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Sample records for rotator cuff tears

  1. Rotator Cuff Tear Shape Characterization

    PubMed Central

    Goodwin, David Steven; Kaplan, Daniel James; Fralinger, David; Gyftopoulos, Soterios; Meislin, Robert J.; Jazrawi, Laith M.

    2016-01-01

    Objectives: Proper surgical planning requires accurate and reliable pre-operative patient information. The more comprehensive the data, the more the surgeon can tailor a general surgical technique to an individual patient’s unique anatomy. A previous retrospective study demonstrated that three-dimensional magnetic resonance imaging more accurately characterized rotator cuff tears compared to two-dimensional images when checked against intra-operative pictures. The purpose of this study was to determine if three-dimensional MRI imaging would continue to be more accurate than two-dimensional imaging in a prospective study. Methods: Patients were prospectively included if they had a full-thickness primary rotator cuff tear on pre-operative MRI. Intra-op videos were taken from the posterior and lateral portals, with a grasper fully mobilizing the torn tendon in each view. 7 surgeons then reviewed the videos and independently characterized the shape of the tears into crescent, U-shaped tears, L-shaped tears, or massive tears. This was considered the gold-standard. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear’s retraction and size 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and fleiss’s kappa. Results: 37 patients were enrolled in the study. Among the 7 surgeons, agreement on cuff tear was 93% ( =.87). The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 73.4% for reader 1 and 71.2% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 92% for reader 1 and 94% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an

  2. Ultrasound determination of rotator cuff tear repairability

    PubMed Central

    Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

    2015-01-01

    Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p < 0.0001) and a specificity of 67% (p < 0.0001). The strongest predictors of rotator cuff repairability were tear size (p < 0.001) and age (p = 0.004). Sonographic assessments of tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

  3. Rotator Cuff Tears

    MedlinePlus

    ... doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder. This means ... or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the ...

  4. Rotator cuff tear measurement by arthropneumotomography

    SciTech Connect

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

    1983-02-01

    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.

  5. Rotator Cuff Tendinitis and Tear (Beyond the Basics)

    MedlinePlus

    ... is usually treated with ice, antiinflammatory drugs, and physical therapy. (See 'Rotator cuff injury treatment' below.) Rotator cuff ... small- to medium-size tears usually improve with physical therapy exercises, stopping painful activities, and, in some cases, ...

  6. Rotator Cuff Tear Consequent to Glenohumeral Dislocation.

    PubMed

    Gilotra, Mohit N; Christian, Matthew W; Lovering, Richard M

    2016-08-01

    The patient was a 21-year-old collegiate running back who was tackled during a football game and sustained a posterior glenohumeral dislocation. He was referred to an orthopaedist and presented 3 weeks after the injury, and, following examination, further imaging was ordered by the orthopaedist due to rotator cuff weakness. Magnetic resonance imaging showed a complete tear of the supraspinatus and infraspinatus, as well as a posterior Bankart lesion, a subscapularis tear, and a dislocation of the biceps long head tendon into the reverse Hill-Sachs lesion. J Orthop Sports Phys Ther 2016;46(8):708. doi:10.2519/jospt.2016.0413. PMID:27477475

  7. Assessment and treatment strategies for rotator cuff tears

    PubMed Central

    Al-Hakim, Wisam; Noorani, Ali

    2014-01-01

    Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment.

  8. Rotator cuff tears: An evidence based approach

    PubMed Central

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

  9. Rotator Cuff Tears in the Elderly Patients

    PubMed Central

    Geary, Michael B.

    2015-01-01

    Rotator cuff tears (RCT) are a common clinical problem in the geriatric population, and debate exists over how to best provide pain relief and restore shoulder function. Treatment options can be broadly divided into nonsurgical and surgical, with the majority of patients initially placed on a trial of conservative therapy. For those with irreparable RCT, low functional demand, or interest in nonoperative management, there are a number of nonsurgical treatments to consider, including rehabilitation and injections of corticosteroids, hyaluronate, and platelet-rich plasma. Surgical treatment is increasingly common, as geriatric patients remain active with high functional demands. Studies in elderly populations have demonstrated satisfactory healing and clinical results following surgical repair. Predictors of poor outcome after repair are large tear size as well as higher stages of fatty infiltration. Decompression is a less invasive surgical option that has been shown to provide short-term pain relief, though the lasting effects may deteriorate over time. A number of factors must be weighed when considering which patients are likely to benefit from surgical intervention. PMID:26328240

  10. No prosthetic management of massive and irreparable rotator cuff tears

    PubMed Central

    Garofalo, Raffaele; Cesari, Eugenio

    2014-01-01

    A massive rotator cuff tear is not necessarily irreparable. Number of tendons involved, muscle-tendon unit quality, and decreased acromionhumeral distance (AHD) are as important as tear size in determining reparability of lesion. Massive and irreparable rotator cuff tears cannot be anatomically repaired to the bone and are a common source of pain and disability even in middle-aged patients. In these patients when conservative management has failed, it is possible to perform different surgical techniques. A functional repair can help to restore the horizontal force couple of the cuff on the humeral head and to increase the AHD. Debridement of irreparable tears and biceps tenotomy or tenodesis can have a role in low functional demand patients but results deteriorate over time. Recently, several commercially available tissue-engineered biological and synthetic scaffolds have been developed to augment rotator cuff repairs. The aim is to provide a mechanical improvement in case of poor quality tissue at time zero and give a support to have a better cuff healing. In selected cases, the scaffold can be used also to bridge tendon defect. Patients who not have pseudoparalysis, cuff tear arthropathy and with intact deltoid function can benefit from tendon transfers with satisfactory outcomes. These different procedures should be chosen for each patient with selected criteria and after a satisfactory explanation about the really possible expectation after surgery.

  11. Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

    PubMed Central

    Mihata, Teruhisa; Lee, Thay Q.; Itami, Yasuo; HASEGAWA, Akihiko; Ohue, Mutsumi; Neo, Masashi

    2016-01-01

    Objectives: An arthroscopic superior capsule reconstruction, in which the fascia lata autograft attached medially to the superior glenoid and laterally to the greater tuberosity, restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function specifically deltoid muscle function and relieves pain. We assessed the clinical outcome of arthroscopic superior capsule reconstruction (Figure 1) in 100 consecutive patients with irreparable rotator cuff tears. Specifically, we focused on the rates of return to sport and work. Methods: From 2007 to 2014, we performed arthroscopic superior capsule reconstruction on 107 consecutive patients (mean 66.7 years; range, 43 to 82) with irreparable rotator cuff tears that had failed conservative treatment. Seven patients were lost to follow-up because of other medical problems or reasons. In the remaining 100 patients there were 56 supraspinatus and infraspinatus tears; 39 supraspinatus, infraspinatus, and subscapularis tears; 3 supraspinatus, infraspinatus, teres minor, and subscapularis tears; and 2 supraspinatus, infraspinatus, and teres minor tears. Physical examination, radiography, and MRI were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Rates of return to sport and work were also investigated in those patients who had been employed (34 patients: 21 manual workers, 10 farmers, 1 butcher, 1 cook, and 1 athletic trainer) or played sport (26 patients: 6 golf, 4 table tennis, 4 swimming, 3 martial arts, 2 baseball, 2 yoga, 1 tennis, 1 badminton, 1 skiing, 1 mountain-climbing, and 1 ground golf) before injury. Results: The average preoperative American Shoulder and Elbow Surgeons (ASES) score was 31.6 points (range, 3.3 to 63.3 points) and the average Japanese Orthopaedic Association (JOA) score was 51.6 points (26.5 to 68.5 points). Average postoperative clinical outcome scores all improved significantly at final

  12. Rotator cuff problems

    MedlinePlus

    ... days, such as in painting and carpentry Poor posture over many years Aging Rotator cuff tears TEARS ... also help prevent rotator cuff problems. Practice good posture to keep your rotator cuff tendons and muscles ...

  13. Biceps Lesion Associated With Rotator Cuff Tears

    PubMed Central

    Jeong, Ho Yeon; Kim, Jung Youn; Cho, Nam Su; Rhee, Yong Girl

    2016-01-01

    Background: Various tenodesis methods are being used for long head of the biceps tendon lesions. However, there is no consensus on the most appropriate surgical method. Hypothesis: There are significant differences in incidence of cosmetic deformity and persistent bicipital pain between open subpectoral and arthroscopic intracuff tenodesis groups. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 72 patients who underwent biceps tenodesis and rotator cuff repair between January 2009 and May 2014 and who were followed for at least 1 year. Open subpectoral tenodesis was performed in 39 patients (group A), and arthroscopic intracuff tenodesis was performed in 33 patients (group B). Results: In group A, the mean visual analog scale (VAS) score for pain during motion and mean University of California, Los Angeles (UCLA) and Constant scores significantly improved from 4.6, 18.6, and 64.5 preoperatively to 1.9, 30.5, and 86.5 at last follow-up, respectively (P < .001 for all). In group B, these scores significantly improved from 5.1, 17.6, and 62.9 preoperatively to 1.8, 31.5, and 85.9 at last follow-up, respectively (P < .001 for all). Popeye deformity was noted in 2 (5.2%) patients from group A and 5 (15.6%) patients from group B (P = .231). Additionally, persistent bicipital tenderness was noted in 1 (2.6%) patient from group A and 8 (24.2%) patients from group B (P = .012). Conclusion: Both open subpectoral tenodesis and arthroscopic intracuff tenodesis show good clinical outcomes for long head of the biceps tendon lesions. However, open subpectoral tenodesis may be more appropriate, considering the low incidence of Popeye deformity and tenderness. PMID:27231699

  14. I.S.Mu.L.T - Rotator Cuff Tears Guidelines.

    PubMed

    Oliva, Francesco; Piccirilli, Eleonora; Bossa, Michela; Via, Alessio Giai; Colombo, Alessandra; Chillemi, Claudio; Gasparre, Giuseppe; Pellicciari, Leonardo; Franceschetti, Edoardo; Rugiero, Clelia; Scialdoni, Alessandro; Vittadini, Filippo; Brancaccio, Paola; Creta, Domenico; Buono, Angelo Del; Garofalo, Raffaele; Franceschi, Francesco; Frizziero, Antonio; Mahmoud, Asmaa; Merolla, Giovanni; Nicoletti, Simone; Spoliti, Marco; Osti, Leonardo; Padulo, Johnny; Portinaro, Nicola; Tajana, Gianfranco; Castagna, Alex; Foti, Calogero; Masiero, Stefano; Porcellini, Giuseppe; Tarantino, Umberto; Maffulli, Nicola

    2015-01-01

    Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. PMID:26958532

  15. I.S.Mu.L.T - Rotator Cuff Tears Guidelines

    PubMed Central

    Oliva, Francesco; Piccirilli, Eleonora; Bossa, Michela; Via, Alessio Giai; Colombo, Alessandra; Chillemi, Claudio; Gasparre, Giuseppe; Pellicciari, Leonardo; Franceschetti, Edoardo; Rugiero, Clelia; Scialdoni, Alessandro; Vittadini, Filippo; Brancaccio, Paola; Creta, Domenico; Buono, Angelo Del; Garofalo, Raffaele; Franceschi, Francesco; Frizziero, Antonio; Mahmoud, Asmaa; Merolla, Giovanni; Nicoletti, Simone; Spoliti, Marco; Osti, Leonardo; Padulo, Johnny; Portinaro, Nicola; Tajana, Gianfranco; Castagna, Alex; Foti, Calogero; Masiero, Stefano; Porcellini, Giuseppe; Tarantino, Umberto; Maffulli, Nicola

    2015-01-01

    Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. PMID:26958532

  16. Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears

    PubMed Central

    Dilisio, Matthew F.; Neyton, Lionel

    2014-01-01

    The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign–directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion. PMID:25685676

