder and subacromial decompression. The rotator cuff tendons were noted to be intact and normal in appearance. The patient eventually had full resolution of her symptoms. Six months postoperatively, she underwent a new scan that showed a normal supraspinatus tendon. Apparently, the subacromial injection penetrated the anterior half of the supraspinatus tendon, causing a transient effect and signal change. One should use caution in the interpretation of magnetic resonance imaging scans of the shoulder soon after the injection of corticosteroids. PMID:18589276

Borick, Jay M; Kurzweil, Peter R

2007-04-24

296

Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study.  

PubMed

To assess the in vitro effect of platelet-rich plasma (PRP) on biological activity of the human rotator cuff fibroblasts and to describe the optimal dose-response to maximize cellular stimulation while reducing potential risk. Rotator cuff (RC) fibroblasts of n?=?6 patients (mean age of 65.2 years) undergoing arthroscopic cuff tear reconstruction were cultured in vitro for 21 days and stimulated with PRP in three different concentrations (1-, 5-, and 10-fold). Samples were obtained for DNA and GAG measurement at 1, 7, 14, and 21 days. The biological outcomes were regressed on the PRP concentration. The application of PRP significantly influenced the fibroblast proliferation and activity of the human rotator cuff with elevated glycosaminoglycan (GAG) and DNA levels. The dosage of PRP had the significantly highest impact on this proliferation using a onefold or fivefold application. PRP has a significant effect on fibroblast proliferation of the human rotator cuff in vitro with an optimal benefit using a onefold or fivefold PRP concentration. This study justifies further in vivo investigations using PRP at the human rotator cuff. PMID:23568511

Sadoghi, Patrick; Lohberger, Birgit; Aigner, Birgit; Kaltenegger, Heike; Friesenbichler, Jörg; Wolf, Matthias; Sununu, Tarek; Leithner, Andreas; Vavken, Patrick

2013-04-08

297

Variations in the anatomy of the anterior-inferior rotator cuff: the "infraglenoid muscle".  

PubMed

During the dissection course, 67 shoulders from 35 cadavers were investigated for an "infraglenoid muscle" (IGM). Of the 67 shoulders, 43 cases showed an IGM. When present, the IGM originated at the so-called "marginal axillary groove" of the Scapula. Of these, 86% of the muscles inserted at the crest of the lesser tubercle, 12% at the lesser tubercle itself and 2% at both anatomical structures. During its twisted course it was observed near the capsule of the shoulder joint. All detected IGMs were separated from the subscapular muscle (SM) by a distinct fascia. Due to its anatomical position and its innervation by the axillary nerve, demonstrated in 19 of 43 shoulders, the IGM should be considered to be independent of the SM. The accessory subscapular muscle, previously described by other authors, must be distinguished from our IGM, mainly due to its origin on the surface of the SM. Considering our mere descriptive findings the biomechanical implications of the IGM concerning the rotator cuff will have to be investigated in future studies. PMID:22264827

Staniek, Manuel; Brenner, Erich

2011-12-16

298

Comparison of two methods for computing abduction moment arms of the rotator cuff.  

PubMed

Biomechanical models of the shoulder mechanism require estimates of muscle moment arm magnitude. Some shoulder models have estimated muscle moment arms by assuming an idealized minimum distance path from the origin to insertion that passes around the bony geometry. Alternatively, the principle of virtual work can be used to estimate moment arms from tendon excursion and joint-angle data. The purpose of this study was to determine if these two methods give different estimates of abduction moment arms for the supraspinatus, infraspinatus, and subscapularis muscles. Muscle moment arms were estimated for these muscles on ten fresh frozen cadaver specimens. The results showed a significant difference between the two estimation methods. Average differences were 3.1 mm (10.6%), 3.9 mm (43.9%), and 7.2 mm (70.3%) for the supraspinatus, subscapularis, and infraspinatus muscles, respectively. These results suggest that shoulder models based on the origin-insertion method may give higher rotator cuff muscle force estimates than methods using the slope of the tendon excursion vs joint angle relationship. PMID:9593209

Hughes, R E; Niebur, G; Liu, J; An, K N

1998-02-01

299

A spectral analysis of rotator cuff musculature electromyographic activity: surface and indwelling.  

PubMed

Electromyography (EMG) of the shoulder girdle is commonly performed; however, EMG spectral properties of shoulder muscles have not been clearly defined. The purpose of this study was to determine the maximum power frequency, Nyquist rate, and minimum sampling rate for indwelling and surface EMG of the normal shoulder girdle musculature. EMG signals were recorded using indwelling electrodes for the rotator cuff muscles and surface electrodes for ten additional shoulder muscles in ten healthy volunteers. A fast Fourier transform was performed on the raw EMG signal collected during maximal isometric contractions to derive the power spectral density. The 95% power frequency was calculated during the ramp and plateau subphase of each contraction. Data were analyzed with analysis of variance (ANOVA) and paired t tests. Indwelling EMG signals had more than twice the frequency content of surface EMG signals (p?

Backus, Sherry I; Tomlinson, Daniel P; Vanadurongwan, Bavornrat; Lenhoff, Mark W; Cordasco, Frank A; Chehab, Eric L; Adler, Ronald S; Henn, R Frank; Hillstrom, Howard J

2010-08-13

300

Prevalence of the Rotator Cuff Tear Increases With Weakness in Hemiplegic Shoulder  

PubMed Central

Objective To investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients. Methods A cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs. Results Comparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025). Conclusion RCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients.

Yi, Youbin; Shim, Jae Seong; Kim, Keewon; Baek, So-Ra; Jung, Se Hee; Kim, Won

2013-01-01

301

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up  

PubMed Central

Background To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. Methods The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. Results The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). Conclusions The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.

Kim, Do-Young; Lee, Sang-Soo; Seo, Eun-Min; Hwang, Jung-Taek; Kwon, Sun-Chang; Lee, Jae-Won

2012-01-01

302

Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder  

Microsoft Academic Search

Objectives  To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint\\u000a with MR arthrography (MR-A) of the shoulder.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions\\u000a (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon\\u000a insertion were depicted. Anatomical locations were

Christoph Schaeffeler; Dirk Mueller; Chlodwig Kirchhoff; Petra Wolf; Ernst J. Rummeny; Klaus Woertler

2011-01-01

303

Physical therapy with subacromial tenoxicam injection in patients with open subacromial decompression and rotator cuff tear repair: a pilot randomized controlled study  

Microsoft Academic Search

Introduction  To investigate the effects of subacromial tenoxicam injection during physical therapy after rotator cuff tear and subacromial\\u000a decompression.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  This is a prospective controlled clinical study. Fourteen patients who had a moderate-size rotator cuff tear were included\\u000a in the study. Two injections of tenoxicam were made to patients in the tenoxicam group into the subacromial space, and two\\u000a injections

Korhan Ozkan; Hakan Cift; Koray Unay; Feyza Unlu Ozkan; Baris Kadioglu; Budak Akman; Mahir Mahiroglu

2010-01-01

304

Platelet-rich plasma protects rotator cuff-derived cells from the deleterious effects of triamcinolone acetonide.  

PubMed

Triamcinolone acetonide (TA) injections are widely used to treat enthesopathy, but they may induce adverse effects such as tendon impairment and rupture. Platelet-rich plasma (PRP) is a blood fraction containing high platelet concentrations and various growth factors that play a role in tissue repair processes. The purpose of this study is to investigate whether TA has deleterious effects on human rotator cuff-derived cells, and if PRP can protect these cells from the effects of TA. Human rotator cuff-derived cells were cultured with and without TA and PRP, and the culture without any additive served as the control. Cell morphology was assessed at days 7 and 21. Cell viability was evaluated at days 1, 7, 14, and 21 by a water-soluble tetrazolium salt assay. Induction of apoptosis was measured by immunofluorescence staining and flow cytometry at day 7. Induction of cleaved caspase-3 was measured by immunofluorescence staining at day 7. The cells cultured with TA had a flattened and polygonal shape at day 7. The cells cultured with both TA and PRP were similar in appearance to control cells. Exposure to TA also significantly decreased cell viability, but cell viability did not decrease when PRP was added along with TA. The number of apoptotic cells increased with TA exposure, while addition of PRP prevented cell apoptosis. In conclusion, the deleterious effect of TA was prevented by PRP, which can be used as a protective agent for patients receiving local TA injections. PMID:23280560

Muto, Tomoyuki; Kokubu, Takeshi; Mifune, Yutaka; Sakata, Ryosuke; Nagura, Issei; Nishimoto, Hanako; Harada, Yoshifumi; Nishida, Kotaro; Kuroda, Ryosuke; Kurosaka, Masahiro

2012-12-31

305

ProSeal(TM) laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery  

PubMed Central

Background: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. Materials and Methods: One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. Results: The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. Conclusion: The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide.

Sharma, Bimla; Gupta, Rajat; Sehgal, Raminder; Koul, Archna; Sood, Jayashree

2013-01-01

306

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears  

Microsoft Academic Search

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and\\u000a isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up,\\u000a 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest\\u000a follow-up was

Huseyin Demirors; Esra Circi; Rahmi Can Akgun; Nefise Cagla Tarhan; Nuri Cetin; Sercan Akpinar; Ismail Cengiz Tuncay

2010-01-01

307

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: A protocol for a randomized trial [NCT00128076  

Microsoft Academic Search

BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS\\/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator

Joy C MacDermid; Richard Holtby; Helen Razmjou; Dianne Bryant

2006-01-01

308

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: A protocol for a randomized trial [NCT00128076  

PubMed Central

Background Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. Methods/Design This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (? = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. Discussion These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.

MacDermid, Joy C; Holtby, Richard; Razmjou, Helen; Bryant, Dianne

2006-01-01

309

Biomechanical comparison of single-row, double-row, and transosseous-equivalent repair techniques after healing in an animal rotator cuff tear model.  

PubMed

The transosseous-equivalent (TOE) rotator cuff repair technique increases failure loads and contact pressure and area between tendon and bone compared to single-row (SR) and double-row (DR) repairs, but no study has investigated if this translates into improved healing in vivo. We hypothesized that a TOE repair in a rabbit chronic rotator cuff tear model would demonstrate a better biomechanical profile than SR and DR repairs after 12 weeks of healing. A two-stage surgical procedure was performed on 21 New Zealand White Rabbits. The right subscapularis tendon was transected and allowed to retract for 6 weeks to simulate a chronic tear. Repair was done with the SR, DR, or TOE technique and allowed to heal for 12 weeks. Cyclic loading and load to failure biomechanical testing was then performed. The TOE repair showed greater biomechanical characteristics than DR, which in turn were greater than SR. These included yield load (p?rotator cuff tear, the TOE technique was the strongest biomechanical construct after healing followed by DR with SR being the weakest. PMID:23572388

Quigley, Ryan J; Gupta, Akash; Oh, Joo-Han; Chung, Kyung-Chil; McGarry, Michelle H; Gupta, Ranjan; Tibone, James E; Lee, Thay Q

2013-04-09

310

Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear  

PubMed Central

The purpose of this study was to describe the outcome after reversed Delta III shoulder prosthesis in patients with rheumatoid arthritis (RA) and irreparable rotator cuff tear. Fifteen patients (17 joints) were prospectively analysed using the Constant-Murley score (CS). Comprehensive outcome measure was carried out by means of four widely used questionnaires as well as clinical and radiographic examinations at an average of 24.3 months postoperatively. The CS improved significantly from 19 to 59.5 points. The mental (MSC) and physical (PCS) component summary score of the Short Form 36 (SF-36) reached 108% and 77%, respectively, while the DASH (Disabilities of the Arm, Shoulder, and Hand) was 58% of a comparative norm population. Remaining deficits were documented by SPADI (Shoulder Pain and Disability; 54.4 points) and ASES (clinical and patient-orientated American Shoulder and Elbow Surgeons; 84.3 and 61.3 points, respectively). No radiological signs of loosening were found, but scapular notching occurred in four cases. Reversed arthroplasty provides a substantial improvement of shoulder function in patients with RA. The high incidence of notching is of concern.

Pap, Geza; Angst, Felix; Flury, Matthias P.; Lieske, Sebastian; Schwyzer, Hans-Kaspar; Simmen, Beat Rene

2009-01-01

311

The modified massive cuff stitch: functional and structural outcome in massive cuff tears  

PubMed Central

Background The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture. Methods We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification. Results The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296). Conclusions The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

2013-01-01

312

A study for evaluating the effect of the deltoid-flap repair in massive rotator cuff defects  

Microsoft Academic Search

The repair of massive cuff defects by direct suture often is impossible. In these cases, a repair by musculo–tendineous flaps (latissimus-dorsi, pectoralis or deltoideus) is required. It was the goal of this study to evaluate the result of delta-flap repair in case of massive cuff defects with a diameter of 5 cm or more. Between 1998 and 2000 for all patients

Gunter Spahn; Stefan Kirschbaum; Hans Michael Klinger

2006-01-01

313

Characteristics and Stimulation Potential with BMP-2 and BMP-7 of Tenocyte-Like Cells Isolated from the Rotator Cuff of Female Donors  

PubMed Central

Tendon bone healing of the rotator cuff is often associated with non-healing or recurrent defects, which seems to be influenced by the patient’s age and sex. The present study aims to examine cellular biological characteristics of tenocyte-like cells that may contribute to this impaired rotator cuff healing. Moreover, a therapeutic approach using growth factors could possibly stimulate tendon bone healing. Therefore, our second aim was to identify patient groups who would particularly benefit from growth factor stimulation. Tenocyte-like cells isolated from supraspinatus tendons of female donors younger and older than 65 years of age were characterized with respect to different cellular biological parameters, such as cell density, cell count, marker expression, collagen-I protein synthesis, and stem cell potential. Furthermore, cells of the donor groups were stimulated with BMP-2 and BMP-7 (200 and 1000 ng/ml) in 3D-culture and analyzed for cell count, marker expression and collagen-I protein synthesis. Female donors older than 65 years of age showed significantly decreased cell count and collagen-I protein synthesis compared to cells from donors younger than 65 years. Cellular biological parameters including cell count, collagen-I and –III expression, and collagen-I protein synthesis of cells from both donor groups were stimulated with BMP-2 and BMP-7. The cells from donors older than 65 years revealed a decreased stimulation potential for cell count compared to the younger group. Cells from female donors older than 65 years of age showed inferior cellular biological characteristics. This may be one reason for a weaker healing potential observed in older female patients and should be taken into consideration for tendon bone healing of the rotator cuff.

Klatte-Schulz, Franka; Pauly, Stephan; Scheibel, Markus; Greiner, Stefan; Gerhardt, Christian; Hartwig, Jelka; Schmidmaier, Gerhard; Wildemann, Britt

2013-01-01

314

Characteristics and stimulation potential with BMP-2 and BMP-7 of tenocyte-like cells isolated from the rotator cuff of female donors.  

PubMed

Tendon bone healing of the rotator cuff is often associated with non-healing or recurrent defects, which seems to be influenced by the patient's age and sex. The present study aims to examine cellular biological characteristics of tenocyte-like cells that may contribute to this impaired rotator cuff healing. Moreover, a therapeutic approach using growth factors could possibly stimulate tendon bone healing. Therefore, our second aim was to identify patient groups who would particularly benefit from growth factor stimulation. Tenocyte-like cells isolated from supraspinatus tendons of female donors younger and older than 65 years of age were characterized with respect to different cellular biological parameters, such as cell density, cell count, marker expression, collagen-I protein synthesis, and stem cell potential. Furthermore, cells of the donor groups were stimulated with BMP-2 and BMP-7 (200 and 1000 ng/ml) in 3D-culture and analyzed for cell count, marker expression and collagen-I protein synthesis. Female donors older than 65 years of age showed significantly decreased cell count and collagen-I protein synthesis compared to cells from donors younger than 65 years. Cellular biological parameters including cell count, collagen-I and -III expression, and collagen-I protein synthesis of cells from both donor groups were stimulated with BMP-2 and BMP-7. The cells from donors older than 65 years revealed a decreased stimulation potential for cell count compared to the younger group. Cells from female donors older than 65 years of age showed inferior cellular biological characteristics. This may be one reason for a weaker healing potential observed in older female patients and should be taken into consideration for tendon bone healing of the rotator cuff. PMID:23825642

Klatte-Schulz, Franka; Pauly, Stephan; Scheibel, Markus; Greiner, Stefan; Gerhardt, Christian; Hartwig, Jelka; Schmidmaier, Gerhard; Wildemann, Britt

2013-06-25

315

Management of the throwing shoulder: cuff, labrum and internal impingement.  

PubMed

Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology. Nonoperative treatment is directed at restoring strength, flexibility, and neuromuscular control to the entire kinetic chain. Surgery is indicated when nonoperative treatment fails, and is directed at correcting labral, capsular, and rotator cuff pathology. PMID:20497808

Greiwe, R Michael; Ahmad, Christopher S

2010-07-01

316

Lysylhydroxylation and non-reducible crosslinking of human supraspinatus tendon collagen: changes with age and in chronic rotator cuff tendinitis  

PubMed Central

OBJECTIVES—To investigate age related and site specific variations in turnover and chemistry of the collagen network in healthy tendons as well as the role of collagen remodelling in the degeneration of the supraspinatus tendon (ST-D) in rotator cuff tendinitis.?METHODS—Collagen content and the amount of hydroxylysine (Hyl), hydroxylysylpyridinoline (HP), lysylpyridinoline (LP), and the degree of non-enzymatic glycation (pentosidine) were investigated in ST-D and in normal human supraspinatus (ST-N) and biceps brachii tendons (BT-N) by high-performance liquid chromatography.?RESULTS—In BT-N, tendons that served as control tissue as it shows rarely matrix abnormalities, pentosidine levels rise linearly with age (20-90 years), indicating little tissue remodelling (resulting in an undisturbed accumulation of pentosidine). A similar accumulation was observed in ST-N up to 50 years. At older ages, little pentosidine accumulation was observed and pentosidine levels showed large interindividual variability. This was interpreted as remodelling of collagen in normal ST after age 50 years because of microruptures (thus diluting old collagen with newly synthesised collagen). All degenerate ST samples showed decreased pentosidine levels compared with age matched controls, indicating extensive remodelling in an attempt to repair the tendon defect. Collagen content and the amount of Hyl, HP, and LP of ST-N and BT-N did not change with age. With the exception of collagen content, which did not differ, all parameters were significantly (p<0.001) lower in BT-N. The ST-D samples had a reduced collagen content and had higher Hyl, HP, and LP levels than ST-N (p<0.001).?CONCLUSIONS—Inasmuch as Hyl, HP, and LP levels in ST-N did not change with age, tissue remodelling as a consequence of microruptures does not seem to affect the quality of the tendon collagen. On the other hand, the clearly different profile of post-translational modifications in ST-D indicates that the newly deposited collagen network in degenerated tendons is qualitatively different. It is concluded that in ST-D the previously functional and carefully constructed matrix is replaced by aberrant collagen. This may result in a mechanically less stable tendon; as the supraspinatus is constantly subjected to considerable forces this could explain why tendinitis is mostly of a chronic nature.?? Keywords: collagen; tendons; crosslinks; pentosidine

Bank, R.; TeKoppele, J.; Oostingh, G.; Hazleman, B.; Riley, G.

1999-01-01

317

Off the cuff consultations.  

PubMed Central

Over six months I recorded 198 off the cuff consultations that occurred at social gatherings, at chance meetings, and in medical settings outside my surgery. More men than women made such consultations, roughly two thirds were a request for health information, and just under half of consultations were with other doctors' patients. It seemed that many patients were seeking a second medical opinion.

Weingarten, M A

1985-01-01

318

Arthroscopically assisted mini-openrotator cuff repair  

Microsoft Academic Search

Although open anterior acromioplasty and rotator cuff repair has reliably provided satisfactory results for several decades, efforts are continually being made to improve on these results. Arthroscopically assisted mini-open rotator cuff repair provides the advantages of arthroscopic glenohumeral inspection and identification and treatment of any concomitant lesions, deltoid origin preservation (with the arthroscopic subacromial decompression), decreased surgical morbidity, and improved

Patrick M. Connor

1998-01-01

319

Rotator Cuff Tears: FAQs  

MedlinePLUS

... older than 40 years. Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected ...

320

Prosthetic replacement of the shoulder for the treatment of defects in the rotator cuff and the surface of the glenohumeral joint.  

PubMed

We operatively treated, between 1978 and 1987, twenty-one shoulders in nineteen patients, fifty-four to eighty-four years old, who had disabling pain attributable to a massive tear of the rotator cuff, accompanied by loss of the surface of the glenohumeral joint. These patients were not candidates for total shoulder replacement because of the massive deficiency in the cuff and the fixed upward displacement of the humeral head. A prerequisite for hemiarthroplasty was a functionally intact coracoacromial arch to provide superior secondary stability for the prosthesis. One important aspect of the operative technique was the selection of a sufficiently small prosthesis so that excessive tightness of the posterior aspect of the capsule could be avoided. Eighteen shoulders in sixteen patients were available for follow-up, which ranged from twenty-five to 122 months. Pain decreased from marked or disabling in fourteen shoulders preoperatively to none or slight in ten and to pain only after unusual activity in four. Active forward elevation improved from an average of 66 degrees preoperatively to an average of 109 degrees postoperatively. One patient, who had had an excellent result, fell and sustained an acromial fracture, so the functional result changed to poor. Three patients had persistent, substantial pain in the shoulder that led to a revision. Neither infection nor prosthetic loosening developed in any shoulder. PMID:8478376

Arntz, C T; Jackins, S; Matsen, F A

1993-04-01

321

Physical and rehabilitation medicine (PRM) care pathways: “Patients after rotator cuff tear surgery  

Microsoft Academic Search

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. “Care pathways in PRM” is a

P. Ribinik; P. Calmels; B. Barrois; F. Le Moine; A. P. Yelnik

322

Open Rotator Cuff Surgery in Swiss Elite Rock Climbers (P31)  

Microsoft Academic Search

Rock and indoor climbing has become a very popular sport. For moving in a vertical or even overhanging wall an intact shoulder\\u000a function is mandatory beside a good grasp function.Hand and particular finger injuries in climbing are well described in the\\u000a literature. Almost no report is avaible about shoulder injuries in climbers. In our retrospective case study 21 shoulders\\u000a in

Hans-Peter Bircher; Christoph Thür; Andreas Schweizer

323

Open Rotator Cuff Surgery in Swiss Elite Rock Climbers (P31)  

Microsoft Academic Search

Rock and indoor climbing has become a very popular sport. For moving in a vertical or even overhanging wall an intact shoulder\\u000a function is mandatory beside a good grasp function. Hand and particular finger injuries in climbing are well described in\\u000a the literature. Almost no report is avaible about shoulder injuries in climbers. In our retrospective case study 21 shoulders

Hans-Peter Bircher; Christoph Thür; Andreas Schweizer

324

[Direct magnetic resonance arthrography, indirect magnetic resonance arthrography, and computed tomography arthrography for rotator cuff lesions and superior labral anterior and posterior tears: state of the art].  

PubMed

Continual improvements in diagnostic modalities used for shoulder imaging have led to better resolution, sensitivity, and specificity. There is no consensus about whether conventional MRI, direct MR arthrography, indirect MR arthrography, or CT arthrography is the best method. Many publications from very diverse origins propose different criteria for selecting the technique to apply in different patients. However, the application of rigid protocols that do not include all the imaging options does not help patients. Moreover, this approach also restricts radiologists' creativity, especially in countries in which resources are more limited. It is important to ensure the rational use of the techniques depending on the patient and the place, considering the patient's age, associated diseases, surgical possibilities, complications, and available equipment. This article reviews the state of the art in imaging rotator cuff and superior labral anterior and posterior lesions, considering the indications, advantages, and advantages of the different techniques in different cases. PMID:23290890

Restrepo González, R

2013-01-04

325

Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: A prospective randomised double-blind placebo-controlled multicentre trial.  

PubMed

The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ? 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment. Cite this article: Bone Joint J 2013;95-B:1521-6. PMID:24151273

Kolk, A; Auw Yang, K G; Tamminga, R; van der Hoeven, H

2013-11-01

326

Is a Mandatory General Surgery Rotation Necessary in the Surgical Clerkship?  