  17. Complications Following Arthroscopic Rotator Cuff Tear Repair

    PubMed Central

    Audigé, Laurent; Blum, Raphael; Müller, Andreas M.; Flury, Matthias; Durchholz, Holger

    2015-01-01

    Background Valid comparison of outcomes after surgical procedures requires consensus on which instruments and parameters should be used, including the recording and evaluation of surgical complications. An international standard outlining the terminology and definitions of surgical complications in orthopaedics is lacking. Purpose This study systematically reviewed the literature for terms and definitions related to the occurrence of negative events or complications after arthroscopic rotator cuff repair (ARCR) with specific focus on shoulder stiffness. Study Design Systematic review; Level of evidence, 4. Methods PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for reviews, clinical studies, and case reports of complications associated with ARCR. Reference lists of selected articles were also screened. The terminology of complications and their definitions were extracted from all relevant original articles by a single reviewer and verified by a second reviewer. Definitions of shoulder stiffness or equivalent terms were tabulated. Results Of 654 references published after 2007 and obtained from the search, 233 full-text papers (44 reviews, 155 studies, 31 case reports, and 3 surgical technique presentations) were reviewed. Twenty-two additional references cited for a definition were checked. One report defined the term surgical complication. There were 242 different terms used to describe local events and 64 to describe nonlocal events. Furthermore, 16 definitions of terms such as frozen shoulder, shoulder stiffness, or stiff painful shoulder were identified. Diagnosis criteria for shoulder stiffness differed widely; 12 various definitions for restriction in range of motion were noted. One definition included a gradation of stiffness severity, whereas another considered the patient’s subjective assessment of motion. Conclusion The literature does not consistently report on complications after ARCR, making valid comparison of the incidence of

  18. A new tear pattern of the rotator cuff and its treatment: Fosbury flop tears

    PubMed Central

    Lädermann, Alexandre; Denard, Patrick J.; Kolo, Frank C.

    2015-01-01

    Purpose: The purpose of this report is to describe a new full-thickness tear pattern of the posterosuperior rotator cuff with reversal healing. We describe the specific radiologic signs associated with this tear pattern and the arthroscopic rotator cuff repair technique. Materials and Methods: A prospective radiologic and clinical study collected all patients with a magnetic resonance imaging arthrogram that underwent an arthroscopic rotator cuff repair over a 1 year period. Results: Among 97 patients, five demonstrated a tear of the posterosuperior rotator cuff with reversal healing. Characteristic radiographic findings included a thicker tendon than normal, the presence of a stump and accumulation of liquid in the superior-medial part of the subacromial bursa, and adhesions between the supraspinatus tendon and the wall of the subacromial bursa. Conclusion: Avulsion of the posterosuperior rotator cuff with reversal healing on its bursal-side is a less common condition. This type of lesion and distinct radiographic signs that can be recognized to facilitate anatomic repair of the rotator cuff. Level of evidence: Level IV. PMID:25709239

  19. Open Rotator Cuff Tear Repair Using Deltopectoral Approach

    PubMed Central

    Guity, Mohammad Reza; Eraghi, Amir Sobhani

    2015-01-01

    Background: The goal of this study was to evaluate the outcome of the open repair of rotator cuff tears via the deltopectoral approach in patients unable to afford arthroscopic repair costs. Methods: We evaluated 80 consecutive patients who were treated for full-thickness rotator cuff tears by open repair through the deltopectoral approach. There were 48 men and 32 women at a mean age of 60.1 years (range, 35-80 years). Preoperative and postoperative clinical assessments were performed with the Constant score, American Shoulder and Elbow Surgeons (ASES) score, modified University of California Los Angeles (UCLA) score, and pain visual analog scale. Results: The mean follow-up period was 30.6 months (range, 18-48 months). At final follow-up visits, the ASES, Constant score, and modified UCLA score were found to have improved significantly from 33.56, 39.24, and 13.0 to 85.64, 81.46, and 32.2, respectively (P <0.01). Pain, as measured on a visual analog scale, was improved significantly (P <0.01). The mean time for recovering the full range of motion was 2.5 months. Postoperative pain at 48 hours and at 6 weeks was relatively low. There were no cases of intractable stiffness. Conclusion: The deltopectoral approach for open rotator cuff repair produced satisfactory results and reduces rate of shoulder stiffness and postoperative pain. PMID:26622080

  20. Rotator Cuff Tears: Surgical Treatment Options

    MedlinePlus

    ... topic.cfm?topic=A00064 Surgery to repair a torn rotator cuff most o en involves re-attaching ... Recommended Your doctor may recommend surgery for a torn rotator cuff if your pain does not improve ...

  1. Association between alcohol consumption and rotator cuff tear

    PubMed Central

    Passaretti, Daniele; Candela, Vittorio; Venditto, Teresa; Giannicola, Giuseppe; Gumina, Stefano

    2016-01-01

    Background and purpose — Long-term alcohol intake is associated with various negative effects on capillary microcirculation and tissue perfusion. We hypothesized that alcohol consumption might be a risk factor for both the occurrence and the severity of rotator cuff tears (RCTs). Patients and methods — A case-control study was performed. We studied 249 consecutive patients (139 men and 110 women; mean age 64 (54–78) years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group had 356 subjects (186 men and 170 women; mean age 66 (58–82) years) with no RCT. All participants were questioned about their alcohol intake. Participants were divided into: (1) non-drinkers if they consumed less than 0.01 g of ethanol per day, and (2) moderate drinkers and (3) excessive drinkers if women (men) consumed > 24 g (36 g) per day for at least 2 years. Results — Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR = 1.7, 95% CI: 1.2–3.9; women: OR = 1.9, 95% CI: 0.94–4.1). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions. Interpretation — Long-term alcohol intake is a significant risk factor for the occurrence and severity of rotator cuff tear in both sexes. PMID:26610042

  2. Association between alcohol consumption and rotator cuff tear.

    PubMed

    Passaretti, Daniele; Candela, Vittorio; Venditto, Teresa; Giannicola, Giuseppe; Gumina, Stefano

    2016-04-01

    Background and purpose - Long-term alcohol intake is associated with various negative effects on capillary microcirculation and tissue perfusion. We hypothesized that alcohol consumption might be a risk factor for both the occurrence and the severity of rotator cuff tears (RCTs). Patients and methods - A case-control study was performed. We studied 249 consecutive patients (139 men and 110 women; mean age 64 (54-78) years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group had 356 subjects (186 men and 170 women; mean age 66 (58-82) years) with no RCT. All participants were questioned about their alcohol intake. Participants were divided into: (1) non-drinkers if they consumed less than 0.01 g of ethanol per day, and (2) moderate drinkers and (3) excessive drinkers if women (men) consumed > 24 g (36 g) per day for at least 2 years. Results - Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR = 1.7, 95% CI: 1.2-3.9; women: OR = 1.9, 95% CI: 0.94-4.1). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions. Interpretation - Long-term alcohol intake is a significant risk factor for the occurrence and severity of rotator cuff tear in both sexes. PMID:26610042

  3. Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios

    PubMed Central

    Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

    2014-01-01

    Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

  4. Optimizing the management of full-thickness rotator cuff tears.

    PubMed

    Murray, Jayson; Gross, Leeaht

    2013-12-01

    The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) on Optimizing the Management of Full-Thickness Rotator Cuff Tears (RC). Evidence-based information, in conjunction with clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The RC AUC Writing Panel began the development of the clinical scenarios by identifying clinical indications typical of patients commonly presenting with full-thickness rotator cuff tears in clinical practice, as well as from the current evidence-based clinical practice guidelines and its supporting literature. The 432 patient scenarios and 5 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (median rating, 7 to 9), may be appropriate (median rating, 4 to 6), or rarely appropriate (median rating, 1 to 3). PMID:24292933

  5. Review article: Risk factors for poor outcome following surgical treatment for rotator cuff tear.

    PubMed

    Sahni, V; Narang, A M

    2016-08-01

    The Medline database was searched using key words: 'rotator cuff', 'tear', and 'treatment'. 12 studies that involved (1) surgical treatment for rotator cuff tear, (2) measurement of pre- and post-operative pain score, functional score, and/or patient satisfaction, (3) patients that failed to improve functionally or had poor satisfaction, (4) preoperative examination of risk factors that could lead to poor outcome, and (5) a minimum follow-up of 6 months were reviewed to identify risk factors associated with poor outcome following surgical treatment for rotator cuff tear. The most common risk factor was tear size, followed by open compensation claim, age, and time from injury to surgery. PMID:27574276

  6. Following rotator cuff tears, the remaining (intact) tendons are mechanically altered

    PubMed Central

    Perry, Stephanie M.; Getz, Charles L.; Soslowsky, Louis J.

    2009-01-01

    Although presumed, damage in the remaining (intact) rotator cuff tendons in the presence of an isolated supraspinatus tendon tear or multiple tendon tear has not been well studied. This study utilized an animal model of multiple rotator cuff tendon tears to investigate alterations in the remaining (intact) tendon mechanical properties at 4 and 8 weeks post-injury. Twenty-four animals served as uninjured controls, while seventy-two were divided among the tendon detachment groups (supraspinatus tendon detachment, supraspinatus+infraspinatus tendon detachment, supraspinatus+subscapularis tendon detachment). We found the remaining (intact) rotator cuff tendons have decreased mechanical properties in the presence of rotator cuff tears. Remaining (intact) subscapularis and infraspinatus tendon cross-sectional area increased, while tendon modulus decreased after both one and two tendon tears. Additionally, the remaining (intact) tendon cross-sectional areas continued to increase with time post-injury. These alterations could potentially lead to further tendon damage and tear progression. PMID:19095175

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

    PubMed Central

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

    2012-01-01

    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

  8. Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

    PubMed Central

    Cadogan, Angela; McNair, Peter; Laslett, Mark; Hing, Wayne; Taylor, Stephen

    2013-01-01

    Objectives: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Methods: Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. Results: A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86–1.00; negative likelihood ratio: 0.00, 95% CI: 0.00–0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86–0.95; positive likelihood ratio 4.66, 95% CI: 2.34–8.74). Discussion: Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation. PMID:24421626

  9. [Controversies in the therapy of rotator cuff tears. Operative or nonoperative treatment, open or arthroscopic repair?].

    PubMed

    Lorbach, O

    2016-02-01

    Rotator cuff tears are a common cause of shoulder pain that may lead to severe impairment of shoulder function with significant limitation of the quality of life. Furthermore, they are associated with high direct and indirect costs.Conservative therapy and various surgical procedures for rotator cuff repair are all possible treatment options. Therefore, the correct treatment for a symptomatic rotator cuff tear is important.The conservative therapy may be considered as an alternative treatment option for a symptomatic rotator cuff tear in patients with small or incomplete tears with no fatty atrophy or tendon retraction, with only slight pain, and in older patients with few functional demands. Surgical treatment is recommended after failed conservative treatment lasting 3-6 months, with the corresponding psychological strain. Moreover, surgical treatment should be considered as a primary treatment option for a symptomatic rotator cuff tear in young patients with high functional demands, patients with a high level of physical strain in their jobs, large tears, and tears where there is already significant muscle atrophy or tendon retraction.Arthroscopic treatment is considered to be the gold standard because of the better cosmetic results and treatment of concomitant pathological conditions, the lower levels of postoperative pain, the potentially lower risk of shoulder stiffness, and more focused adhesiolysis. However, arthroscopy does not improve clinical results. Because of the current financial situation, however, open rotator cuff repair is still a viable alternative. PMID:26694070

  10. Rotator Cuff Injuries

    MedlinePlus

    ... cuff are common. They include tendinitis, bursitis, and injuries such as tears. Rotator cuff tendons can become ... cuff depends on age, health, how severe the injury is, and how long you've had the ...