Microsoft Academic Search

Background: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question.Methods: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were

Dan Poenaru; Lindsay Davidson; Michael Donnely

1998-01-01

327

Il trattamento chirurgico del conflitto subacromiale e della rottura della cuffia dei rotatori: esperienza personale in 134 casi Surgical treatment of the impingement syndrome and of the rotator cuff tears: personal experience in 134 cases  

Microsoft Academic Search

SUMMARY The time-course covered by the original definition of scapulo-humeral periarthritis suggested by Duplay through the more recent term of subacromial impingement syndrome coined by Neer, follows the identification of the pathogene- tic mechanisms leading to chronic subacromial impingement and degenerative tears of the rotator cuff. The Authors recall the functional-anatomic development evolution of the shoulder and the disequilibrium between

S. Candiotto; A. Majoni; L. Londei; A. Rioda; P. Ostuni

328

Repetitive H-Wave® device stimulation and program induces significant increases in the range of motion of post operative rotator cuff reconstruction in a double-blinded randomized placebo controlled human study  

Microsoft Academic Search

BACKGROUND: Albeit other prospective randomized controlled clinical trials on H-Wave Device Stimulation (HWDS), this is the first randomized double-blind Placebo controlled prospective study that assessed the effects of HWDS on range of motion and strength testing in patients who underwent rotator cuff reconstruction. METHODS: Twenty-two patients were randomly assigned into one of two groups: 1) H-Wave device stimulation (HWDS); 2)

Kenneth Blum; Amanda LC Chen; Thomas JH Chen; Roger L Waite; B William Downs; Eric R Braverman; Mallory M Kerner; Stella M Savarimuthu; Nicholas DiNubile

2009-01-01

329

Anchor Design and Bone Mineral Density Affect the Pull-Out Strength of Suture Anchors in Rotator Cuff RepairWhich Anchors Are Best to Use in Patients With Low Bone Quality?  

Microsoft Academic Search

Background: Different metal and biodegradable suture anchors are available for rotator cuff repair. Poor bone quality may result in anchor loosening and tendon rerupture.Hypotheses: Higher bone mineral density is associated with higher pull-out strength of suture anchors. Depending on anchor placement, pull-out strengths of anchors are different within the greater tuberosity.Study Design: Cadaveric biomechanical study.Methods: Trabecular and cortical bone mineral

Markus J. Tingart; Maria Apreleva; Janne Lehtinen; David Zurakowski; Jon J. P. Warner

2004-01-01

330

Accessory coracobrachialis muscle as a cause of anterior impingement syndrome of the rotator cuff in an athlete  

Microsoft Academic Search

. Subcoracoid impingement is a rare but well-know cause of anterior shoulder pain in throwing and overhead athletics. Bulging of the walls or the contents of the coracohumeral space may hamper the smooth gliding of soft tissue between the coracoid process and glenohumeral joint, especially in forward elevation and internal rotation of the arm. Following is a case report of

H. Mestdagh; C. Maynou; X. Cassagnaud

2002-01-01

331

Minimally invasive transrotator cuff approach for arthroscopic stabilization of the posterosuperior glenoid labrum  

Microsoft Academic Search

We describe a novel technique for repair of the superior glenoid labrum posterior to the biceps anchor. This approach optimizes access for fixation of the superior and posterosuperior labrum, but involves significantly less trauma to the rotator cuff and subacromial space compared with previously described transrotator cuff methods. We suspect that the relative lack of trauma to the rotator cuff

Heber C Crockett; John M Wright; Daniel P Slawski; Bruce Kohtz; Dwain Rosse; Sandra Rosse

2004-01-01

332

The Tendon-to-Bone Transition of the Rotator Cuff: A Preliminary Raman Spectroscopic Study Documenting the Gradual Mineralization Across the Insertion in Rat Tissue Samples  

PubMed Central

We applied Raman spectroscopy to monitor the distribution of minerals and the degree of mineralization across the tendon–bone insertion site in the shoulders of five rats. We acquired Raman spectra from 100 to 4000 ?cm-1 on individual 1 ?m points across the 120 ?m wide transition zone of each tissue sample and identified all the peaks detected in pure tendon and in pure bone, as well as in the transition zone. The intensity of the 960 ?cm-1 P–O stretch for apatite (normalized to either the 2940 ?cm-1 C–H stretch or the 1003 ?cm-1 C–C stretch for collagen) was used as an indicator of the abundance of mineral. We relate the observed histological morphology in the tissue thin section with the observed Raman peaks for both the organic component (mostly collagen) and the inorganic component (a carbonated form of the mineral apatite) and discuss spectroscopic issues related to peak deconvolution and quantification of overlapping Raman peaks. We show that the mineral-to-collagen ratio at the insertion site increases linearly (R2 = 0.8 for five samples) over the distance of 120 ?m from tendon to bone, rather than abruptly, as previously inferred from histological observations. In addition, narrowing of the 960 ?cm-1 band across the traverse indicates that the crystalline ordering within the apatite increases concomitantly with the degree of mineralization. This finding of mineral gradation has important clinical implications and may explain why the uninjured tendon-to-bone connection of the rotator cuff can sustain very high stress concentrations without failure. Our finding is also consistent with recent mechanical models and calculations developed to better understand the materials properties of this unusually strong interface.

WOPENKA, BRIGITTE; KENT, ALISTAIR; PASTERIS, JILL D.; YOON, YOUNG; THOMOPOULOS, STAVROS

2009-01-01

333

Rotator cuff - self-care  

MedlinePLUS

... injury and avoid re-injury. Your position and posture during the day and night can help relieve ... of pillows may help. When sitting, use good posture. This means keeping your head over your shoulder ...

334

Endobronchial cuff pressures.  

PubMed

In 20 adult patients (18 male) who presented for thoracotomy, the trachea was intubated using Mallinckrodt disposable double-lumen tubes (18 large and two medium). The endobronchial cuff was inflated by a trained operating department assistant using an air-filled syringe. The volume of air and the initial endobronchial cuff pressure were measured. The minimum cuff pressure required to prevent respiratory gas leakage from the isolated lung was measured also and maintained using the Cardiff Cuff Controller. Mean initial cuff pressure was 69.3 (SEM 6.0) mm Hg, whereas the mean minimum cuff pressure was 29.5 (4.0) mm Hg (P < 0.0001). The results suggest that the method described of inflating the endobronchial cuff may lead to overinflation and subsequent excessive pressure on the endobronchial wall. PMID:8318334

Cobley, M; Kidd, J F; Willis, B A; Vaughan, R S

1993-05-01

335

Suprascapular Nerve: Is It Important in Cuff Pathology?  

PubMed Central

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

Shi, Lewis L.; Freehill, Michael T.; Yannopoulos, Paul; Warner, Jon J. P.

2012-01-01

336

Suprascapular nerve: is it important in cuff pathology?  

PubMed

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting. PMID:23193484

Shi, Lewis L; Freehill, Michael T; Yannopoulos, Paul; Warner, Jon J P

2012-11-01

337

[Arthroscopic reconstruction of the rotor cuff].  

PubMed

Over the last years treatment of rotator cuff tears is evolving gradually from open to complete arthroscopic repair. There had been fast developments in arthroscopic techniques and instruments and there is a better understanding of biomechanical backgrounds. For a good clinical outcome it is not necessary to obtain a watertight closure in all cases but to balance the force couples in the coronal and transverse plane. There is recent discussion regarding the optimum techniques and stitches for cuff reconstruction and resulting developments in this field. To determine the individual reconstruction technique it is crucial to recognize the different tear categories. Based on these findings we are now able to treat nearly every cuff tear arthroscopically, even a retracted massive lesion. PMID:16897022

Bauer, G J; Kniesel, B

2006-08-01

338

Signal strength versus cuff length in nerve cuff electrode recordings  

Microsoft Academic Search

When a nerve cuff electrode is used for the recording of signals from peripheral nerves, cuff dimensions have to be chosen. Traditionally, the peak-to-peak amplitude of the single-fiber action potential (SFAP) is optimized through the choice of cuff diameter and cuff length. In this paper, the dependency of the root-mean-square (RMS) value of the nerve signal on the cuff dimensions

Lotte N. S. Andreasen; Johannes J. Struijk

2002-01-01

339

Patients undergoing stabilization surgery for recurrent, traumatic anterior shoulder instability commonly have restricted passive external rotation.  

PubMed

An important component in the surgical treatment of recurrent anterior shoulder dislocations is the Bankart repair. This is often supplemented with ligament plication for perceived laxity. The glenohumeral ligaments define translational laxity and restrict glenohumeral range of motion. The purpose of this study was to measure the external rotation (ER) range of motion of patients under anesthesia for glenohumeral stabilization surgery. A blinded observer measured bilateral shoulder ER in 15 patients by use of a standardized torque and goniometry. ER in the unstable shoulder with the arm abducted 90 degrees averaged 14 degrees less than that in the uninjured shoulder, and this was statistically significant. There was a significant loss of 11 degrees ER in the unstable shoulder with the arm at the side. The findings indicate that the glenohumeral joint in patients with a Bankart lesion is commonly rotationally stiff. PMID:17498588

Di Silvestro, Matthew D; Lo, Ian K Y; Mohtadi, Nicholas; Pletsch, Kristie; Boorman, Richard S

340

Latissimus dorsi tendon transfer for irreparable tears of the rotator cuff: An anatomical study to assess the neurovascular hazards and ways of improving tendon excursion.  

PubMed

Latissimus dorsi tendon transfer (LDTT) is technically challenging. In order to clarify the local structural anatomy, we undertook a morphometric study using six complete cadavers (12 shoulders). Measurements were made from the tendon to the nearby neurovascular structures with the arm in two positions: flexed and internally rotated, and adducted in neutral rotation. The tendon was then transferred and measurements were taken from the edge of the tendon to a reference point on the humeral head in order to assess the effect of a novel two-stage release on the excursion of the tendon. With the shoulder flexed and internally rotated, the mean distances between the superior tendon edge and the radial nerve, brachial artery, axillary nerve and posterior circumflex artery were 30 mm (26 to 34), 28 mm (17 to 39), 21 mm (12 to 28) and 15 mm (10 to 21), respectively. The mean distance between the inferior tendon edge and the radial nerve, brachial artery and profunda brachii artery was 18 mm (8 to 27), 22 mm (15 to 32) and 14 mm (7 to 21), respectively. Moving the arm to a neutral position reduced these distances. A mean of 15 mm (8 to 21) was gained from a standard soft-tissue release, and 32 mm (20 to 45) from an extensile release. These figures help to define further the structural anatomy of this region and the potential for transfer of the latissimus dorsi tendon. PMID:23539704

Henry, P D G; Dwyer, T; McKee, M D; Schemitsch, E H

2013-04-01

341

The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery  

PubMed Central

Background The large defects resulting from head and neck tumour surgeries present a reconstructive challenge to surgeons. Although numerous methods can be used, they all have their own limitations. In this paper, we present our experience with cervicofacial and cervicothoracic rotation flaps to help expand the awareness and application of this useful system of flaps. Methods Twenty-one consecutive patients who underwent repair of a variety of defects of the head and neck with cervicofacial or cervicothoracic flaps in our hospital from 2006 to 2009 were retrospectively analysed. Statistics pertaining to the patients' clinical factors were gathered. Results Cheek neoplasms are the most common indication for cervicofacial and cervicothoracic rotation flaps, followed by parotid tumours. Among the 12 patients with medical comorbidities, the most common was hypertension. Defects ranging from 1.5 cm × 1.5 cm to 7 cm × 6 cm were reconstructed by cervicofacial flap, and defects from 3 cm × 2 cm to 16 cm × 7 cm were reconstructed by cervicothoracic flap. The two flaps also exhibited versatility in these reconstructions. When combined with the pectoralis major myocutaneous flap, the cervicothoracic flap could repair through-and-through cheek defects, and in combination with a temporalis myofacial flap, the cervicofacial flap was able to cover orbital defects. Additionally, 95% patients were satisfied with their resulting contour results. Conclusions Cervicofacial and cervicothoracic flaps provide a technically simple, reliable, safe, efficient and cosmetic means to reconstruct defects of the head and neck.

2011-01-01

342

Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis  

Microsoft Academic Search

Femoral component malalignment is one of the main causes of persisting anterior knee pain after knee replacement. This study examined interindividual reproducibility in perioperative definition of the transepicondylar axis (TEA) as a reference for measuring the rotational alignment of the femoral component. Eight surgeons experienced in knee prosthetic surgery marked on Thiel-embalmed cadaver specimens the reference points that they would

J. Jerosch; E. Peuker; B. Philipps; T. Filler

2002-01-01

343

Arthroscopic repair of full-thicknessrotator cuff tears: Operative technique  

Microsoft Academic Search

Arthroscopic repair of full-thickness rotator cuff tears is currently performed by a number of surgeons. The goals, indications, and postoperative rehabilitation are identical to traditional open repair. The principles of the operative technique are also identical to open repair, with the differences occurring in the manner in which the tendon is repaired to bone. This article describes in detail the

Gary M. Gartsman; Steven M. Hammerman

1998-01-01

344

Isokinetic rotator muscles fatigue in glenohumeral joint instability before and after Latarjet surgery: a pilot prospective study.  

PubMed

We aimed to analyze the changes in isokinetic internal (IR) and external (ER) rotator muscles fatigue (a) in patients with non-operated recurrent anterior instability, and (b) before and after shoulder surgical stabilization with the Bristow-Latarjet procedure. Thirty-seven patients with non-operated unilateral recurrent anterior post-traumatic instability (NG) were compared with 12 healthy subjects [control group (CG)]. Twenty patients with operated recurrent anterior instability group (OG) underwent isokinetic evaluation before and 3, 6, and 21 months after Bristow-Latarjet surgery. IR and ER muscles strength was evaluated with Con-Trex® dynamometer, with subjects seated and at a 45° shoulder abduction angle in scapular plane. IR and ER muscle fatigue was determined after 10 concentric repetitions at 180° · s(-1) through the fatigue index, the percent decrease in performance (DP), and the slope of peak torque decrease. There were no differences in rotator muscles fatigue between NG and CG. In OG, 3 months post-surgery, IR DP of operated shoulder was significantly (P < 0.001) higher than presurgery and 6 and 21 months post-surgery. Rotator muscles fatigability was not associated with recurrent anterior instability. After surgical stabilization, there was a significantly higher IR fatigability in the operated shoulder 3 months post-surgery, followed by recovery evidenced 6 months post-surgery and long-term maintenance over 21 months. PMID:23116174

Edouard, P; Bankolé, C; Calmels, P; Beguin, L; Degache, F

2012-11-01

345

Surgery for Osteosarcoma  

MedlinePLUS

... cuff will fit into the end of a prosthetic (artificial) limb. Reconstructive surgery can help some patients ... Of course, the patient would still need a prosthetic limb to extend the leg. With proper physical ...

346

Pneumomediastinum after arthroscopic shoulder surgery -A case report-  

PubMed Central

An 86-year-old female with a history of right rotator cuff injury was admitted for arthroscopic shoulder surgery under general anesthesia. There were no remarkable immediate postoperative complications. However, while recovering in the general ward, she developed dyspnea with hypoxia. She was immediately treated with oxygen, and antibiotics after pneumomediastinum was confirmed on both chest x-ray and chest computed tomography. Subcutaneous emphysema on either face or neck followed by arthroscopic shoulder surgery was common, but pneumomediastinum with hypoxia is a rare but extremely dangerous complication. Thus we would like to report our case and its pathology, the diagnosis, the treatment and prevention, with literature review.

Kim, Hae-Kyoung; Ko, Eun-Sung; Kim, Jee-Young; Park, Jung-Min; Kim, Jae-Yun

2013-01-01

347

Endotracheal tube cuffs filled with lidocaine as a drug delivery system: in vitro and in vivo investigations  

Microsoft Academic Search

The purpose of this study was to examine if lidocaine diffusion across an endotracheal tube cuff could improve post-operative tolerance, especially sore throat. The in vitro release of lidocaine from tube cuffs filled with different lidocaine formulations (base form, hydrochloride form or alkalinized lidocaine hydrochloride) was investigated. A preliminary pilot clinical study in anaesthesia for spine surgery in smoker patients

Gilles Dollo; Jean-Pierre Estebe; Pascal Le Corre; François Chevanne; Claude Ecoffey; Roger Le Verge

2001-01-01

348

Rotator cuff function during a golf swing  

Microsoft Academic Search

A study of bilateral shoulder muscle activity during the golf swing was undertaken using electromyography and high-speed photography. Understanding of the muscle firing patterns could lead to injury prevention and development of appropriate training and condition ing regimens. The swings of seven adult male right- handed professional golfers without shoulder problems were examined. Indwelling electrodes were inserted into the supraspinatus,

Frank W. Jobe; Diane R. Moynes; Daniel J. Antonelli

1986-01-01

349

Long-Term Efficacy and Rotational Stability of AcrySof Toric Intraocular Lens Implantation in Cataract Surgery  

PubMed Central

Purpose To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients. Methods This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3±5.0 months) follow-up were evaluated. Results At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28±0.38 diopter (D) from -1.28±0.48 D. The mean rotation of the toric IOL was 3.45±3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees. Conclusions Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients.

Kim, Myung Hun; Chung, Tae-Young

2010-01-01

350

Stomach pierced by apical cuff late after removal of Toyobo assist device.  

PubMed

A 38-year-old woman suffering from dilated cardiomyopathy underwent successful removal of a Toyobo left ventricular assist device after 11 months of support. Four months later, discharge of pus from the skin resulted from the contaminated residual apical cuff. The purulence stopped spontaneously 16 months later, but halitosis then developed. Two weeks later, fever and hematemesis occurred. Emergency surgery revealed gastric perforation by the apical cuff, which was removed under cardiopulmonary bypass. PMID:20124303

Nawata, Kan; Kyo, Shunei; Ono, Minoru; Motomura, Noboru; Takamoto, Shinichi

2010-02-01

351

Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy -A case report-  

PubMed Central

We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-old male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient's head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient's head to obtain easy access to the patient is essential for safe anesthetic care.

Lee, Hyung-Chul; Goo, Eui-Kyoung; Bahk, Jae-Hyon; Park, Hee-Pyoung; Jeon, Young-Tae; Lee, Sang Chul

2010-01-01

352

Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery.  

PubMed

Excessive bleeding after cardiopulmonary bypass (CPB) is risk factor for adverse outcomes after elective cardiac surgery (ECS). Differentiating between patients who bleed due to surgical issues and those whose excessive chest tube output (CTO) is due to coagulopathy, remains challenging. Bedside suitable tests to identify hemostatic disturbances and predict excessive bleeding are desirable. The study sought to evaluate prediction of excessive bleeding after ECS using two bedside suitable devices for platelet function and viscoelastic blood clot properties assessment. We enrolled 148 patients (105 male and 43 female) undergoing ECS in a prospective observational study. Patients were characterized as bleeders if their 24 h CTO exceeded the 75th percentile of distribution. Multiple electrode aggregometry (MEA, with ASPI, ADP and the TRAP test) and rotational thromboelastometry (TEM, with ExTEM, HepTEM and FibTEM test), were performed at three time points: preoperatively (T1), during CPB (T2), and after protamine administration (T3). The primary endpoint was CTO and the secondary endpoint was administration of blood products, 30-day and 1 year mortality. The best predictors of increased bleeding tendency were the tests performed after protamine administration (T3). At T3, patients characterized as bleeders had significantly lower MEA ASPI (median, 14 vs. 27 AUC, p = 0.004) and ADP test values (median, 22 vs. 41 AUC, p = 0.002) as well as TEM values expressed in maximum clot firmness after 30 min (MCF 30) for ExTEM (53 vs. 56 mm, p = 0.005), HepTEM (48 vs. 52 mm, p = 0.003) and FibTEM (8 vs. 11 mm, p < 0.001) test. 24 h CTO inversely correlated with both the MEA (ASPI test: r = -0.236, p = 0.004; ADP test: r = -0.299, p < 0.001), and TEM MCF 30 (ExTEM: r = -0.295, p < 0.001; HepTEM: -0.329, p < 0.001; FibTEM: -0.377, p < 0.001) test values. Our study showed that MEA and TEM are useful methods for prediction of excessive bleeding after ECS. In order to prevent excessive postoperative CTO, hemostatic interventions with timely and targeted blood component therapy according to MEA and TEM results should be considered. PMID:23341179

Petricevic, Mate; Biocina, Bojan; Milicic, Davor; Konosic, Sanja; Svetina, Lucija; Leki?, Ante; Zdilar, Boris; Burcar, Ivan; Milosevic, Milan; Brahimaj, Rifat; Samardzic, Jure; Gasparovic, Hrvoje

2013-01-23

353

21 CFR 868.5760 - Cuff spreader.  

Code of Federal Regulations, 2013 CFR

...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a...

2013-04-01

354

Evaluation of Intratracheal Cuffs for Aeromedical Evacuation.  

National Technical Information Service (NTIS)

Conventional, low-residual-volume intratracheal cuffs exert possible trachea damaging pressures at ground level and definitely damaging pressures upon ascent to 8,000 ft. Also, these cuffs exert excessively high pressures with decompression to 35,000 ft. ...

D. L. Stoner J. P. Cooke

1973-01-01

355

Effect of xenon on endotracheal tube cuff  

Microsoft Academic Search

Study Design:To investigate the effect of xenon on the endotracheal tube cuff in comparison to that of nitrous oxide.Design:Prospective, randomized study.Setting:Laboratory in vitro testing of endotracheal tubes.Interventions:Exposure of air-filled endotracheal tube cuffs to xenon or nitrous oxide (79 vol%) mixed with a balance of oxygen (21 vol%) for 3 hours.Measurements:The intra-cuff pressure and gas volume in the cuff were measured

Yoshiki Ishiguro; Hayato Saito; Yoshinori Nakata; Takahisa Goto; Katsuo Terui; Yoshinari Niimi; Shigeho Morita

2000-01-01

356

Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique.  

PubMed

Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

De Cupis, Vincenzo; De Cupis, Mauro

2012-09-10

357

Two cases of post-coital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted laparoscopic hysterectomy  

PubMed Central

INTRODUCTION Vaginal cuff dehiscence following robotic surgery is uncommon. Published reports of vaginal cuff dehiscence following robotic surgery are increasing, but the true incidence is unknown. PRESENTATION OF CASE Case 1. A 45 year old female had sexual intercourse and presented with a vaginal cuff dehiscence complicated by small bowel evisceration 4 months after RA-TLH. Case 2. A 44 year old female had sexual intercourse and presented with a vaginal cuff dehiscence with small bowel evisceration 6 weeks after RA-TLH. DISCUSSION We discuss the rate of vaginal cuff dehiscence by mode of hysterectomy, surgical and non-surgical risk factors that may contribute to vaginal cuff dehiscence, and proposed preventative methods at the time of RA-TLH to reduce this complication. CONCLUSION Vaginal cuff dehiscence with associated evisceration of intraabdominal contents is a potentially severe complication of hysterectomy. We recommend counseling patients who undergo RA-TLH to abstain from vaginal intercourse for a minimum of 8–12 weeks.

Nguyen, My-Linh T.; Kapoor, Monica; Pradhan, Tana S.; Pua, Tarah L.; Tedjarati, Sean S.

2013-01-01

358

Surgery  

MedlinePLUS

... After surgery there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery. Agency for Healthcare Research and Quality

359

Surgery  

MedlinePLUS

... how pain will be treated Preparing for the Day of Surgery Various preparations are made in the ... Then, this device can perform more accurately. The Day of Surgery Before most operations, a person removes ...

360

Postoperative shoulder rotators strength in stages II and III impingement syndrome.  

PubMed

In healthy subjects, the shoulder internal rotator muscle strength overrides the external rotators. This has been confirmed in different isokinetic studies showing the ratio of the relative strengths of the internal to external rotators to range from 1.3 to 1.5 points, depending on the study. The authors previously reported a decrease in the relative strength ratio of the internal to external rotators to close to 1 in patients suffering from Neer's impingement syndrome. The aim of the present study was to assess, long after surgery (mean, 44.5 months), the isokinetic strength performance of shoulder rotator muscles in 72 patients who had had operative treatment for chronic subacromial impingement using anterior acromioplasty, sometimes combined with cuff repair surgery. Tests were conducted with a Biodex Multi-Joint System in the plane of the scapula and in 45 degrees abduction at 60 degrees and 180 degrees per second. Peak torque and average power were calculated. The mean ratios of relative strengths of the internal to external rotators ranged from 1.3 to 1.6 points depending on the parameter studied and the test speed. These results indicate that surgery restores normal muscular balance between shoulder rotator muscles affected by the impingement syndrome. PMID:7586841

Leroux, J L; Hebert, P; Mouilleron, P; Thomas, E; Bonnel, F; Blotman, F

1995-11-01

361

Hypopharyngeal Wall Exposure within the Surgical Field : The Role of Axial Rotation of the Thyroid Cartilage during Anterior Cervical Surgery  

PubMed Central

Objective Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). Methods The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. Results The angle of ARTC ranged from -6.9° to 29.7°, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. Conclusion Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.