  11. All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique

    PubMed Central

    Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

    2013-01-01

    Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

  12. Elevated plasma levels of TIMP-1 in patients with rotator cuff tear

    PubMed Central

    2012-01-01

    Background and purpose Extracellular matrix remodeling is altered in rotator cuff tears, partly due to altered expression of matrix metalloproteinases (MMPs) and their inhibitors. It is unclear whether this altered expression can be traced as changes in plasma protein levels. We measured the plasma levels of MMPs and their tissue inhibitors (TIMPs) in patients with rotator cuff tears and related changes in the pattern of MMP and TIMP levels to the extent of the rotator cuff tear. Methods Blood samples were collected from 17 patients, median age 61 (39–77) years, with sonographically verified rotator cuff tears (partial- or full-thickness). These were compared with 16 age- and sex-matched control individuals with sonographically intact rotator cuffs. Plasma levels of MMPs and TIMPs were measured simultaneously using Luminex technology and ELISA. Results The plasma levels of TIMP-1 were elevated in patients with rotator cuff tears, especially in those with full-thickness tears. The levels of TIMP-1, TIMP-3, and MMP-9 were higher in patients with full-thickness tears than in those with partial-thickness tears, but only the TIMP-1 levels were significantly different from those in the controls. Interpretation The observed elevation of TIMP-1 in plasma might reflect local pathological processes in or around the rotator cuff, or a genetic predisposition in these patients. That the levels of TIMP-1 and of certain MMPs were found to differ significantly between partial and full-thickness tears may reflect the extent of the lesion or different etiology and pathomechanisms. PMID:23043271

  13. Latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: surgical technique.

    PubMed

    Qadir, Rabah; Romine, Lucas; Yao, David C; Duncan, Scott F M

    2014-09-01

    Massive rotator cuff tears remain a complex and challenging problem for both the patient and the surgeon. Although significant advancements in surgical techniques as well as technology for arthroscopic and mini-open rotator cuff repairs have been made, many massive tears result in failed repair with continued progressive tendon retraction and degeneration. In cases when primary tendon to bone healing is impractical, latissimus dorsi tendon transfer provides promising and reproducible clinical results. Herein, we present a latissimus tendon transfer surgical technique, a procedure we have used as a salvage operation for failed arthroscopic/mini-open primary rotator cuff repair. PMID:24854152

  14. High incidence of acute full-thickness rotator cuff tears

    PubMed Central

    Abu-Zidan, Fikri; Lunsjo, Karl

    2015-01-01

    Background and purpose Epidemiological studies of full-thickness rotator cuff tears (FTRCTs) have mainly investigated degenerative lesions. We estimated the population-based incidence of acute FTRCT using a new diagnostic model. Patients and methods During the period November 2010 through October 2012, we prospectively studied all patients aged 18–75 years with acute onset of pain after shoulder trauma, with limited active abduction, and with normal conventional radiographs. 259 consecutive patients met these inclusion criteria. The patients had a median age of 51 (18–75) years. 65% were males. The patients were divided into 3 groups according to the clinical findings: group I, suspected FTRCT; group II, other specific diagnoses; and group III, sprain. Semi-acute MRI was performed in all patients in group I and in patients in group III who did not recover functionally. Results We identified 60 patients with FTRCTs. The estimated annual incidence of MRI-verified acute FTRCT was 16 (95% CI: 11–23) per 105 inhabitants for the population aged 18–75 years and 25 (CI: 18–36) per 105 inhabitants for the population aged 40–75 years. The prevalence of acute FTRCT in the study group was 60/259 (23%, CI: 18–28). The tears were usually large and affected more than 1 tendon in 36 of these 60 patients. The subscapularis was involved in 38 of the 60 patients. Interpretation Acute FTRCTs are common shoulder injuries, especially in men. They are usually large and often involve the subscapularis tendon. PMID:25708526

  15. Simvastatin reduces fibrosis and protects against muscle weakness after massive rotator cuff tear

    PubMed Central

    Davis, Max E; Korn, Michael A; Gumucio, Jonathan P; Harning, Julie A; Saripalli, Anjali L; Bedi, Asheesh; Mendias, Christopher L

    2014-01-01

    Background Chronic rotator cuff tears are a common source of shoulder pain and disability, and patients with chronic cuff tears often have substantial weakness, fibrosis, inflammation and fat accumulation. Identifying therapies to prevent the development of these pathologies will likely have a positive impact on clinical outcomes. Simvastatin is a drug with demonstrated anti-inflammatory and anti-fibrotic effects in many tissues, but had not previously been studied in the context of rotator cuff tears. We hypothesized that following the induction of a massive supraspinatus tear, simvastatin would protect muscles from a loss of force production and fibrosis. Methods We measured changes in muscle fiber contractility, histology and biochemical markers of fibrosis and fatty infiltration in rats that received a full-thickness supraspinatus tear and were treated with either carrier alone or simvastatin. Results Compared to vehicle treated controls, simvastatin did not have an appreciable effect on muscle fiber size, but treatment did increase muscle fiber specific force by 20%. Simvastatin also reduced collagen accumulation by 50%, but did not effect triglyceride content of muscles. Several favorable changes in the expression of genes and other markers of inflammation, fibrosis and regeneration were also observed. Conclusions Simvastatin partially protected muscles from the weakness that occurs as a result of chronic rotator cuff tear. Fibrosis was also markedly reduced in simvastatin treated animals. While further studies are necessary, statin medication could potentially help to improve outcomes for patients with rotator cuff tears. PMID:25213828

  16. Pre-Existing Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes

    PubMed Central

    Gibbs, Daniel; Lynch, Thomas Sean; Gomberawalla, M. Mustafa; Schroeder, Greg; LaBelle, Mark; Hollett, Brian P.; Saltzman, Matthew; Nuber, Gordon W.

    2015-01-01

    Objectives: Fifty percent of all athletes at the National Football League (NFL) Combine report having had a shoulder injury at some point during their playing career. Rotator cuff tears are rare injuries in young athletes, but an increasing incidence has been noted amongst competitive football players. It is unknown how pre-existing rotator cuff tears affect career longevity and performance of NFL athletes. In Combine athletes with pre-existing rotator cuff tears, knowledge of outcomes may help athletes and physicians manage expectations of draft potential, career length and performance. Methods: The written medical evaluations of prospective professional American football athletes from 2003-2011 during the NFL Combine were compiled and evaluated. All players were evaluated for the diagnosis of a pre-existing rotator cuff tear and stratified based on whether or not they underwent surgical intervention. Athletes with rotator cuff tears, who were selected in the NFL draft, were matched by age, position, year, and round drafted to control draftees without significant documented shoulder pathology. Career statistics, including a previously established “Performance Score,” were compiled. The continuous variables of each cohort were compared using a Student's t-test. A Chi Squared test was performed to analyze the categorical data. Statistical significance was accepted with a p-value < 0.05. Results: Between the years of 2003 and 2011, 2,965 consecutive athletes were evaluated. Forty-nine athletes were identified with a pre-existing rotator cuff tear; twenty-two of these athletes underwent surgical intervention for their tear and 27 were treated non-operatively. Those who attended the NFL Combine with a history of a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs. 77.5% respectively, p = 0.002) (Table 1A). The 27 drafted athletes with pre-existing rotator cuff tears played significantly fewer years (4.3 vs

  17. Living with a symptomatic rotator cuff tear ‘bad days, bad nights’: a qualitative study

    PubMed Central

    2014-01-01

    Background Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients’ perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. Methods An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. Results The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. Conclusions Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient’s lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to

  18. Predictors of Pain and Function in Patients With Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears

    PubMed Central

    Harris, Joshua D.; Pedroza, Angela; Jones, Grant L.

    2013-01-01

    Background Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined. Purpose To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program. Study Design Cross-sectional study; Level of evidence, 3. Methods A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores. Results A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P <.001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant. Conclusion Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore

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

    PubMed Central

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

    2013-01-01

    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 PMID:24167400

  20. Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review

    PubMed Central

    Levy, David M.; Abrams, Geoffrey D.; Harris, Joshua D.; Bach, Bernard R.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Rotator cuff tears have been reported to be uncommon following total shoulder arthroplasty (TSA). Postoperative rotator cuff tears can lead to pain, proximal humeral migration, and glenoid component loosening. The purpose of this paper was to evaluate the incidence of post-TSA rotator cuff tears or dysfunction in osteoarthritic patients. A systematic review of multiple databases was performed using preferred reporting items for systematic reviews and meta-analyses guidelines. Levels I-IV evidence clinical studies of patients with primary osteoarthritis with a minimum 2-year follow-up were included. Fifteen studies with 1259 patients (1338 shoulders) were selected. Student's t-tests were used with a significant alpha value of 0.05. All patients demonstrated significant improvements in motion and validated clinical outcome scores (P < 0.001). Radiographic humeral head migration was the most commonly reported data point for extrapolation of rotator cuff integrity. After 6.6 ± 3.1 years, 29.9 ± 20.7% of shoulders demonstrated superior humeral head migration and 17.9 ± 14.3% migrated a distance more than 25% of the head. This was associated with an 11.3 ± 7.9% incidence of postoperative superior cuff tears. The incidence of radiographic anterior humeral head migration was 11.9 ± 15.9%, corresponding to a 3.0 ± 13.6% rate of subscapularis tears. We found an overall 1.2 ± 4.5% rate of reoperation for cuff injury. Nearly all studies reported indirect markers of rotator cuff dysfunction, such as radiographic humeral head migration and clinical exam findings. This systematic review suggests that rotator cuff dysfunction following TSA may be more common than previously reported. IV, systematic review of Levels I-IV studies. PMID:27186060

  1. Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid

    PubMed Central

    Osti, Leonardo; Buda, Matteo; Buono, Angelo Del; Osti, Raffaella; Massari, Leo

    2015-01-01

    Summary Purpose the aim of this quantitative review is to document potential benefit and adverse effects of hyaluronic acid (HA) injection into the shoulder with rotator cuff tears. Methods a systematic literature search was performed in english PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined key words “hyaluronic acid”, “rotator cuff tear”, “hyaluronate”, “shoulder”, “viscosupplementation”, with no limit regarding the year of publication. Articles were included if they reported data on clinical and functional outcomes, complications in series of patients who had undergone HA injection for management of rotator cuff tears. Two Authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The papers were accurately analyzed focusing on objective rating scores reported. Results a total of 11 studies, prospective, 7 were randomized were included by full text. A total of 1102 patients were evaluated clinically after different HA injection compare with corticosteroid injection, physically therapies, saline solution injection and control groups. The use of HA in patients with rotator cuff tears improve VAS and functional score in all trials that we have analyzed. Conclusion intra-articular injection with HA is effective in reducing pain and improving function in shoulder with rotator cuff tears and without severe adverse reaction. Level of evidence Level I. PMID:26958534

  2. Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study

    PubMed Central

    Lee, Woo Hyung; Do, Hyun Kyung; Lee, Joong Hoon; Kim, Bo Ram; Noh, Jee Hyun; Choi, Soo Hyun; Chung, Sun Gun; Lee, Shi-Uk; Choi, Ji Eun; Kim, Seihee; Kim, Min Jee

    2016-01-01

    Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear. Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments. Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups. Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear. PMID:27152275

  3. Effect of tamoxifen on fatty degeneration and atrophy of rotator cuff muscles in chronic rotator cuff tear: An animal model study.