Choi, Byung Kwan; Cho, Won Ho; Choi, Chang Hwa; Song, Geun Sung; Kim, Choongrak

2010-01-01

362

Stomach Pierced by Apical Cuff late after Removal of Toyobo Assist Device  

Microsoft Academic Search

A 38-year-old woman suffering from dilated cardiomyopathy underwent successful removal of a Toyobo left ventricular assist device after 11 months of support. Four months later, discharge of pus from the skin resulted from the contaminated residual apical cuff. The purulence stopped spontaneously 16 months later, but halitosis then developed. Two weeks later, fever and hematemesis occurred. Emergency surgery revealed gastric

Kan Nawata; Shunei Kyo; Minoru Ono; Noboru Motomura; Shinichi Takamoto

2010-01-01

363

Surgery  

MedlinePLUS

... candidate for lung surgery. Lung Volume Reduction Surgery (LVRS) is a procedure to help people with severe COPD. LVRS is not a cure for COPD but can ... that the remaining healthier portion can perform better. LVRS can also allow the diaphragm to return to ...

364

Vaginal cuff dehiscence after vaginal cuff brachytherapy for uterine cancer. A case report  

PubMed Central

Vaginal cuff dehiscence is a rare, but potentially serious complication after total hysterectomy. We report a case of vaginal cuff dehiscence after vaginal cuff brachytherapy. A 62 year old female underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and was found to have International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB endometrioid adenocarcinoma of the uterus. The patient was referred for adjuvant vaginal cuff brachytherapy. During the radiation treatment simulation, a computerized tomography (CT) of the pelvis showed abnormal position of the vaginal cylinder. She was found to have vaginal cuff dehiscence that required immediate surgical repair. Vaginal cuff dehiscence triggered by vaginal cuff brachytherapy is very rare with only one case report in the literature.

Cattaneo, Richard; Bellon, Maria

2013-01-01

365

Surgery  

MedlinePLUS

... be treated with radiation or chemotherapy. Enable direct access for chemotherapy, radiation implants, or genetic treatment of malignant tumors. Relieve seizures (due to a brain tumor) that are hard to control. Types The most common types of surgery for ...

366

Polyimide cuff electrodes for peripheral nerve stimulation  

Microsoft Academic Search

This paper describes a new tripolar spiral cuff electrode, composed of a thin (10 ?m) and flexible polyimide insulating carrier and three circumneural platinum electrodes, suitable for stimulation of peripheral nerves. The cuffs were implanted around the sciatic nerve of two groups of ten rats each, one in which the polyimide ribbon was attached to a plastic connector to characterize

Francisco J. Rodri´guez; Dolores Ceballos; Antoni Valero; Elena Valderrama; Thomas Stieglitz; Xavier Navarro

2000-01-01

367

Laboratory Evaluation of 4 Brands of Endotracheal Tube Cuff Inflator  

Microsoft Academic Search

INTRODUCTION: Routine measurement of endotracheal tube (ETT) cuff pressure is a standard in respiratory care, and several devices are available for measuring ETT cuff pressure. Yet an informed choice in the buying process is hindered by the present paucity of unbiased, comparative data. METHODS: Four brands of cuff inflator were tested: Posey Cufflator, DHD Cuff-Mate 2, Rusch Endotest, and SIMS-Portex

Paul B Blanch

368

Determinants of the cuff-leak test: a physiological study  

Microsoft Academic Search

INTRODUCTION: The cuff-leak test has been proposed as a simple method to predict the occurrence of post-extubation stridor. The test is performed by cuff deflation and measuring the expired tidal volume a few breaths later (VT). The leak is calculated as the difference between VT with and without a deflated cuff. However, because the cuff remains deflated throughout the respiratory

George Prinianakis; Christina Alexopoulou; Eutichis Mamidakis; Eumorfia Kondili; Dimitris Georgopoulos

2005-01-01

369

Effects of Electrosurgery and Vaginal Closure Technique on Postoperative Vaginal Cuff Dehiscence  

PubMed Central

Background and Objectives: The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. Methods: From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure—laparoscopically in the TLH group and vaginally in the LAVH group. Results: Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). Conclusion: It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique.

Kesterson, Joshua; Davies, Matthew; Green, Janis; Penezic, Lindsey; Vargas, Roberto; Harkins, Gerald

2013-01-01

370

The accuracy of measuring glenohumeral motion with a surface humeral cuff  

PubMed Central

Conclusions about normal and pathologic shoulder motion are frequently made from studies using skin surface markers, yet accuracy of such sensors representing humeral motion is not well known. Nineteen subjects were investigated with flock of birds electromagnetic sensors attached to transcortical pins placed into the scapula and humerus, and a thermoplastic cuff secured on the arm. Subjects completed two repetitions of raising and lowering the arm in the sagittal, scapular and coronal planes, as well as shoulder internal and external rotation with the elbow at the side and abducted to ninety degrees. Humeral motion was recorded simultaneously from surface and bone fixed sensors. The average magnitude of error was calculated for the surface and bone fixed measurements throughout the range of motion. ANOVA tested for differences across angles of elevation, raising and lowering, and differences in body mass index. For all five motions tested, the plane of elevation rotation average absolute error ranged from 0-2°, while the humeral elevation rotation average error ranged from 0-4°. The axial rotation average absolute error was much greater, ranging from 5° during elevation motions to approaching 30° at maximum excursion of internal/external rotation motions. Average absolute error was greater in subjects with body mass index greater than 25. Surface sensors are an accurate way of measuring humeral elevation rotations and plane of elevation rotations. Conversely, there is a large amount of average error for axial rotations when using a humeral cuff to measure glenohumeral internal/external rotation as the primary motion.

Hamming, David; Braman, Jonathan P.; Phadke, Vandana; LaPrade, Robert F.; Ludewig, Paula M.

2012-01-01

371

Robotic-Assisted Laparoscopic Nephroureterectomy and Bladder Cuff Excision  

PubMed Central

Background and Objectives: Our aim was to show that bladder cuff excision and distal ureterectomy can be safely performed by using the LigaSure device during robotic-assisted laparoscopic nephroureterectomy. Methods: A 60-year-old man presented with gross hematuria. He was diagnosed with upper urinary tract transitional cell carcinoma (TCC) on the left side and was scheduled for robot-assisted laparoscopic surgery. Without changing the patient's position, sealing with the LigaSure atlas for bladder cuff excision and distal ureterectomy was performed. Results: The operating time was 140 minutes from the initial incision to skin closure of all incisions. The estimated blood loss during the surgery was 120mL. There were no intraoperative or postoperative complications. The Foley drain was removed on day 3 after normal cystographic findings, and the patient was discharged from the hospital on the fourth postoperative day. Conclusion: Robot-assisted nephroureterectomy with distal ureterectomy in the same position using a LigaSure device is a safe alternative for upper tract transitional cell carcinoma.

Ozdemir, A. T.; Asil, E.; Balbay, M. D.

2012-01-01

372

Endotracheal Tube Cuff Pressure Following Intubation.  

National Technical Information Service (NTIS)

An endotracheal tube (ETT) is frequently necessary for airway management. Proper inflation of the ETT cuff is critical for patient safety. Pressure must be high enough to seal the trachea to prevent aspiration of regurgitated stomach contents and avoid ai...

M. A. Powell D. Y. Duncan D. A. Pojman R. E. Wyatt B. A. Schoneboom

2005-01-01

373

A Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation  

Microsoft Academic Search

A new type of newe cuff electrode consisting of conduc- tive segments embedded within a self-curling sheath of biocompatihle insulation has been developed. This spiral nerve cuff is biased to self- wrap around peripheral nerves and possesses a \\

GREGORY G. NAPLES; J. THOMAS MORTIMER; AVRAM SCHEINER; JAMES D. SWEENEY

1988-01-01

374

Adaptable Blood Pressure Cuff for Humans and Animals.  

National Technical Information Service (NTIS)

This invention relates to blood pressure measuring cuffs for humans and animals, and more particularly to a cuff wherein the pressure-transmitting parts are composed of strong, very thin, readily flexible sheet material made of polyurethane or material of...

E. C. Walker J. E. Pierce

1983-01-01

375

Synchronized intermittent mandatory insufflation of the endotracheal tube cuff  

Microsoft Academic Search

Continuous inflation of endotracheal tube cuffs causes tracheal injury in up to 11% of intubated patients. To avoid this complication and its consequences of tracheal and laryngeal stenosis and tracheosophageal fistula, we designed a simple device which enables intermittent inflation of the cuff during inspiratory periods of mechanical ventilation. This was achieved by connecting the inlet of the cuff of

A. Lev; E. Barzilay

1983-01-01

376

An artificial nerve fiber for evaluation of nerve cuff electrodes  

Microsoft Academic Search

The different applications of natural sensors for feedback in rehabilitation systems using functional electrical stimulation (FES) require specialised and optimised designs of nerve cuff electrodes for recording of the sensory information. This paper describes a simple artificial nerve fiber for evaluation of nerve cuff electrode designs, cuff recording configurations and noise reduction methods in a controlled environment. The idea is

Lotte N. S. Andreasen; Johannes J. Struijk; Morten Haugland

1997-01-01

377

A flexible method for fabrication of nerve cuff electrodes  

Microsoft Academic Search

A method for construction of cuff electrodes is presented. The method is based on using platinum foil electrodes fixed by rubber bands on a Teflon coated mandrel, that is then dip-coated with silicone. The method allows for design of cuff electrodes of practically any size, shape and electrode configuration, and simple cuffs can be built in less than one hour

M. Haugland

1996-01-01

378

Whole sensory nerve recordings with spiral nerve cuff electrode  

Microsoft Academic Search

We have used a self-curling nerve cuff electrode to record sensory information from a cutaneous nerve. This type of cuffs has previously been used only for stimulation, but its mechanical properties could make it very suitable for recording also, since it can be fitted closer to the nerve than traditional cuffs without compromising the nerve. In this study we show

T. Sinjar; B. Hinge; A. Jorgensen; M. L. Jensen; M. Haugland

1992-01-01

379

Variation in External Rotation Moment Arms among Subregions of Supraspinatus, Infraspinatus, and Teres Minor Muscles  

PubMed Central

A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study’s purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were measured for full ranges of rotation on 10 independent glenohumeral specimens with the humerus abducted in the scapular plane at 10 and 60°. Supraspinatus and infraspinatus tendons were divided into equal width subregions. Two conditions were tested: tendon divided to the musculotendinous junction, and tendon divided to the insertion on the humerus. Moment arms were determined from tendon excursion via the principle of virtual work. Moment arms for the infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly greater when the tendon was only divided to the musculotendinous junction versus division to the humeral head. Moment arms across subregions of infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly different. A difference in teres minor moment arm was not found for the two cuff tendon conditions. Moment arm differences between muscle subregions and for tendon division conditions have clinical implications. Interaction between cuff regions could explain why some subjects retain strength after a small cuff tear. This finding helps explain why a partial cuff repair may be beneficial when a complete repair is not possible. Data presented here can help differentiate between cuff tear cases that would benefit from cuff repair and cases for which cuff repair might not be as favorable.

Langenderfer, Joseph E.; Patthanacharoenphon, Cameron; Carpenter, James E.; Hughes, Richard E.

2006-01-01

380

Vaginal cuff dehiscence with adnexal mass evisceration after abdominal hysterectomy  

PubMed Central

INTRODUCTION More commonly, a vaginal cuff dehiscence is a complication of robotic or laparoscopic hysterectomy while dehiscence is less commonly observed following total abdominal or vaginal hysterectomies. PRESENTATION OF CASE Three years after an uncomplicated total abdominal hysterectomy for fibroid uterus, a 50 year old female with a known, large adnexal mass presented with vaginal cuff dehiscence and prolapse of the adnexal mass through the vaginal cuff. DISCUSSION We discuss surgical risk factors including route of hysterectomy, method of colpotomy and vaginal cuff closure as contributing factors for vaginal cuff dehiscence in our patient. CONCLUSION Any large pelvic mass that may potentially exert pressure necrosis on the vaginal cuff, even remote from hysterectomy may result a vaginal cuff dehiscence. Emergent surgical intervention is warranted.

Nguyen, My-Linh T.; Anyikam, Adanna L.; Paolucci, Michele

2013-01-01

381

Tripolar nerve cuff recording: stimulus artifact, EMG and the recorded nerve signal  

Microsoft Academic Search

Properties of nerve cuff recording electrodes were analyzed. Tripolar cuff electrodes have to be described essentially different for (propagating) nerve signals inside the cuff, and electrical muscle activity and stimulus artifacts arising from sources outside the cuff. It was experimentally shown that the signals originating outside the cuff are differently and much stronger influenced by the addition of a balancing

Johanna Jan Struijk; Morten Thomsen

1995-01-01

382

INJURIES OF THE MUSCULOTENDINOUS CUFF OF THE SHOULDER  

PubMed Central

Injuries of the musculotendinous cuff are frequent and often cause long periods of disability. The cuff is subject to progressive degenerative changes which are visible microscopically in most persons past 30 years of age, and visible grossly in those past 40. The cuff ruptures through areas of degeneration. A great majority of patients recover good shoulder function under conservative treatment. Operation is not urgent. Accurate diagnosis of a complete tear of the cuff cannot be made until the acute phase of injury has passed, and delay in operating does not decrease chances of good results. ImagesFigure 1.Figure 2.

Blanche, Donald W.

1953-01-01

383

Transverse versus longitudinal tripolar configuration for selective stimulation with multipolar cuff electrodes.  

PubMed

The ability to stimulate subareas of a nerve selectively is highly desirable, since it has the potential of simplifying surgery to implanting one cuff on a large nerve instead of many cuffs on smaller nerves or muscles, or alternatively can improve function where surgical access to the smaller nerves is limited. In this paper, stimulation was performed with a four-channel multipolar cuff electrode implanted on the sciatic nerve of nine rabbits to compare the extensively researched longitudinal tripolar configuration with the transverse tripolar configuration, which has received less interest. The performance of these configurations was evaluated in terms of selectivity in recruitment of the three branches of the sciatic nerve. The results showed that the transverse configuration was able to selectively activate the sciatic nerve branches to a functionally relevant level in more cases than the longitudinal configuration (20/27 versus 11/27 branches) and overall achieved a higher mean selectivity [0.79 ± 0.13 versus 0.61 ± 0.09 (mean ± standard deviation)]. The transverse configuration was most successful at recruiting the small cutaneous and medium-sized peroneal branches, and less successful at recruiting the large tibial nerve. PMID:21421427

Nielsen, Thomas N; Kurstjens, G A Mathijs; Struijk, Johannes J

2011-04-01

384

Descriptive Report of Shoulder Range of Motion and Rotational Strength Six and 12 Weeks Following Arthroscopic Superior Labral Repair  

PubMed Central

Objectives To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Background Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist. Methods Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery. Results At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points. Conclusion The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy.

Sueyoshi, Tetsuro; Winters, Matthew; Zeman, David

2008-01-01

385

The effect of tracheal tube size on air leak around the cuffs  

PubMed Central

Background This randomized single-blinded, cross-over study was done to evaluate the influence of the size of tracheal tubes on air leaks around the cuffs. Methods In a benchtop model, the number of longitudinal folds on the cuffs was evaluated for different sizes of tracheal tubes. In an anesthetized patient study, thirty patients scheduled for elective surgery under general anesthesia were included. After induction of anesthesia, the trachea was intubated with two sizes of tracheal tubes in a random sequence: in men, internal diameter of 7.5 mm and 8.0 mm; in women, internal diameter of 7.0 mm and 7.5 mm. After tracheal intubation with each tube, air leak pressures were evaluated at intracuff pressures of 20, 25 and 30 cmH2O by auscultation. To calculate the tracheal tube resistance (R), an inspiratory pause of 20% was applied and the resulting peak airway pressure (Ppeak), plateau pressure (Ppl) and mean expiratory tidal volume (Flow) were inserted in the formula R = (Ppeak - Ppl)/Flow. Results More longitudinal folds of the tracheal tube cuffs occurred in larger sized tubes compared to the smaller ones in a benchtop model. Air leakage was significantly less for the smaller tracheal tubes than for the larger ones for each gender at intracuff pressures of 20, 25 and 30 cmH2O. Tracheal tube resistances were not significantly altered by the size of tracheal tube. Conclusions The use of a smaller tracheal tube within an acceptable size can reduce air leakage around the cuff without significantly changing the tracheal tube resistance.

Hwang, Jin-Young; Park, Sang-Hyun; Han, Sung-Hee; Park, Seong-Joo; Park, Soo-kyung

2011-01-01

386

Endotracheal tube cuff pressures in patients intubated before transport  

Microsoft Academic Search

IntroductionProlonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H2O cause complications ranging from sore throat to rare cases of tracheoesophageal fistula. In a series of patients, we sought to determine the proportion of patients with overinflated cuffs and to determine whether overinflation was associated with demographics, diagnostic category, or intubator credentials.

Jacob Chapman; Daniel Pallin; Larisa Ferrara; Sarah Mortell; John Pliakas; Melissa Shear; Stephen Thomas

2009-01-01

387

Improved nerve cuff electrode recordings with subthreshold anodic currents  

Microsoft Academic Search

A method has been developed for improving the signal amplitudes of the recordings obtained with nerve cuff electrodes. The amplitude of the electroneurogram (ENG) has been shown to increase with increasing distance between the contacts when cuff electrodes are used to record peripheral nerve activity. The effect is directly related to the propagation speed of the action potentials. Computer simulations

Mesut Sahin; Dominique M. Durand

1998-01-01

388

Quantification of recruitment properties of multiple contact cuff electrodes  

Microsoft Academic Search

Nerve-based stimulating electrodes provide the technology for advancing the function of motor system neural prostheses. The goal of this work was to measure and quantify the recruitment properties of a 12 contact spiral nerve cuff electrode. The cuff was implanted on the cat sciatic nerve trunk, which consists of at least four distinct motor fascicles, and the torque generated at

Warren M. Grill Jr; J. Thomas Mortimer

1996-01-01

389

Selective recording with a multi-contact nerve cuff electrode  

Microsoft Academic Search

A multi-contact cylindrical nerve cuff electrode was evaluated for its ability to record neural signals selectively in an in vitro preparation, Three branches of a Beagle hypoglossal nerve are stimulated sequentially while compound action potentials (CAP) are recorded from its trunk with the multi-contact cuff electrode. A selectivity index (SI) is defined and applied to the CAP recorded from the

Mesut Sahin; Dominique M. Durand

1996-01-01

390

Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure  

Microsoft Academic Search

BACKGROUND: Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. METHODS: With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to

Papiya Sengupta; Daniel I Sessler; Paul Maglinger; Spencer Wells; Alicia Vogt; Jaleel Durrani; Anupama Wadhwa

2004-01-01

391

Velocity-Selective Recording from Frog Nerve Using a MultiContact Cuff Electrode  

Microsoft Academic Search

Obtaining neural information from nerve cuff recordings for use as feedback signals for neural prostheses is slowly becoming state-of-the-art. Traditional tripolar cuff recordings cannot provide information on the fiber type contributing to the compound electro neurogram. In order to get this data we employed a novel nerve cuff carrying eleven electrode contacts equally distributed along its axis. Connecting this cuff

Martin Schuettler; Vipin Seetohul; John Taylor; Nick Donaldson

2006-01-01

392

Does the reverse shoulder prosthesis medialize the center of rotation in the glenohumeral joint?  

PubMed

Reverse shoulder arthroplasty is commonly used to improve the function of osteoarthritic shoulders in cases with irreparable refractory rotator cuff-tear arthropathy when conventional prosthesis designs cannot be applied. There is indication that moving the glenohumeral joint center more medially may lead to improved shoulder function by extending the lever arm for the deltoid muscle and facilitating muscle recruitment. However, there is little experimental evidence for this medialization effect. Marker based motion data of pre- and one year postoperative examinations on nine subjects who underwent reverse shoulder arthroplasty were analyzed applying functional methods for joint center estimation. The aim was to determine the location of the functional center of rotation in the operated and the non-operated contralateral side before and after surgery to verify if the joint center of this reverse prosthesis design is located more medially compared to the anatomic situation before surgery. It was shown that the operated shoulders demonstrated a medialization effect of 8.3±4.3mm. For the non-operated side the difference was 0.1±2.3mm, proving the accuracy of measurements. PMID:22858175

Rettig, Oliver; Maier, Michael W; Gantz, Simone; Raiss, Patric; Zeifang, Felix; Wolf, Sebastian I

2012-08-02

393

Rotation-abduction analysis in 10 normal and 20 pathologic shoulders. Elite system application  

Microsoft Academic Search

Summary Kinematics of shoulder rotation-abduction in the plane of the scapula were analysed using the Elite system. We evaluated 10 asymptomatic subjects and 20 patients with painful conditions affecting the shoulder, 10 adhesive capsulitis and 10 rotator cuff-tears. The last pathologic cases were reexamined after rehabilitation treatment. The Elite system computed on line the trajectories of 8 retro reflective markers

J L Leroux; J P Micallef; F Blotman

1992-01-01

394

Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation  

SciTech Connect

Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average ({+-} standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 {+-} 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 {+-} 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 {+-} 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

Ma, Daniel J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Michaletz-Lorenz, Martha [Department of Education and Training, Elekta, Maryland Heights, MO (United States); Goddu, S. Murty [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W., E-mail: pgrigsby@wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)

2012-03-15

395

Technical communication: design and in vitro testing of a pressure-sensing syringe for endotracheal tube cuffs.  

PubMed

Endotracheal intubation is a frequently performed procedure in the prehospital setting, intensive care unit, and for patients undergoing surgery. The endotracheal tube cuff must be inflated to a pressure that prevents air leaks without compromising tracheal mucosal blood flow. For simultaneous endotracheal tube cuff inflation and measurement, we designed and tested a novel pressure-sensing syringe in vitro. The prototype was developed using a standard 10-mL polycarbonate syringe body that houses a plunger and a silicone rubber bellows, the pressure-sensing element. Bellow feasibility was determined and modeled using finite element analysis. Repeatability testing at each pressure measurement for each bellows (pressure versus deflection) was within an average standard deviation of 0.3 cm to 1.61 cm (1%-5% error). Using an aneroid manometer for comparison, there was excellent linear correlation with a Spearman rank of 0.99 (P < 0.001), up to 30 cm H(2)O. PMID:22492187

Slocum, Alexander H; Slocum, Alexander H; Spiegel, Joan E

2012-04-04

396

Damage to the cuff of EMG tube at endotracheal intubation by using a lightwand -A case report-.  

PubMed

Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation. PMID:21286432

Kim, Hyun-Sook; Park, Keun-Suk; Kang, Mae-Hwa; Park, Chong Doo

2010-12-31

397

Damage to the cuff of EMG tube at endotracheal intubation by using a lightwand -A case report-  

PubMed Central

Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation.

Kim, Hyun-Sook; Park, Keun-Suk; Kang, Mae-Hwa

2010-01-01

398

What Are Shoulder Problems?  

MedlinePLUS

... and swelling Exercise, after a time of rest Surgery if tears are severe. Rotator Cuff Disease: Tendinitis and Bursitis In tendinitis of the ... drug if the shoulder does not get better Surgery if the shoulder does not get better ... Rotator Cuff Tear Rotator cuff tendons can become inflamed from ...

399

The role of the endotracheal tube cuff in microaspiration.  