    PubMed

    Cho, Edward; Zhang, Yue; Pruznak, Anne; Kim, H Mike

    2015-12-01

    Fatty degeneration of the rotator cuff muscles is an irreversible change resulting from chronic rotator cuff tear and is associated with poor clinical outcomes following rotator cuff repair. We evaluated the effect of Tamoxifen, a competitive estrogen receptor inhibitor, on fatty degeneration using a mouse model for chronic rotator cuff tear. Sixteen adult mice were divided into two diet groups (Tamoxifen vs. Regular) and subjected to surgical creation of a large rotator cuff tear and suprascapular nerve transection in their left shoulder with the right shoulder serving as a control. The rotator cuff muscles were harvested at 16 weeks and subjected to histology and RT-PCR for adipogenic and myogenic markers. Histology showed substantially decreased atrophy and endomysial inflammation in Tamoxifen group, but no significant differences in the amount of intramuscular adipocytes and lipid droplets compared to the Regular group. With RT-PCR, the operated shoulders showed significant upregulation of myogenin and PPAR-γ, and downregulation of myostatin compared to the nonsurgical shoulder. No significant differences of gene expression were found between the two diet groups. Our study demonstrated that tamoxifen diet leads to decreased muscle atrophy and inflammatory changes following chronic rotator cuff tear, but has no apparent effect on adipogenesis. PMID:26121952

  4. Synovial Chondromatosis of the Subacromial Bursa Causing a Bursal-Sided Rotator Cuff Tear

    PubMed Central

    Neumann, Julie A.; Garrigues, Grant E.

    2015-01-01

    Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up. PMID:25861500

  5. Synovial chondromatosis of the subacromial bursa causing a bursal-sided rotator cuff tear.

    PubMed

    Neumann, Julie A; Garrigues, Grant E

    2015-01-01

    Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up. PMID:25861500

  6. Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

    PubMed Central

    Bhatia, M; Singh, B; Nicolaou, N; Ravikumar, KJ

    2009-01-01

    INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears. PMID:19409148

  7. Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

    PubMed Central

    Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe

    2014-01-01

    Summary Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient’s pain and disability, surgery should be considered. Methods: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation. Purpose: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears. PMID:25767779

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

    PubMed Central

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

    2012-01-01

    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

  9. Arthroscopic Knotless, Double-Row, Extended Linked Repair for Massive Rotator Cuff Tears.

    PubMed

    Greenspoon, Joshua A; Petri, Maximilian; Millett, Peter J

    2016-02-01

    The management of massive rotator cuff tears remains a challenge for physicians, with failure rates being higher when compared with smaller tears. Many surgical treatment options exist including debridement with biceps tenodesis, complete repair, partial repair, repair with augmentation devices, superior capsule reconstruction, tendon transfer, and reverse total shoulder arthroplasty. The purpose of this article is to describe our preferred surgical technique for a complete arthroscopic repair using an extended linked, knotless, double-row construct. PMID:27330944

  10. Biologically based strategies to augment rotator cuff tears

    PubMed Central

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

    2012-01-01

    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. PMID:22787334

  11. [Irreparable rotator cuff tears. Debridement, partial reconstruction, tendon transfer or reversed shoulder arthroplasty].

    PubMed

    Patzer, Th; Hufeland, M; Krauspe, R

    2016-02-01

    Therapeutic options for the treatment of irreparable rotator cuff tears are fluent, are dependent on the patients' claims and demands and on the grade of the ongoing cuff tear arthropathy.A partial rotator cuff reconstruction with sufficient tenolysis combined with interval slide techniques to restore the anterior and posterior force couple may be indicated if there is no fatty degeneration > grade 3 of the rotator cuff muscles in a well-centered joint. The margin convergence technique with side-by-side adaptation of the tendon limbs may reduce the load on the reconstructed tendons.The role of the suprascapular nerve, which can probably be constricted by the retracted rotator cuff, and its therapy has not been completely clarified. When distinct symptoms are present neurolysis may be reasonable.Tendon transfers can be indicated in a cooperative patient < 65 years with a higher grade of muscular atrophy but without degenerative changes > grade II according to Hamada with the loss of active external rotation but performable active flexion. For posterosuperior tears the latissimus dorsi or recently the teres major tendon transfer to the rotator cuff footprint may be appropriate. For nonreconstructable anterosuperior tears a partial transfer of the pectoralis major tendon is possible.Careful subacromial debridement combined with biceps tenotomy and a cautious or reversed decompression may reduce the pain temporarily without having an influence on active motion until with the loss of active elevation the indication for a reversed shoulder arthroplasty is reached.In the mean time, absorbable subacromial spacers may re-center the humeral head, but the effectiveness of this therapy on clinical outcome should be analyzed in further studies. PMID:26768144

  12. Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

    PubMed Central

    Chung, Seok Won; Kim, Sae Hoon; Tae, Suk-Kee; Yoon, Jong Pil; Choi, Jung-Ah

    2013-01-01

    Background Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. Methods We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. Results The mean occupation ratio was significantly increased postoperatively from 0.44 ± 0.17 to 0.52 ± 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). Conclusions The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair. PMID:23467404

  13. Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

    PubMed Central

    Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

    2014-01-01

    The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

  14. Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity

    PubMed Central

    Dunn, Warren R.; Kuhn, John E.; Sanders, Rosemary; An, Qi; Baumgarten, Keith M.; Bishop, Julie Y.; Brophy, Robert H.; Carey, James L.; Holloway, G. Brian; Jones, Grant L.; Ma, C. Benjamin; Marx, Robert G.; McCarty, Eric C.; Poddar, Sourav K.; Smith, Matthew V.; Spencer, Edwin E.; Vidal, Armando F.; Wolf, Brian R.; Wright, Rick W.

    2014-01-01

    Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders. Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4. Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25). Conclusions

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

    PubMed

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

    2011-06-01

    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

  16. Magnetic Resonance Imaging of Rotator Cuff Tears in Shoulder Impingement Syndrome

    PubMed Central

    Freygant, Magdalena; Dziurzyńska-Białek, Ewa; Guz, Wiesław; Samojedny, Antoni; Gołofit, Andrzej; Kostkiewicz, Agnieszka; Terpin, Krzysztof

    2014-01-01

    Summary Background Shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and non-invasive nature of the study. The aim of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with shoulder impingement syndrome and to review the literature on the causes and classification of rotator cuff tears. Material/Methods We retrospectively analyzed the results of 137 shoulder MRI examinations performed in 57 women and 72 men in Magnetic Resonance facility of the Department of Radiology and Diagnostic Imaging at the St. Jadwiga the Queen Regional Hospital No. 2 in Rzeszow between June 2010 and February 2013. Examinations were performed using Philips Achieva 1.5T device, including spin echo and gradient echo sequences with T1-, T2- and PD-weighted as well as fat saturation sequences in transverse, frontal and sagittal oblique planes. Patients were referred from hospital wards as well as from outpatient clinics of the subcarpathian province. Results The most frequently reported injuries included partial supraspinatus tendon tear and complete tearing most commonly involved the supraspinatus muscle tendon. The smallest group comprised patients with complete tear of subscapularis muscle tendon. Among 137 patients in the study population, 129 patients suffered from shoulder pain, including 57 patients who reported a history of trauma. There was 44% women and 56% men in a group of patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, while women comprised a larger group of patients with shoulder pain not preceded by injury. Conclusions Rotator cuff injury is a very common

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

    PubMed Central

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

    2011-01-01

    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. PMID:21669100

  18. Long Head of the Biceps Pathology Combined with Rotator Cuff Tears

    PubMed Central

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

    2012-01-01

    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. PMID:23209915

  19. Exercise Therapy for Total Tear of Rotator Cuff: A Case Report

    PubMed Central

    Nejati, Parisa; Akbari, Faramarz

    2013-01-01

    Background Shoulder pain is one of the most common problems in ages older than 60 years of age. Rotator cuff pathology is the most common etiology of shoulder pain. Most of rotator cuff pathologies are treated conservatively in old ages and exercise therapy is not an accepted intervention for management of rotator cuff tear yet. Case presentation The case was a man of 53 years age with shoulder pain who had total tear of supraspinatus tendon and biceps tendinitis in the right shoulder. He had regularly gone swimming, mountain climbing and running in the last 10 years. The case was managed by exercise therapy for 3 months and physical modalities for 20 sessions. Shoulder pain and his function and right shoulder range of motion increased after 3 months. Para clinical findings did not change after treatment, though. The improvements continued 15 months after the beginning of the treatment. Conclusion Exercise therapy was very effective for improving pain and function in total tear of supraspinatus tendon and tendinitis of biceps. PMID:24868434

  20. Evaluation of muscular activity duration in shoulders with rotator cuff tears using inertial sensors and electromyography.

    PubMed

    Duc, Cyntia; Pichonnaz, Claude; Bassin, Jean-Philippe; Farron, Alain; Jolles, Brigitte M; Aminian, Kamiar

    2014-12-01

    Shoulder disorders, including rotator cuff tears, affect the shoulder function and result in adapted muscle activation. Although these adaptations have been studied in controlled conditions, free-living activities have not been investigated. Based on the kinematics measured with inertial sensors and portable electromyography, the objectives of this study were to quantify the duration of the muscular activation in the upper trapezius (UT), medial deltoid (MD) and biceps brachii (BB) during motion and to investigate the effect of rotator cuff tear in laboratory settings and daily conditions. The duration of movements and muscular activations were analysed separately and together using the relative time of activation (T(EMG/mov)). Laboratory measurements showed the parameter's reliability through movement repetitions (ICC > 0.74) and differences in painful shoulders compared with healthy ones (p < 0.05): longer activation for UT; longer activation for MD during abduction and tendency to shorter activation in other movements; shorter activation for BB. In daily conditions, T(EMG/mov) for UT was longer, whereas it was shorter for MD and BB (p < 0.05). Moreover, significant correlations were observed between these parameters and clinical scores. This study thus provides new insights into the rotator cuff tear effect on duration of muscular activation in daily activity. PMID:25390457

  1. Arthroscopic Changes of the Biceps Pulley in Rotator Cuff Tear and Its Clinical Significance in Relation to Treatment

    PubMed Central

    Choi, Chang Hyuk; Kim, Se Sik; Lee, Ju Hwan

    2015-01-01

    Background In the case of rotator cuff tears, the biceps pulley can be stressed by the unstable biceps tendon, and this can subsequently affect the stability of the subscapularis tendon. Therefore, it is important to distinguish between normal variations and lesions of the biceps pulley that affect anterosuperior lesions in cases of rotator cuff tears. Methods From January 2002 through November 2010, we observed biceps pulley and associated anterosuperior lesions in 589 of 634 cases (93%) of arthroscopic rotator cuff repair, including 72 cases (12.2%) of small tears, 219 cases (37.2%) of medium tears, 134 cases (22.8%) of large tears, and 164 cases (27.8%) of massive tears. We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV. Results We were able to classify 589 cases of biceps pulleys as type I, II, III, or IV associated lesions in rotator cuff tears. Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%). Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases. Conclusions Biceps pulley lesions with more than partial tears were identified in 48% of rotator cuff tear cases. The incidence and severity of pulley lesions were related to the rotator cuff tear size, the status of the long head of the biceps tendon and subscapularis tendon lesion, and the treatment methods. PMID:26330960

  2. Arthroscopic rotator cuff repair.

    PubMed

    Burkhart, Stephen S; Lo, Ian K Y

    2006-06-01

    Arthroscopic rotator cuff repair is being performed by an increasing number of orthopaedic surgeons. The principles, techniques, and instrumentation have evolved to the extent that all patterns and sizes of rotator cuff tear, including massive tears, can now be repaired arthroscopically. Achieving a biomechanically stable construct is critical to biologic healing. The ideal repair construct must optimize suture-to-bone fixation, suture-to-tendon fixation, abrasion resistance of suture, suture strength, knot security, loop security, and restoration of the anatomic rotator cuff footprint (the surface area of bone to which the cuff tendons attach). By achieving optimized repair constructs, experienced arthroscopic surgeons are reporting results equal to those of open rotator cuff repair. As surgeons' arthroscopic skill levels increase through attendance at surgical skills courses and greater experience gained in the operating room, there will be an increasing trend toward arthroscopic repair of most rotator cuff pathology. PMID:16757673

  3. PDGFRα+ Progenitor Cells Contribute to Muscle Fibroadipogensis Following Massive Rotator Cuff Tears in a Mouse Model

    PubMed Central

    Jensen, Andrew; Dar, Ayelet; Eliasberg, Claire; Kelley, Benjamin; Devana, Sai; McAllister, David R.; Petrigliano, Frank A.