PubMed

The cuff of the endotracheal tube (ETT) is designed to provide a seal within the airway, allowing airflow through the ETT but preventing passage of air or fluids around the ETT. Deliberate or inadvertent movement of the ETT may affect cuff pressure or shift folds in the cuff, mobilizing pooled secretions. When this seal is compromised, microaspirations contaminated with gastric contents or bacterially colonized oral secretions can occur that leave the patient susceptible to a host of problems, such as hypoxia, pneumonitis, and respiratory infections. These complications are costly in terms of morbidity and mortality, as well as hospital expense. We will discuss the role of the ETT cuff in microaspiration and identify potential directions for future research to improve outcomes in mechanically ventilated patients. PMID:22209048

Hamilton, V Anne; Grap, Mary Jo

2011-12-30

400

Compliance in Anastomoses With and Without Vein Cuff Interposition  

Microsoft Academic Search

Objective to compare anastomotic compliance in end-to-side anastomoses with and without vein cuff interposition. Materials polytetrafluoroethylene graft to bovine carotid artery without (standard) and with vein interposition (Linton-patch and Miller-cuff). Methods zonewise compliance measurement of end-to-side anastomoses in anin-vitro circulation system. The zone most distal to the suture-line served as reference compliance. Resultsdirectly distal to the suture-line the compliance of

D. Piorko; P. Knez; K. Nelson; T. Schmitz-Rixen

2001-01-01

401

Endotracheal Tube Cuff Pressure Is Unpredictable in Children  

Microsoft Academic Search

The use of cuffed tracheal tubes in children younger than 8 yr of age has recently increased, although cuff hyperinflation may cause tracheal mucosal damage. In this study, we sought to measure the cuff pressure (Pcuff) after initial free air inflation (iPcuff) and to follow its evolution throughout the duration of 50% nitrous oxide (N2O) anesthesia. One-hundred-seventy-four children, aged 0

Marie-Louise Felten; Emmanuelle Schmautz; Sonia Delaporte-Cerceau; Gilles A. Orliaguet; Pierre A. Carli

2003-01-01

402

Endotracheal tube cuff pressure monitoring: a review of the evidence.  

PubMed

Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13-20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively. PMID:22165491

Sultan, Pervez; Carvalho, Brendan; Rose, Bernd Oliver; Cregg, Roman

2011-11-01

403

Endotracheal tube cuff leak with mysterious laryngotracheal pathology.  

PubMed

A 63 year-old obese man with gastroesophageal reflux disease, hiatal hernia, and no known history of airway pathology was to undergo a total knee arthroplasty. After intubation, however, repeated cuff leaks, decreasing tidal volumes, and desaturations prompted five additional endotracheal tube placements. Findings on radiography, computed tomography, and fiberoptic laryngoscopy and tracheoscopy were equivocal. Factors contributing to this challenge of persistent and repeated cuff leaks in the absence of known airway pathology could include various laryngotracheal abnormalities. PMID:23634577

Lafleur, J Lance; Boddu, Krishna; Baluch, Amir R; Kaye, Alan D

2012-10-01

404

Lidocaine in the endotracheal tube cuff reduces postoperative sore throat  

Microsoft Academic Search

Study Objectives: To test the hypothesis that continuous application of local anesthesia at the contact area between the endotracheal tube cuff and trachea would reduce both the incidence and severity of postoperative sore throat by blocking the tracheal pain receptors with local anesthetic delivered via endotracheal tube (ETT) cuff.Design: Double-blind randomized study.Setting: University affiliate hospital.Patients: 106 ASA physical status I

Rosa M. Navarro; Verna L. Baughman

1997-01-01

405

Whole nerve recordings with the spiral nerve cuff electrode  

Microsoft Academic Search

The feasibility of whole nerve recordings from the hypoglossal (HG) nerve is demonstrated in acute cats using the spiral nerve cuff electrode. A good contact between the nerve and the electrodes, provided by the spiral nerve cuff due to its self-coiling property, should improve the signal-to-noise ratio. An instrumentation amplifier with very low input noise characteristics is also utilized. The

Mesut Sahin; Dominique M. Durand; Musa A. Haxhiu

1994-01-01

406

Chronic cuff electrode recordings from walking Göttingen mini-pigs.  

PubMed

We present data from cuff electrode recordings from a mixed sensory-/motor nerve as expressed during walking in chronically implanted Göttingen mini-pigs. Our results show that it is possible to filter out residual electromyographic interference and that the energy content of the resulting electroneurographic (ENG) signals modulate clearly with gait. The approach may be used to detect heel strike from cuff electrode measurements to control the timing of stimulation in implantable foot drop correction systems. PMID:22254796

Andersen, Mads P; Munch, Majken; Jensen, Winnie; Sørensen, Preben; Eder, Clemens F

2011-01-01

407

Measurement of the performance of nerve cuff electrodes for recording  

Microsoft Academic Search

New designs of cuff electrodes for the recording of signals from peripheral nerves are typically tested in acute animal experiments\\u000a before long-term evaluation takes place. A reproducible, cost-effective and fast method is presented for evaluating cuff electrodes\\u000a with respect to signal amplitude, noise rejection, and, in some cases, selectivity, as an alternative to acute in vivo experiments.\\u000a Comparisons with a

L. N. S. Andreasen; J. J. Struijk; S. Lawrence

2000-01-01

408

The cuff-leak test: what are we measuring?  

Microsoft Academic Search

Stridor is one of the most frequent causes of early extubation failure. The cuff-leak test may help to identify patients at risk to develop post-extubation laryngeal edema. However the discrimination power of the cuff-leak test is highly variable and can be use, at best, to detect patients at risk to develop edema but should not be used to postpone extubation

Daniel De Backer

2005-01-01

409

Mechanics of the occlusive arm cuff and its application as a volume sensor.  

PubMed

Although a common medical instrument, the mechanical function of an occlusive arm cuff has not been fully described in an engineering sense. The occlusive arm cuff is examined here using a mathematical mechanics model and experimental measurements. Cuff stretch was modeled by a nonlinear pressure-volume function. Air compression was represented by Boyle's law. An apparatus was developed to measure pressure due to the air volume pumped into the cuff for fixed arm volume. Data were obtained for two different cuff designs, and reveal a nonlinear cuff pressure-volume relationship that could be represented accurately by the mathematical model. Calibration constants are provided for the two types of occlusive cuff. Thus, the cuff pressure was found to consist of a balance between that produced by stretch of the elastic cuff bladder and that of the compression of the air contained within the bladder. The use of the gas law alone was found to be inadequate to represent the cuff mechanics. When applying the cuff to measure change in arm volume, such as during plethysmography or oscillometry, it cannot be assumed that the cuff sensitivity is constant. More precisely, it was found that the occlusive cuff is a transducer with a volume sensitivity that increases with cuff pressure and volume until it becomes nearly constant at high levels of cuff pressure (150 mmHg). A hypothetical case of a linear elastic artery with constant pulse pressure was used as input to the cuff model to illustrate the change in cuff pressure oscillations that occurs while cuff pressure is released.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8244431

Drzewiecki, G; Bansal, V; Karam, E; Hood, R; Apple, H

1993-07-01

410

Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study  

PubMed Central

Objective: To compare the three common methods of endotracheal tube cuff inflation (sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications. Methods: Seventy-five adult patients scheduled for N2 O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group (n=25), the cuff was inflated to a pressure of 25 cm H2O; sealing group (n=25), the cuff was inflated to prevent air leaks at airway pressure of 20 cm H2O and finger group (n=25), the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested. Results: Although cuff pressure was significantly low in the sealing group compared to the control group (P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group (P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff.. Conclusions: In N2O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat.

Al-metwalli, Roshdi R.; Al-Ghamdi, Abdulmohsen A.; Mowafi, Hany A.; Sadek, Sayed; Abdulshafi, Mohammed; Mousa, Wesam F.

2011-01-01

411

A simple method of partial inflation of the LMA cuff before insertion in children to allow cuff pressure without adjustment after insertion  

PubMed Central

Background The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion. Methods One hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer. Results The mean intra-cuff pressure was 50 ± 12.9 cmH2O; intra-cuff pressures were 39.1 ± 9.3, 51.6 ± 11.2, and 64.6 ± 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure. Conclusions The cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion.

Moon, Bo-Eun; Kim, Min-Soo

2012-01-01

412

A Profile of Glenohumeral Internal and External Rotation Motion in the Uninjured High School Baseball Pitcher, Part II: Strength  

PubMed Central

Context: A database describing the range of normal rotator cuff strength values in uninjured high school pitchers has not been established. Chronologic factors that contribute to adaptations in strength also have not been established. Objectives: To establish a normative profile of rotator cuff strength in uninjured high school baseball pitchers and to determine whether bilateral differences in rotator cuff strength are normal findings in this age group. Design: Cohort study. Setting: Baseball playing field. Patients or Other Participants: A total of 165 uninjured male high school baseball pitchers (age = 16 ± 1 years, height = 1.8 ± 0.1 m, mass = 76.8 ± 10.1 kg, pitching experience = 7 ± 2 years). Main Outcome Measure(s): Isometric rotator cuff strength was measured bilaterally with a handheld dynamometer. We calculated side-to-side differences in strength (external rotation [ER], internal rotation [IR], and the ratio of ER:IR at 90° of abduction), differences in strength by age, and the influence of chronologic factors (participant age, years of pitching experience) on limb strength. Results: Side-to-side differences in strength were found for ER, IR, and ER:IR ratio at 90° of abduction. Age at the time of testing was a significant but weak predictor of both ER strength (R2 = 0.032, P = .02) and the ER:IR ratio (R2 = 0.051, P = .004) at 90° of abduction. Conclusions: We established a normative profile of rotator cuff strength for the uninjured high school baseball pitcher that might be used to assist clinicians and researchers in the interpretation of muscle strength performance in this population. These data further suggested that dominant-limb adaptations in rotator cuff strength are a normal finding in this age group and did not demonstrate that these adaptations were a consequence of the age at the time of testing or the number of years of pitching experience.

Hurd, Wendy J.; Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.

2011-01-01

413

Endotracheal tube cuff--small important part of a big issue.  

PubMed

Many of the complications related to prolonged ventilation are related to inappropriate handling of endotracheal tube (ETT) cuff. This article reviews the possible complications associated with the ETT cuff, and the landmark development made in that field. The article challenges the present paradigm of cuff use and reviews the current clinical practice in that area. PMID:22212414

Efrati, Shai; Deutsch, Israel; Gurman, Gabriel M

2012-01-03

414

Utility of portable chest radiographs as a predictor of endotracheal tube cuff pressure  

Microsoft Academic Search

Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure

JOSEPH VALENTINO; ROBERT K. MYERS; MICHAEL D. BAKER; JOHN H. WOODRING

1999-01-01

415

A miniaturized cuff electrode for electrical stimulation of peripheral nerves in the freely moving rat  

Microsoft Academic Search

A bipolar cuff electrode for electrical stimulation of small diameter peripheral nerves is described. The cuff is made of a highly flexible rubber-impression material, and the electrode assembly is suited for chronic implantation. Its manual construction is easy and reliable, utilizing only simple tools. The cuff completely envelopes nerves of varying diameter and requires a minimal amount of manipulations of

T. Jellema; J. L. J. M. TEEPENI

1995-01-01

416

Comparison between monopolar and tripolar configurations in chronically implanted nerve cuff electrodes  

Microsoft Academic Search

Nerve cuff electrodes have been shown to be safe and able to activate selectively specific fascicles in a nerve trunk. Selectivity has been shown using a cuff with four radially placed tripoles thus requiring twelve contacts and twelve lead wires. This study evaluates a simplified cuff electrode, consisting of four radially placed monopole electrodes, requiring only four lead wires, and

H. Tarler; W. M. Grill; J. T. Mortimer

1995-01-01

417

Perivascular fluid cuffs decrease lung compliance by increasing tissue resistance  

PubMed Central

Objective Lung inflammation causes perivascular fluid cuffs to form around extra-alveolar blood vessels; however, the physiologic consequences of such cuffs remain poorly understood. Herein, we tested the hypothesis that perivascular fluid cuffs, without concomitant alveolar edema, are sufficient to decrease lung compliance. Design Prospective, randomized, controlled study. Setting Research laboratory. Subjects One hundred twenty male CD40 rats. Interventions To test this hypothesis, the plant alkaloid thapsigargin was used to activate store-operated calcium entry and increase cytosolic calcium in endothelium. Thapsigargin was infused into a central venous catheter of intact, sedated, and mechanically ventilated rats. Measurements Static and dynamic lung mechanics and hemodynamics were measured continuously. Main Results Thapsigargin produced perivascular fluid cuffs along extra-alveolar vessels but did not cause alveolar flooding or blood gas abnormalities. Lung compliance dose-dependently decreased after thapsigargin infusion, attributable to an increase in tissue resistance that was attributed to increased tissue damping and tissue elastance. Airway resistance was not changed. Neither central venous pressure nor left ventricular end diastolic pressure was altered by thapsigargin. Heart rate did not change, although thapsigargin decreased pressure over time sufficient to reduce cardiac output by 50%. Infusion of the type 4 phosphodiesterase inhibitor, rolipram, prevented thapsigargin from inducing perivascular cuffs and decreasing lung compliance. Rolipram also normalized pressure over time and corrected the deficit in cardiac output. Conclusions Our findings resolve for the first time that perivascular cuff formation negatively impacts mechanical coupling between the bronchovascular bundle and the lung parenchyma, decreasing lung compliance without impacting central venous pressure.