    2016-01-01

    Objectives: Rotator cuff tears affect an estimated 10% of patients over the age of 60, leading to significant activity related pain and decreased quality of life. After sustaining a tear, the rotator cuff musculature often undergoes muscle atrophy and fatty degeneration, which have been shown to result in poor clinical outcomes and high failure rates for surgical repairs. The cellular processes underlying these fibroadipogenic changes remain unknown although PDGFRβ+ cells have previously been implicated. Recently, it has been demonstrated in hind limb muscle that following acute, reversible injury via Cardiotoxin injection, PDGFRα-expressing cells are responsible for fibrotic and adipogenic muscle degeneration. Our study aimed to distinguish between the contribution of PDGFRα+ PDGFRβ+ cells and PDGFRα- PDGFRβ+ cells to fibroadipogenesis following massive rotator cuff tears. Methods: We performed supraspinatus tenotomy and denervation (TT+DN) operations on 8-10 week-old PDGFRβ-Cre x mTmG mice. These transgenic mice express GFP in cells co-expressing PDGFRβ, which allows PDGFRβ+ cell populations to be tracked via their GFP expression. At 5 days, 2-, 4- and 6-weeks postop, these mice and sham surgery controls were sacrificed and their supraspinatus muscles were harvested. We stained tissue sections with Oil Red O and Picro Sirius to compare levels of adipogenesis and fibrosis after TT+DN, respectively. In addition, sectioned muscle tissues were immuno-labeled with anti-PDGFRα and anti-PDGFRβ to assess differences in PDGFRα+ PDGFRβ+ cell localization. GFP expression was used to trace PDGFRβ cells and their progenies after TT+DN. Dissociated cells from supraspinatus tissue of TT+DN versus sham mice were either analyzed by flow cytometry for PDGFRα and GFP expression at established postop time points or sorted and cultured for in vitro differentiation experiments to assess the fibroadipogenic potential of these cell populations. Results: Oil Red O and

  4. PROSPECTIVE AND COMPARATIVE STUDY ON FUNCTIONAL OUTCOMES AFTER OPEN AND ARTHROSCOPIC REPAIR OF ROTATOR CUFF TEARS

    PubMed Central

    de Castro Veado, Marco Antônio; Castilho, Rodrigo Simões; Maia, Philipe Eduardo Carvalho; Rodrigues, Alessandro Ulhôa

    2015-01-01

    Objective: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to compare occurrences of renewed tearing. Methods: Sixty patients underwent operations performed by the same surgeon (29 via open surgery and 31 via arthroscopy), to repair complete rotator cuff tears. The procedures were performed at Hospital Governor Israel Pinheiro (HGIP) and Mater Dei Hospital in Belo Horizonte, Minas Gerais, between August 2007 and February 2009. The patients were assessed functionally by means of the UCLA score before and after the operation, and magnetic resonance imaging was done before the operation. All the patients were reassessed at least 12 months after the operation, and an ultrasound examination was also performed at this time. Results: Out of the 29 patients who underwent open surgery, 27 (93.1%) presented good or excellent results, with a mean UCLA score of 32 after the operation. Their mean follow-up was 14 months. Three patients presented renewed tearing on ultrasound, of whom one remained asymptomatic. Out of the 31 patients who underwent arthroscopic procedures, 29 (93.5%) presented good or excellent results, with a mean UCLA score of 33 after the operation. Their mean follow-up was 19 months. Two patients presented renewed tearing, of whom one remained asymptomatic and one evolved with loosening of an anchor, with an unsatisfactory result. Conclusion: The repairs on rotator cuff injuries presented good results by means of both open surgery and arthroscopy, with similar functional results in the two groups and similar rates of renewed tearing. PMID:27027052

  5. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE

    PubMed Central

    Edwards, Peter; Ebert, Jay; Joss, Brendan; Bhabra, Gev; Ackland, Tim; Wang, Allan

    2016-01-01

    The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries. Level of Evidence Level 5 PMID:27104061

  6. Rotator cuff problems

    MedlinePlus

    ... tear occurs when one of the tendons is torn from the bone from overuse or injury. Causes ... surgery with a larger incision) to repair the torn tendon. Outlook (Prognosis) With rotator cuff tendinitis, rest, ...

  7. Rotator cuff repair

    MedlinePlus

    ... already torn from chronic rotator cuff problems. A partial tear may not require surgery. Instead, rest and ... Follow any discharge and self-care instructions you are given. You will be wearing a sling when you leave the hospital. ...

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

    PubMed Central

    Gavriilidis, Iosif; Magosch, Petra; Lichtenberg, Sven; Habermeyer, Peter

    2009-01-01

    The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the rotator cuff that does not allow for a direct tendon-to-bone reconstruction. Between 2000 and 2006, 15 patients were treated using a deltopectoral approach and transfer of the clavicular part of the pectoralis major to the lesser tuberosity and to the anterior part of the greater tuberosity. After an average follow-up (follow-up rate 100%) of 37 months the average functional rating using the Constant and Murley score (CS) increased from 51.73 ± 16.18 to 68.17 ± 8.84 points (p = 0.005). The mean subcategories of the Constant score for pain (p = 0.005), activities of daily living (p = 0.008) but not for range of motion (p = 0.9), significantly improved. At follow-up 13 patients (87%) were available for magnetic resonance imaging (MRI) of the shoulder. Nine patients (70%) had an intact transferred pectoralis major muscle, two (15%) had one that was thin but intact and two patients a rupture (one complete). Two patients had postoperative haematoma and one patient developed cuff tear arthropathy. The good results confirm that pectoralis major transfer is a reliable treatment option for irreparable anterosuperior rotator cuff injuries with significant improvement in pain and function. PMID:19434410

  9. Surgical treatment of os acromiale with and without associated rotator cuff tears.

    PubMed

    Abboud, Joseph A; Silverberg, David; Pepe, Mathew; Beredjiklian, Pedro K; Iannotti, Joseph P; Williams, Gerald R; Ramsey, Matthew L

    2006-01-01

    Nineteen consecutive patients treated surgically for meso-os acromiale and subacromial pathology were reviewed retrospectively, with a mean length of follow-up of 40 months (range, 24-94 months). Of the patients, 11 (58%) were treated with acromioplasty in the presence of a stable os acromiale; 8 patients (42%) underwent open reduction-internal fixation for an unstable and painful os fragment. Of the 19 patients, 8 (42%) with an os acromiale had an associated full-thickness rotator cuff tear. Overall, only 10 of 19 patients (53%) achieved a satisfactory result. All 8 patients (100%) treated with open reduction-internal fixation achieved union of the os fragment, although only 3 (37.5%) achieved a satisfactory result. Of the 11 patients who underwent acromioplasty, only 7 (64%) achieved a satisfactory result. The outcome of surgical management of symptomatic meso-os acromiale with concomitant rotator cuff pathology was satisfactory in 4 of 8 patients in our study group. The rate of satisfactory results was similar in patients with (50%) and without (55%) associated rotator cuff tears. When we analyzed our results to exclude workers' compensation patients, 80% achieved satisfactory results (compared with only 22% in our workers' compensation group). PMID:16679224

  10. In Vivo Measurement of Rotator Cuff Tear Tension: Medial Versus Lateral Footprint Position.

    PubMed

    Dierckman, Brian D; Wang, David W; Bahk, Michael S; Burns, Joseph P; Getelman, Mark H

    2016-01-01

    We conducted a study to evaluate in vivo tension applied to the rotator cuff tendon positioned at the medial versus lateral footprint during arthroscopic rotator cuff repair. We evaluated 20 consecutive patients who underwent arthroscopic rotator cuff repair. During repair, a grasper was inserted through a lateral portal, and a digital weigh scale was attached. The tendon was grasped and translated to the medial footprint, and tension recorded. After a relaxation period, the tendon edge was translated to the lateral footprint, and tension recorded. Mean (SD) tension was 0.41 (0.33) pound when tendons were positioned at the medial footprint and 2.21 (1.20) pounds when they were positioned at the lateral footprint, representing a 5.4-fold difference (P < .0001). For smaller tears (≤20 mm anterior-posterior), 7.6 times less tension was applied to the tendons when pulled to the medial versus lateral footprint. For larger tears, 4.1 times less tension was applied to the tendons when pulled to the medial versus lateral footprint. This study demonstrated a significant, 5.4-fold increase in tension when the tendon edge was reduced to the lateral as opposed to the medial footprint in vivo. PMID:26991588

  11. Arthroscopic Superior Capsular Reconstruction for Treatment of Massive Irreparable Rotator Cuff Tears

    PubMed Central

    Hirahara, Alan M.; Adams, Christopher R.

    2015-01-01

    Massive irreparable rotator cuff tears have been troublesome entities to treat, especially in younger patients. Few good options exist, leaving most patients in recent years receiving a reverse total shoulder arthroplasty. Reverse shoulder arthroplasty carries serious risks, a limited lifespan, and no other viable options should it fail. Recent biomechanical studies have shown that the superior capsule is critical to containing the glenohumeral joint reduced, allowing the larger muscles like the deltoid and pectoralis major to function properly. The superior capsular reconstruction is an anatomic reconstruction of the superior capsule to restore the normal restraint to superior translation that occurs with a deficient rotator cuff. The technique described in this article is an arthroscopic reconstruction of the superior capsule with dermal allograft. PMID:26870638

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

    PubMed Central

    Agrawal, Vivek

    2012-01-01

    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. PMID

  13. Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft

    PubMed Central

    Dimitrios, Varvitsiotis; Athanasios, Papaspiliopoulos; Eleni, Antipa; Xenofon, Papacharalampous; George, Flevarakis; John, Feroussis

    2015-01-01

    Background: Despite the advances in surgical treatment options, massive rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. This study assesses the effectiveness of fascia lata allograft in reconstruction of massive and irreparable r-c tear and to evaluate the healing and functional outcomes. Materials and Methods: 68 patients (38 men, 30 women, mean age 64.9 years) with massive or irreparable r-c tears were treated with placement of fascia lata allograft to fill the defect between February 2006 and February 2010. At 43 months followup they were evaluated clinically using the constant score, preoperatively and postoperatively. Magnetic resonance imaging (MRI) and ultrasound were used postoperatively, to assess the integrity of the allograft at the repair site. Postoperatively, standard rehabilitation protocol was followed with gradual restoration. Results: Postoperative constant score increased from 32.5 preoperatively to 88.7 postoperatively. The most important was the pain relief from 2.4 preoperatively to 14.1 postoperatively and range of motion. The results of the MRI were not reliable, but the ultrasound was satisfactory. Finally, there was no infection or rejection of the graft in any of the patients. Conclusions: Despite advances in surgical methods, there is still not a universally accepted treatment for massive and irreparable rotator cuff tears, because the standard methods have dubious results, with excessive retear rates and poor outcomes, necessitating the need for new repair strategies. We documented significant clinical improvement using fascia lata allograft in the repair of massive irreparable r-c tear, acting as scaffold to bridge the defect, enhancing the healing at the repair site. PMID:26015630

  14. Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence

    PubMed Central

    Abdul-Wahab, Taiceer A.; Betancourt, Jean P.; Hassan, Fadi; Thani, Saeed Al.; Choueiri, Hened; Jain, Nitin B.; Malanga, Gerard A.; Murrell, William D.; Prasad, Anil; Verborgt, Olivier

    2016-01-01

    Summary Background rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Methods a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 – 1 December 2014), search terms: ‘rotator cuff tear’, ‘natural history’, ‘atraumatic’, ‘injection’, ‘physiotherapy’ or ‘physical therapy’, ‘injection’, ‘corticosteroid’, ‘PRP‘, ‘MSC’, risk of conservative treatment’, and ‘surgical indication’. Results eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88–44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome. Conclusions complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy. PMID:27331030

  15. Deltoid muscle shape analysis with magnetic resonance imaging in patients with chronic rotator cuff tears

    PubMed Central

    2013-01-01

    Background It seems appropriate to assume, that for a full and strong global shoulder function a normally innervated and active deltoid muscle is indispensable. We set out to analyse the size and shape of the deltoid muscle on MR-arthrographies, and analyse its influence on shoulder function and its adaption (i.e. atrophy) for reduced shoulder function. Methods The fatty infiltration (Goutallier stages), atrophy (tangent sign) and selective myotendinous retraction of the rotator cuff, as well as the thickness and the area of seven anatomically defined segments of the deltoid muscle were measured on MR-arthrographies and correlated with shoulder function (i.e. active abduction). Included were 116 patients, suffering of a rotator cuff tear with shoulder mobility ranging from pseudoparalysis to free mobility. Kolmogorov-Smirnov test was used to determine the distribution of the data before either Spearman or Pearson correlation and a multiple regression was applied to reveal the correlations. Results Our developed method for measuring deltoid area and thickness showed to be reproducible with excellent interobserver correlations (r = 0.814–0.982). The analysis of influencing factors on active abduction revealed a weak influence of the amount of SSP tendon (r = −0.25; p < 0.01) and muscle retraction (r = −0.27; p < 0.01) as well as the stage of fatty muscle infiltration (GFDI: r = −0.36; p < 0.01). Unexpectedly however, we were unable to detect a relation of the deltoid muscle shape with the degree of active glenohumeral abduction. Furthermore, long-standing rotator cuff tears did not appear to influence the deltoid shape, i.e. did not lead to muscle atrophy. Conclusions Our data support that in chronic rotator cuff tears, there seems to be no disadvantage to exhausting conservative treatment and to delay implantation of reverse total shoulder arthroplasty, as the shape of deltoid muscle seems only to be influenced by natural aging

  16. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.

    PubMed

    Luenam, Suriya; Kosiyatrakul, Arkaphat

    2013-12-01

    A massive rotator cuff tear in association with acute traumatic posterior glenohumeral dislocation is rare. To our knowledge, only four documented cases have been reported in the literature. We present two additional cases of such injury secondary to the traffic accident. The first patient had an unsuccessful closed reduction due to the posterior instability while the second developed the profound shoulder weakness following the reduction. From the findings of our cases together with the previous reports, every patient had a unique injury mechanism of high-energy directed axial loading on an outstretched, adducted, and internally rotated arm. The glenohumeral capsule and rotator cuff were uniformly avulsed from the humeral attachment, and the supraspinatus and infraspinatus were always involved. However, the clinical presentations were variable based on the severity of the associated rotator cuff tear. The outcomes of operative treatment in this type of injury with the open repair were favorable. PMID:22782426

  17. Role of Serum Fibrinogen Levels in Patients with Rotator Cuff Tears

    PubMed Central

    Longo, Umile Giuseppe; Petrillo, Stefano; Berton, Alessandra; Spiezia, Filippo; Loppini, Mattia; Maffulli, Nicola; Denaro, Vincenzo

    2014-01-01

    Although rotator cuff (RC) tendinopathy is a frequent pathology of the shoulder, the real understanding of its aetiopathogenesis is still unclear. Several studies showed that RC tendinopathy is more frequent in patients with hyperglycemia, diabetes, obesity, or metabolic syndrome. This paper aims to evaluate the serum concentration of fibrinogen in patients with RC tears. Metabolic disorders have been related to high concentration of serum fibrinogen and the activity of fibrinogen has been proven to be crucial in the development of microvascular damage. Thus, it may produce progression of RC degeneration by reducing the vascular supply of tendons. We report the results of a cross-sectional frequency-matched case-control study comparing the serum concentration of fibrinogen of patients with RC tears with that of a control group of patients without history of RC tears who underwent arthroscopic meniscectomy. We choose to enrol in the control group patients with pathology of the lower limb with a likely mechanic, not metabolic, cause, different from tendon pathology. We found no statistically significant differences in serum concentration of fibrinogen when comparing patients with RC tears and patients who underwent arthroscopic meniscectomy (P = 0.5). Further studies are necessary to clarify the role of fibrinogen in RC disease. PMID:24817887

  18. PLATELET-RICH PLASMA IN ARTHROSCOPIC REPAIRS OF COMPLETE TEARS OF THE ROTATOR CUFF

    PubMed Central

    Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; Sunada, Edwin Eiji; Benegas, Eduardo; de Santis Prada, Flavia; Neto, Raul Bolliger; Rodrigues, Marcelo Bordalo; Neto, Arnaldo Amado Ferreira; de Camargo, Olavo Pires

    2015-01-01

    Objective: To evaluate shoulder functional results and the retear rate of arthroscopic repair of the rotator cuff augmented with platelet-rich plasma (PRP).Methods: Prospective case series with single-row arthroscopic repair of the rotator cuff augmented with PRP. Only cases of isolated supraspinatus tears with retraction of less than 3 cm were included in this series. The PRP used was obtained by apheresis. It was applied on liquid consistency in its activated form, with the addition of autologous thrombin. Patients were evaluated after 12 months of the surgical procedure. The Constant-Murley, UCLA and VAS scales were used, and the retear rate was assessed using magnetic resonance imaging (MRI). Results: Fourteen patients were evaluated (14 shoulders). The mean Constant-Murley score was 45.64 ± 12.29 before the operation and evolved to 80.78 ± 13.22 after the operation (p < 0.001). The UCLA score increased from 13.78 ± 5.66 to 31.43 ± 3.9 (p < 0.001). The patients’ pain level decreased from a median of 7.5 (p25% = 6, p75% = 8) to 0.5 (p25% = 0, p75% = 3) (p = 0.0013) according to the VAS score. None of the patients presented complete retear. Three patients (21.4%) showed partial retear, without transfixation. Only one patient developed complications (adhesive capsulitis). Conclusion: Patients submitted to arthroscopic rotator cuff repair augmented with PRP showed significant functional improvement and none of them had complete retearing. PMID:27047894

  19. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears.

    PubMed

    Gumina, S; Di Giorgio, G; Perugia, D; Postacchini, F

    2008-02-01

    Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant's method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion. PMID:17410365

  20. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears

    PubMed Central

    Di Giorgio, G.; Perugia, D.; Postacchini, F.

    2007-01-01

    Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant’s method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion. PMID:17410365

  1. Fascia lata allograft bridging of a rotator cuff tear in a rabbit animal model

    PubMed Central

    Varvitsiotis, Dimitrios; Papaspiliopoulos, Athanasios; Vlachou, Vasiliki; Feroussis, John; Papalois, Apostolos; Papacharalampous, Xenofon; Soucacos, Panayotis N.; Zoubos, Aristides

    2014-01-01

    Purpose: Despite advances in surgical treatment options, large rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. The purpose of this study was to evaluate the temporary and spatial histological incorporation of fascia lata allografts, used for bridging artificially created defects of the r-c. Materials and Methods: Seventy-two rabbits were divided into two groups and a supraspinatus tendinous defect was created. Half of the rabbit population underwent repair only, while in the other half, the defect was bridged utilizing fascia lata allograft. The animals were euthanized at 2, 4, and 6 weeks postoperative. Half of the specimens were evaluated histologically and the other half underwent mechanical testing. Results: There was an increased remodeling activity, fibroblastic in growth and strong presence of collagen fibers observed at 6 weeks on both groups. A gradually increasing mechanical strength was noticed by week 6 and increased toughness was also found at the same time period. There was no significant difference observed between the two groups regarding their histological and mechanical properties. Conclusions: In the difficult scenario of a large irreparable tear where the simple suture of the remaining r-c is impossible, allograft bridging, could be used with satisfactory results. Clinical Relevance: Treatment Study, Level 1. PMID:25114414

  2. The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear

    PubMed Central

    2014-01-01

    Background It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear. Methods This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regression analysis. Results and discussion In this cohort, 38 patients were diagnosed with rotator cuff tears. The individual overall accuracy of the rotator cuff clinical tests was 61%–75%. After backward selection, the model determined that the most important predictors of rotator cuff tears were higher age and a positive Neer test. This internally validated prediction model had good discriminative ability (area under the receiver operating characteristic curve (AUC) = 0.73). Conclusion Our results showed that individual clinical shoulder tests had moderate diagnostic value for diagnosing rotator cuff tear. Our prediction model showed improved diagnostic value. However, the prediction value is still relatively low, supporting a low threshold for additional diagnostic tests for the diagnosis of rotator cuff tears. Level of evidence Study of diagnostic test: level I. PMID:25099359

  3. Systematic Review of All-Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis

    PubMed Central

    Huang, Rongzhong; Wang, Sanrong; Wang, Yule; Qin, Xiaoxia; Sun, Yang

    2016-01-01

    The objective of this study was to compare outcomes in patients with rotator cuff tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A systematic review and meta-analysis of outcomes of all-arthroscopic repair versus mini-open repair in patients with rotator cuff repair was conducted. Studies meeting the inclusion criteria were screened and included from systematic literature search for electronic databases including Medline, Embase, Cochrane CENTRAL, and CINAHL library was conducted from 1969 and 2015. A total of 18 comparative studies including 4 randomized clinical trials (RCTs) were included. Pooled results indicate that there was no difference in the functional outcomes, range of motion, visual analog scale (VAS) score, and short-form 36 (SF-36) subscales. However, Constant-Murley functional score was found to be significantly better in patients with mini-open repair. However, the results of the review should be interpreted with caution due to small size and small number of studies contributing to analysis in some of the outcomes. All-arthroscopic and mini-open repair surgical techniques for the management of rotator cuff repair are associated with similar outcomes and can be used interchangeably based on the patient and rotator tear characteristics. PMID:26947557

  4. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

    PubMed Central

    Godinho, Glaydson Gomes; Freitas, José Márcio Alves; de Oliveira França, Flávio; Santos, Flávio Márcio Lago; de Simoni, Leandro Furtado; Godinho, Pedro Couto

    2016-01-01

    Objective To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. Methods Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. Results The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). Conclusion The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation. PMID:27069884

  5. FUNCTIONAL EVALUATION OF PATIENTS WHO HAVE UNDERGONE ARTHROSCOPIC DEBRIDEMENT TO TREAT MASSIVE AND IRREPARABLE TEARS OF THE ROTATOR CUFF

    PubMed Central

    Veado, Marco Antônio de Castro; Rodrigues, Alessandro Ulhôa

    2015-01-01

    To evaluate the results from patients who underwent arthroscopic debridement of extensive irreparable rotator cuff injuries. Methods: 27 patients were operated between 2003 and 2007, and 22 of them were evaluated. The surgical procedure consisted of arthroscopic debridement of the stumps of the tendons involved, bursectomy, removal of acromial osteophytes and, possibly, biceps tenotomy and tuberoplasty. Results: All the patients showed involvement of the supraspinatus and infraspinatus tendons at the preoperative stage. In the postoperative evaluation, 14 patients had a complete teres minor muscle, and three had partial tears of the subscapularis tendon. There was an improvement in the UCLA criteria, from 15 preoperatively to 31 postoperatively. There was no improvement in muscle strength, but there was a reduction in the pain. Conclusion: Arthroscopic debridement is a recommended procedure for elderly patients with irreparable rotator cuff tears, good range of motion and low functional demand, when the main objective is to diminish pain. PMID:27022590

  6. Perivascular Stem Cells Diminish Muscle Atrophy and Retain Viability in a Rotator Cuff Tear Model

    PubMed Central

    Eliasberg, Claire; Jensen, Andrew; Dar, Ayelet; Kowalski, Tomasz J.; Murray, Iain; Khan, Adam Z.; Natsuhara, Kyle; Garagozlo, Cameron; McAllister, David R.; Petrigliano, Frank A.

    2016-01-01

    Objectives: Rotator cuff tears (RCTs) are a common cause of shoulder pain and often necessitate surgical repair. Muscle changes including atrophy, fibrosis, and fatty degeneration can develop after RCTs, which may compromise surgical repair and clinical outcomes. Lipoaspirate-derived human perivascular stem cells (PSCs) have demonstrated myogenic and angiogenic potential in other small animal models of muscle injury. We hypothesized that the administration of PSCs following massive RCTs may help to diminish these muscle changes in a small animal model. Methods: A total of 90 immunodeficient mice were used (15 groups, N=6). Each was assigned to one of three surgical groups: i) sham, ii) supraspinatus and infraspinatus tendon transection (TT), or iii) TT and suprascapular nerve denervation (TT+DN). PSCs were harvested from human lipoaspirate and sorted using fluorescence-activated cell sorting into small blood vessel residing pericytes (CD146+ CD34- CD45- CD31-) and large blood perivascular adventitial cells (CD146- CD34+ CD45- CD31-). Mice received either a) no injection, b) saline injection, c) pericyte injection, or d) adventitial cell injection at the time of the index procedure or at two weeks following index surgery. The supraspinatus muscles were harvested six weeks after the index procedure. Muscle atrophy was assessed by measuring percent wet muscle weight change for each sample. Muscle fiber cross-sectional area (CSA), fibrosis, and fatty degeneration were analyzed using Image J™. Additionally, pericytes and adventitial cells were transduced with a luciferase-containing construct. Animals were given injections of luciferin and imaged using IVIS to track in vivo bioluminescence following injections to assess cell viability. Results: Treatment with PSC injection after TT resulted in less wet weight loss and greater muscle fiber CSA than control groups (P<0.05). The TT+DN groups treated with PSC injections two weeks post-op also had less muscle weight loss

  7. Rotator Cuff Injuries

    MedlinePlus

    ... others can be very painful. Treatment for a torn rotator cuff depends on age, health, how severe ... is, and how long you've had the torn rotator cuff. Treatment for torn rotator cuff includes: ...

  8. Evidence for an Environmental and Inherited Predisposition Contributing to the Risk for Global Tendinopathies or Compression Neuropathies in Patients With Rotator Cuff Tears

    PubMed Central

    Tashjian, Robert Z.; Farnham, James M.; Granger, Erin K.; Teerlink, Craig C.; Cannon-Albright, Lisa A.

    2016-01-01

    Background: Rotator cuff tearing has been found to be clinically associated with other tendinopathies and compression neuropathies; a significant excess of these phenotypes has been seen in patients with rotator cuff tears. It is unclear if the association is secondary to environmental or genetic influences. Purpose: To examine population-based data for comorbid association of rotator cuff tearing and tendinopathies and compression neuropathies and to determine whether the association extends to relatives of patients with rotator cuff tears, which could suggest a genetic contribution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Utah Population Database (UPDB) contains health and genealogical data on over 2 million Utah residents. Current Procedural Terminology, Fourth Revision, codes (CPT 4) and International Classification of Diseases, Ninth Revision, codes (ICD-9) entered in patient records were used to identify patients with rotator cuff tearing and with comorbid tendinopathies and compression neuropathies. We tested the hypothesis of excess familial clustering of these other phenotypes with rotator cuff tearing using a well-established method (estimation of relative risks) in the overall study group of rotator cuff patients (N = 1889). Results: Significantly elevated risk for elbow, hand/wrist, foot/ankle, knee, and hip tendinopathies, as well as for all tendinopathies and compression neuropathies, was observed in rotator cuff tear cases themselves (P < 2.8e–13), in their spouses (P < .02), and in their first-degree relatives (P < 5.5e–4). A significant excess of elbow (P = .01), foot/ankle (P = .04), and all tendinopathies (P = 3.1e–3) was also observed in second-degree relatives, and a significant excess of compression neuropathies (P = .03) was observed in third-degree relatives. Conclusion: The current study shows strong evidence of familial clustering of rotator cuff tearing with other tendinopathies and with compression

  9. Clinical and Magnetic Resonance Imaging Results of Arthroscopic Repair of Intratendinous Partial-thickness Rotator Cuff Tears

    PubMed Central

    Xiao, Jian; Cui, Guo-Qing

    2015-01-01

    Background: Partial-thickness rotator cuff tears (PTRCTs) are being diagnosed more often because of high-resolution magnetic resonance imaging (MRI). Compared with articular and bursal side tears, there have been few studies about evaluating the clinical and structural outcomes after intratendinous tear repair. Methods: From 2008 to 2012, 33 consecutive patients with intratendinous PTRCTs underwent arthroscopic repair. All of them were retrospectively evaluated. The University of California at Los Angeles (UCLA) and constant scores were evaluated before operation and at the final follow-up. Postoperative cuff integrity was determined using MRI according to Sugaya's classification. Results: At the 2-year follow-up, the average UCLA score increased from 16.7 ± 1.9 to 32.5 ± 3.5, and the constant score increased from 66.2 ± 10.5 to 92.4 ± 6.9 (P < 0.001). Twenty seven patients received follow-up MRI examinations at an average of 15.2 months after surgery. Of these 27 patients, 22 (81.5%) had a healed tendon, and five patients had partial tears. There was no association between functional and anatomic results. Conclusions: For intratendinous PTRCT, clinical outcomes and tendon healing showed good results at a minimum 2-year after arthroscopic repair. PMID:26021507

  10. Identification of suitable reference genes for gene expression studies in tendons from patients with rotator cuff tear.

    PubMed

    Leal, Mariana Ferreira; Belangero, Paulo Santoro; Figueiredo, Eduardo Antônio; Cohen, Carina; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; de Castro Pochini, Alberto; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    Rotator cuff tear is one of the most common causes of shoulder dysfunction. Gene expression analysis may be a useful tool for understanding tendon tears and the failure of cuff healing, and reverse-transcription quantitative polymerase chain reaction (RT-qPCR) has become an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluate the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1 and TBP) using samples from the rotator cuff tendons of 28 individuals with tendon tears (3 tendons regions) and 8 controls (2 tendon regions); for the tear patients, we evaluated ruptured and non-ruptured tendon samples. The stability of the candidate reference genes was determined using the NormFinder, geNorm, BestKeeper and DataAssist software packages. Overall, HPRT1 was the best single reference gene, and HPRT1+TBP composed the best pair and HPRT1+TBP+ACTB composed the best trio of reference genes from the analysis of different groups, including the simultaneous analysis of all tissue samples. To identify the optimal combination of reference genes, we evaluated the expression of COL1A1 and COL3A1, and no obvious differences were observed when using 2, 3 or 4 reference genes for most of the analyses. However, COL3A1 expression differed between ruptured and non-ruptured (posterior superior region) tendons of patients only when normalized by HPRT1+TBP+B2M and HPRT1+TBP. On the other hand, the comparison between these two groups using the best trio of reference genes (HPRT1+TBP+ACTB) and 4 reference genes did not revealed a significant difference in COL3A1 expression. Consequently, the use of suitable reference genes for a reliable gene expression evaluation by RT-qPCR should consider the type of tendon samples investigated. HPRT1+TBP+ACTB seems to be the best combination of reference genes for the analysis of involving different tendon samples of individuals with rotator cuff tears

  11. The MRI geyser sign: acromioclavicular joint cysts in the setting of a chronic rotator cuff tear.

    PubMed

    Cooper, H John; Milillo, Ralph; Klein, Devon A; DiFelice, Gregory S

    2011-06-01

    We present the case of a 71-year-old man with a large acromioclavicular (AC) joint cyst successfully managed with surgical excision. AC joint cysts are soft tissue masses generally signifying underlying rotator cuff pathology. Traditionally, these cysts were identified with shoulder arthrography as a "geyser" of fluid escaping through the AC joint. Magnetic resonance imaging (MRI) is today's preferred imaging modality; we describe the MRI equivalent of the "geyser sign," signifying synovial fluid escaping through the cuff defect, across the subacromial bursa, and decompressing superiorly through a degenerated AC joint. Surgical management is preferred for symptomatic cysts. Based on a review of limited retrospective case series, recommendations for management of these lesions are as follows. Repair of the rotator cuff is preferable whenever possible. In the case of an irreparable defect, good results can be achieved through excisional AC joint arthroplasty and resection of the cyst base. Aspiration of these cysts should not be attempted, due to the high recurrence rate and potential for a draining sinus. Hemiarthroplasty also may be effective in indirectly decompressing these cysts; but given the invasive nature of this procedure, it should be reserved for patients who are also symptomatic from cuff arthropathy. PMID:21869946

  12. Factors affecting rotator cuff healing.

    PubMed

    Mall, Nathan A; Tanaka, Miho J; Choi, Luke S; Paletta, George A

    2014-05-01

    Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP. There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair. PMID:24806015

  13. Arthroscopic Management of Full-Thickness Rotator Cuff Tears in Major League Baseball Pitchers: The Lateralized Footprint Repair Technique.

    PubMed

    Dines, Joshua S; Jones, Kristofer; Maher, Patrick; Altchek, David

    2016-01-01

    Clinical outcomes of surgical management of full-thickness rotator cuff tears in professional baseball players have been uniformly poor. We conducted a study to investigate return-to-play data and functional performance using a novel arthroscopic repair technique. We hypothesized that arthroscopic rotator cuff repair would result in a high rate of return to professional pitching and favorable functional outcomes. We identified 6 consecutive Major League Baseball (MLB) pitchers who underwent surgical repair of full-thickness rotator cuff injuries using the lateralized footprint repair technique. At most recent follow-up, patients were evaluated to determine their ability to return to athletic activity. Functional outcomes were also assessed using player performance statistics. By mean follow-up of 66.7 months (range, 23.2-94.6 months), 5 (83%) of the 6 pitchers had returned to their preinjury level of competition for at least 1 full season. Despite the high rate of return to MLB play, few pitchers resumed pitching productivity at their preoperative level; mean number of innings pitched decreased from 1806.5 to 183.7. A slight performance reduction was also found in a comparison of preoperative and postoperative pitching statistics. Of note, the return rate was higher for players over age 30 years than for those under 30 years. Overhead athletes require a delicate balance of shoulder mobility and stability to meet functional demands. Anatomical adaptations at the glenohumeral joint should be considered when performing rotator cuff repair in these patients in order to preserve peak functional performance. This novel repair technique affords a high rate of return to MLB play, though elite overhead throwers should be counseled that pitching productivity might decrease after surgery. PMID:26991564

  14. Management of In-Season Concurrent Rotator Cuff Tear With Shoulder Instability in Professional Contact Football Athletes; Respect the Career Goals!

    PubMed Central

    Mueller, Maike; Hoy, Gregory; Branson, Ruben

    2016-01-01

    Introduction Professional sports injuries are usually all dealt with at one single operation to return the player to the sport after appropriate rehabilitation. We questioned the assumption that rotator cuff tears must be repaired concurrently with instability syndromes, and aimed to allow a professional rugby league player to achieve career goals by NOT correcting all pathology at one surgery. Case Presentation A professional rugby league player presented with acute shoulder instability on a setting of a chronic full thickness rotator cuff tear. We performed an “in season” arthroscopic stabilization on an elite rugby league player, leaving a previously diagnosed large full thickness rotator cuff tear untreated. This allowed aggressive rehabilitation and return to contact competition at 12 weeks post-surgery. The player achieved a long held career goal of winning a premiership ring before undertaking rotator cuff repair at the end of the season. Latest follow up at seven years (still at elite level) demonstrated an asymptomatic shoulder. Conclusions The assumption that all pathology found at surgical exploration requires correction to play at elite level is not universally correct. We postulate that whilst rotator cuff deficiency has severe long-term sequelae, it is shoulder instability alone that prevents high level contact sports participation. Career goal management is an important part of managing elite level athletes. We have demonstrated that by careful management of the specific pathology preventing participation can allow elite athletes to achieve career goals without compromising long-term health. PMID:27217928

  15. Patch-Augmented Latissimus Dorsi Transfer and Open Reduction–Internal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

    PubMed Central

    Petri, Maximilian; Greenspoon, Joshua A.; Bhatia, Sanjeev; Millett, Peter J.

    2015-01-01

    Latissimus dorsi transfer is a reasonable treatment option for massive posterosuperior rotator cuff tears that can substantially improve chronically painful and dysfunctional shoulders. This report and accompanying video describe the treatment of an active 43-year-old man with severe pain and weakness in the right shoulder after 3 failed rotator cuff repairs. Preoperative imaging showed a massive posterosuperior rotator cuff tear retracted to the glenoid as well as a hypermobile os acromiale likely causing dynamic impingement and recurrent rotator cuff tears. After diagnostic arthroscopy, the latissimus tendon is harvested and augmented with a 3-mm human acellular dermal patch (ArthroFlex; Arthrex, Naples, FL). The native rotator cuff tissue is repaired as much as possible, and the latissimus tendon is passed underneath the deltoid and posterior to the teres minor. The patch-augmented tendon is then integrated into a double-row SpeedBridge repair of eight 4.75-mm BioComposite SwiveLock anchors (Arthrex). The bony surface of the os acromiale is prepared and then fixed to the acromion with 2 cannulated partially threaded screws and additional tension-band wiring. Postoperative rehabilitation initially focuses on early passive range of motion, followed by active and active-assisted motion and a biofeedback program starting at 6 weeks postoperatively. PMID:26697309

  16. Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study

    PubMed Central

    2016-01-01

    Objective To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. Methods During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. Results Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42–68 years). Pain diminished from a baseline value of 64 mm (range, 40–80 mm) to 16 mm (range, 0–30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51–66 points) to 85 points (range, 70–100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). Conclusion Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears. PMID:27606278

  17. Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

    PubMed Central

    Chen, Xiaobin; Giambini, Hugo; Ben-Abraham, Ephraim; An, Kai-Nan; Nassr, Ahmad; Zhao, Chunfeng

    2015-01-01

    Introduction An increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff. Materials and Methods Eighteen New England white rabbits were divided into the 3 groups: Control, Ovariectomy-Saline (OVX-Saline), and Ovariectomy-PTH (OVX-PTH). The OVX-Saline group and the OVX-PTH were administered daily saline and Teriparatide injections for 8 weeks starting at 17 weeks of OVX. BMD of the humeral head was measured, the ISP tendon failure load was tested and the failure stress was calculated. One specimen from each group was used for histological analysis. Linear regression analysis was used to derive equations for the BMD and failure stress. Results Significant differences were observed in the measured humeral head BMD of the Control and OVX-PTH groups compared to the OVX-Saline group (P = 0.0004 and P = 0.0024, respectively). No significant difference was found in failure stress among the three groups, but an expected trend with the control group and OVX-PTH group presenting higher failure strength compared to the OVX-Saline group. BMD at the humeral head showed a positive linear correlation with stress (r2 = 0.54). Histology results showed the superiority in OVX-PTH group ISP enthesis compared to the OVX-Saline group. Conclusion Bone loss of the humeral head leads to decreased tendon/bone insertion strength of the infraspinatus tendon enthesis. Teriparatide administration can increase bone

  18. Ultrasound for the detection of full-thickness rotator cuff tears: the learning curve for an orthopaedic surgeon using a novel training method

    PubMed Central

    Ibrahim, Edward F; Petrou, Charalambos

    2014-01-01

    Background The present study aims to add to the body of evidence delineating the learning curve for a shoulder surgeon to become proficient in focussed ultrasound for the detection of full-thickness rotator cuff tears, as well as to describe a learning method for this skill. Methods Consecutive patients who were scheduled to undergo an arthroscopy for rotator cuff disease were scanned immediately before surgery by a senior shoulder surgeon with limited previous experience of shoulder ultrasound. The presence or absence of a full-thickness rotator cuff tear on scan was compared with intra-operative findings as the gold standard. Results Two hundred and ten shoulders were scanned over three equal learning periods. Comparing predictive values from the first to the third training period, sensitivity improved from 0.86 to 0.95, specificity from 0.92 to 0.98, negative predictive value from 0.94 to 0.98, and positive predictive value from 0.82 to 0.95. Conclusions The high predictive values obtained in the present study for surgeon-led detection of cuff tears using ultrasound are comparable with those quoted for musculoskeletal radiologists in the literature. The present study adds evidence that a shoulder surgeon can achieve accelerated learning of this skill and offers some potentially time-saving and patient-friendly alternatives to existing guidelines.

  19. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed Central

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  20. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  1. Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up

    PubMed Central

    Bokor, Desmond John; Sonnabend, David; Deady, Luke; Cass, Ben; Young, Allan; Van Kampen, Craig; Arnoczky, Steven

    2016-01-01

    Summary Background partial-thickness rotator cuff tears frequently enlarge due to increased local strain and often progress to full-thickness tears. Studies suggest the addition of new tendinous tissue to injured cuff tendons would significantly decrease peak strain, possibly protecting against tear progression. The aim of this study was to assess the ability of a highly-porous collagen implant to induce new tissue formation and limit tear progression when placed on the bursal surface of partial-thickness cuff tears. Methods following arthroscopic subacromial decompression, the implant was attached to the bursal surface of the supraspinatus tendon in a prospective series of 13 consecutive patients with intermediate – (3–6 mm) to high-grade (>6 mm) partial – thickness cuff tears (5 articular, 3 bursal, 5 intra-substance). Tendon thickness, defect size, and tendon quality were evaluated using magnetic resonance imaging (MRI) preoperatively and at 3, 6, 12, and 24 months postoperatively. Clinical outcomes were assessed using the Constant and American Shoulder and Elbow Society scores at the same preoperative and follow-up times. All 13 patients completed all follow-up exams (mean length of follow-up 27.0 months, range 23.3–32.0); no patients were lost to follow-up. Results the implant induced significant new tissue formation in all patients by 3 months (mean increase in tendon thickness 2.2 ± 0.26 mm). This tissue matured over time and became radiologically indistinguishable from the underlying tendon. The partial-thickness cuff tears showed consistent filling of the defects, with complete healing in 7 patients at 12 months, and a progressive improvement in tendon quality in the remaining patients. No tear progression was observed by MRI in any of the patients at 24 months. All clinical scores improved significantly over time. At 24 months, 12 of 13 patients (92%) had satisfactory or better results. Conclusions the results of this clinical study demonstrated

  2. Rotator cuff injuries in adolescent athletes.

    PubMed

    Weiss, Jennifer M; Arkader, Alexandre; Wells, Lawrence M; Ganley, Theodore J

    2013-03-01

    The cause of rotator cuff injuries in the young athlete has been described as an overuse injury related to internal impingement. Abduction coupled with external rotation is believed to impinge on the rotator cuff, specifically the supraspinatus, and lead to undersurface tears that can progress to full-thickness tears. This impingement is believed to be worsened with increased range of motion and instability in overhead athletes. A retrospective review of seven patients diagnosed with rotator cuff injuries was performed to better understand this shoulder injury pattern. The type of sport played, a history of trauma, diagnosis, treatment method, and outcome were noted. Six patients were male and one was a female. Baseball was the primary sport for four patients, basketball for one, gymnastics for one, and wrestling for one. The following injury patterns were observed: two patients tore their subscapularis tendon, two sustained avulsion fractures of their lesser tuberosity, one tore his rotator interval, one tore his supraspinatus, and one avulsed his greater tuberosity. Only four patients recalled a specific traumatic event. Three patients were treated with arthroscopic rotator cuff repair, three with miniopen repair, and one was treated with rehabilitation. Six of the seven patients returned to their preinjury level of sport after treatment. Rotator cuff tears are rare in the adolescent age group. The injury patterns suggest that acute trauma likely accounts for many rotator cuff tears and their equivalents in the young patient. Adolescents with rotator cuff tears reliably return to sports after treatment. The possibility of rotator cuff tears in skeletally immature athletes should be considered. The prognosis is very good once this injury is identified and treated. PMID:22668571

  3. Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

    PubMed Central

    Lee, Sung-Moon; Lee, Young-Kuk; Shin, Hong-Kwan

    2014-01-01

    Background The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results. Methods Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively. Results The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient. Conclusions Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint. PMID:25177460

  4. Medium- to long-term results of a randomized controlled trial to assess the efficacy of arthoscopic-subacromial decompression versus mini-open repair for the treatment of medium-sized rotator cuff tears

    PubMed Central

    Birch, Ann; Temperley, David; Odak, Saurabh; Walton, Michael J; Haines, John F; Trail, Ian

    2015-01-01

    Background We report on the medium- to long-term results of a randomized controlled trial (RCT) aiming to determine whether rotator cuff repair confers any advantage over arthroscopic sub-acromial decompression (ASAD) alone in the management of medium-sized rotator cuff tears. Methods Ethical approval was sought to follow-up patients previously enrolled in a completed and previously published RCT comparing the outcome of ASAD with mini-open cuff repair for the treatment of rotator cuff tear. Forty-two patients were enrolled in the original study, with a mean of 64 years (range 54 years to 77 years). Results Fifteen of the original 17 patients randomized to ASAD alone and 18 of the original 25 patients randomized to cuff repair were available for follow-up. Each patient underwent American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scoring, and clinical and ultrasound examination. Mean duration of follow-up was 7 years (range 5 years to 11 years). There was no statistically significant difference in terms of ASES, DASH and Constant scores at follow-up between the two groups. Some 33% of patients in the cuff-repair group had a proven re-rupture on ultrasound. This patient subgroup had significantly worse Constant scores compared to patients where the repair remained intact. None of the patients from either group developed cuff-tear arthropathy requiring arthroplasty surgery. Conclusions In this medium- to longer-term study, there is no demonstrable significant benefit of cuff repair over decompression alone for the treatment of medium-sized rotator cuff tears, in terms of ASES, DASH and Constant scores for pain, function and strength modules. The presence of cuff tear does not necessitate surgical repair. This conclusion should drive surgical strategies and shared decision-making between patients and surgeons. PMID:27583006

  5. Minimally Important Differences and Change Across Time in Patients Treated Surgically and Non-Surgically for Full-Thickness Rotator Cuff Tears

    PubMed Central

    Miller, Bruce S.; Robbins, Christopher; Gagnier, Joel Joseph

    2016-01-01

    Objectives: The minimally important difference (MID) is the smallest change in an outcome measure that is perceived by patients as beneficial. The MIDs for the ASES and WORC scores have not been established in a homogenous population of patients with rotator cuff tears. The objective of the present study was to establish the MIDs for patients with known cuff tears who were treated both surgically and non-surgically, and to compare the MIDs over time. Methods: We included 209 subjects with known full-thickness rotator cuff tears who were followed prospectively for two years. The WORC and ASES scores were collected at baseline, 4, 8, 16, 32, and 48 weeks, 1 year and 2 years. At the final follow-up point patients filled out an end-of-study form which included questions regarding change in their condition after treatment. Results: For those that indicated being minimally better, the change from baseline for the ASES score was -20.57 (-2.94 to -38.20) and for the WORC was 418.60 (70.39 to 766.81); both indicated improvement in outcomes. When converted to the percentage change score the WORC change represented 19.93%. The plots of these new MID values for the ASES and WORC indicate that not only does the operative group improve more than the non-operative group but it does so to an extent that is greater than the MID. The non-operative group also improved across time, but the magnitude did not exceed the MID for either the WORC or the ASES. Conclusion: We