Lowe, Kevin; Alvarez, Diego F.; King, Judy A.; Stevens, Troy

2010-01-01

418

Cuff of wrist-mount blood pressure monitor  

US Patent & Trademark Office Database

A cuff of a wrist-mount blood pressure monitor capable of oppressing an artery of the wrist securely without having effects of muscle, tendon or bone existing in the wrist area is presented. This cuff 10 of a wrist-mount blood pressure monitor comprises a first air bag 14A as a first inflatable portion, and a second air bag 16A as a second inflatable region disposed between the first inflatable portion 14A and the wrist, being made of a material of a higher stretchability than the material for the first air bag 14A.

Yamakoshi; Ken-ichi (Kanazawa, JP); Oku; Shojiro (Kyoto, JP); Tanaka; Takahide (Kyoto, JP); Sano; Yoshihiko (Kyoto, JP); Kato; Hiroyuki (Kyoto, JP)

2004-02-24

419

Variables affecting leakage past endotracheal tube cuffs: a bench study  

Microsoft Academic Search

Purpose  Leakage of oral secretions past endotracheal tubes (ETT) has been implicated in ventilator associated pneumonia. The aim of\\u000a this bench study was to compare the ability of current generation ETT cuffs to prevent fluid leakage and to determine the\\u000a specific mechanical ventilator settings that affect movement of fluid across an inflated ETT cuff.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Using a 2.3-cm internal diameter (ID) tracheal

Renée Pitts; Daniel Fisher; Demet Sulemanji; Joseph Kratohvil; Yandong Jiang; Robert Kacmarek

2010-01-01

420

A low-noise preamplifier for nerve cuff electrodes.  

PubMed

A single-stage, low-noise preamplifier is designed using the concept of noise matching for recordings of neural signal with cuff electrodes. The signal-to-noise ratio is approximately 1.6 times higher than that of a low-noise integrated amplifier (AMP-01) for a cuff impedance of 1.5 komega. The bandwidth is 230 Hz-8.25 kHz (Rs=2 komega), and the common-mode-rejection-ratio is 91.2 dB at 1 kHz. PMID:16425839

Sahin, Mesut

2005-12-01

421

A low-noise preamplifier for nerve cuff electrodes  

Microsoft Academic Search

A single-stage, low-noise preamplifier is designed using the concept of noise matching for recordings of neural signal with cuff electrodes. The signal-to-noise ratio is approximately 1.6 times higher than that of a low-noise integrated amplifier (AMP-01) for a cuff impedance of 1.5 k?. The bandwidth is 230 Hz-8.25 kHz (Rs=2 k?), and the common-mode-rejection-ratio is 91.2 dB at 1 kHz.

Mesut Sahin

2005-01-01

422

A double-layer tracheal tube cuff designed to prevent leakage: a bench-top study  

Microsoft Academic Search

Objective  We designed a new endotracheal tube (ETT) cuff that does not form the folds that cause leakage of colonized subglottic secretions\\u000a upon inflation within the trachea: a standard high-volume low-pressure cuff was draped with a second, highly elastic cuff\\u000a made of a low-protein guayule natural latex rubber with 0.5?ml gel between the cuffs. We compared this prototype ETT cuff\\u000a with four commercially available ETTs

Alberto Zanella; Massimo Cressoni; Myra Epp; Mario Stylianou; Theodor Kolobow

2008-01-01

423

Optimisation techniques in vaginal cuff brachytherapy.  

PubMed

The aim of this study was to explore whether an in-house dosimetry protocol and optimisation method are able to produce a homogeneous dose distribution in the target volume, and how often optimisation is required in vaginal cuff brachytherapy. Treatment planning was carried out for 109 fractions in 33 patients who underwent high dose rate iridium-192 (Ir(192)) brachytherapy using Fletcher ovoids. Dose prescription and normalisation were performed to catheter-oriented lateral dose points (dps) within a range of 90-110% of the prescribed dose. The in-house vaginal apex point (Vk), alternative vaginal apex point (Vk'), International Commission on Radiation Units and Measurements (ICRU) rectal point (Rg) and bladder point (Bl) doses were calculated. Time-position optimisations were made considering dps, Vk and Rg doses. Keeping the Vk dose higher than 95% and the Rg dose less than 85% of the prescribed dose was intended. Target dose homogeneity, optimisation frequency and the relationship between prescribed dose, Vk, Vk', Rg and ovoid diameter were investigated. The mean target dose was 99+/-7.4% of the prescription dose. Optimisation was required in 92 out of 109 (83%) fractions. Ovoid diameter had a significant effect on Rg (p = 0.002), Vk (p = 0.018), Vk' (p = 0.034), minimum dps (p = 0.021) and maximum dps (p<0.001). Rg, Vk and Vk' doses with 2.5 cm diameter ovoids were significantly higher than with 2 cm and 1.5 cm ovoids. Catheter-oriented dose point normalisation provided a homogeneous dose distribution with a 99+/-7.4% mean dose within the target volume, requiring time-position optimisation. PMID:19470571

Tuncel, N; Garipagaoglu, M; Kizildag, A U; Andic, F; Toy, A

2009-05-26

424

Rotational Seismometer.  

National Technical Information Service (NTIS)

Elastic wave theory predicts that the elastic waves generated by an earthquake and other seismic events include a measurable component of horizontal elastic rotation. Several rotational seismometers have been designed to measure this rotational component....

P. W. Rodgers C. A. Dann

1970-01-01

425

[Cuff tear arthropathy – long-term results of reverse total shoulder arthroplasty].  

PubMed

The results after reverse total shoulder arthroplasty for cuff tear arthropathy are superior and the complications fewer than for other etiologies, such as rheumatoid arthritis, fracture, fracture sequelae or even revision. The improvements in function and pain are excellent whereas rotation may be unaffected. Revisions and complications can be encountered in the first 3 years and the survival curve of the prosthesis is still good after 10 years with 90%. Progressive functional and radiological deterioration is observed after 9 years in approximately 30% of the patients without apparent problems with the prosthesis. Notching is progressive with incidence and size over time, without a proven correlation to the functional results but remains a major concern. Modification of the implants, the operative techniques and experience could significantly improve the results and reduce the rate of complications. Lateralization of the center of rotation and smaller inclination angles have a positive effect on the rate of notching and the range of motion, especially for the rotation. New prosthetic designs and operative techniques attempt to implement a combination of the biomechanical improvements. Reverse shoulder arthroplasty remains a challenging operation with a high rate of complications. The results depend on the etiology and the function of the remaining muscles and therefore on the experience and the skill of the surgeon to implement the appropriate biomechanical factors. Because of the concerns regarding the longevity, reverse shoulder arthroplasty should be reserved for the elderly over 70 years of age. PMID:23797763

Brunner, U; Rückl, K; Fruth, M

2013-07-01

426

Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.  

PubMed

Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital. PMID:23252881

Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara

2012-12-19

427

Properties of orderly recruited motor units with tripolar cuff electrode  

Microsoft Academic Search

Summary form only given, as follows. Motor units of the soleus and m. gastrocnemius muscles were recruited in order according to size with stimuli delivered by a tripolar nerve cuff electrode. One stimulus controlled the firing rate, while the second recruited the motor units, with the electrode's center pole serving both stimuli. A series of test procedures verified that motor

R. Barratta; M. Ichie; M. Solomonow

1988-01-01

428

Measurement of external pressures generated by nerve cuff electrodes  

Microsoft Academic Search

When external pressures are applied to a peripheral nerve, tissue damage can occur via compression and blood flow occlusion, resulting in degeneration and demyelination of axons. Although many types of nerve electrodes have been designed to avoid or minimize this pressure during stimulation of the nerve or recording of its activity, the measurement of the pressure exerted by these cuffs

Frank A. Cuoco; Dominique M. Durand

2000-01-01

429

Multichannel neural cuff electrodes with integrated multiplexer circuit  

Microsoft Academic Search

In order to restore hand function in spinal cord injured people by functional electrical stimulation of arm nerves, the authors developed an 18polar neural cuff type electrode with integrated multiplexer circuit. This circuit reduces the number of necessary interconnection leads to a stimulator from twelve to four. Cable reduction was intended to reduce the risk of cable breakage which is

Martin Schuettler; Klaus Peter Koch; Thomas Stieglitz; Oliver Scholz; Werner Haberer; Ralf Keller; Joerg-Uwe Meyer

2000-01-01

430

Fascicle selective recording with a nerve cuff electrode  

Microsoft Academic Search

A multipolar split cuff electrode is used for fascicle selective recording of the electroneurogram (ENG) of the sciatic nerve of the rabbit. Several electrode configurations were evaluated with regarding to selectivity: the peroneal and tibial nerves were stimulated alternately and the ENG was recorded at different sides of the sciatic nerve. The results for two electrode configurations are presented

Johannes J. Struijk; Morten K. Haugland; Morten Thomsen

1996-01-01

431

Intraoperative Testing of Selectivity of Spiral Nerve Cuff Electrodes  

Microsoft Academic Search

Nerve cuff electrodes were used intraoperatively to stimulate peripheral nerves to examine electrode selectivity in the human upper extremity. Subjects were recruited from patients undergoing upper extremity nerve repair procedures. The nerves were stimulated through four individual contacts located radially around the nerve with varying parameters. Data was recorded to estimate stimulation threshold and determine selectivity. Thresholds appeared to be

Polasek KH; Hoyen HA; Keith MW; Kirsch RF; Tyler DJ

432

18polar Hybrid Cuff Electrodes for Stimulation of Peripheral Nerves  

Microsoft Academic Search

For restoration of neuro-muscular functions in disabled people, cuff type electrodes have been used for several 10 years. A lot of experiences were collected using 12polar electrodes, which consisted of silicone tubes, carrying 4 stimulation tripoles, each tripole orientated longitudinally to the nerve. The tripoles were at 0°, 90°, 180°, and 270° position around the nerve. It is obvious that

Martin Schuettler; Thomas Stieglitz

433

An interface for nerve recording and stimulation with cuff electrodes  

Microsoft Academic Search

A nerve cuff electrode interface capable of both stimulating and recording from a nerve is described. The interface also rejects the EMG contamination in the recordings using reactive components without adding noise to the ENG signal. A transformer is added to the design for noise matching and the signal-to-noise ratio improvement is evaluated for a specific amplifier (AMP-O1)

Mesut Sahin; Dominique M. Durand

1997-01-01

434

Temporal stability of nerve cuff electrode recruitment properties  

Microsoft Academic Search

The recruitment properties of multiple contact nerve cuff electrodes chronically implanted on the cat sciatic nerve were measured, and the week to week variability was documented. The variability in recruitment properties was greatest between 1 week and 8 weeks post-implant. After 8 weeks the session to session changes were significantly smaller than in the early post-implant period. No trends were

Warren M. Grill; J. Thomas Mortimer

1995-01-01

435

21 CFR 868.5800 - Tracheostomy tube and tube cuff.  

Code of Federal Regulations, 2013 CFR

...tracheostomy tube. The cuff is used to prevent the patient's aspiration of substances, such as blood or vomit, or to provide a means for positive-pressure ventilation of the patient. This device is made of either stainless steel or plastic....

2013-04-01

436

Do International Rotations Make Surgical Residents More Resource-Efficient? A preliminary study  

Microsoft Academic Search

OBJECTIVEInterest in international surgery among general surgery residents in the US has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource-efficient after they have completed

Jason L. Oliphant; Ronell R. Ruhlandt; Stanley R. Sherman; Marc G. Schlatter; Joel A. Green

437

Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.  

PubMed

Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes. PMID:23945890

Mahmoodpoor, Ata; Peyrovi-Far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad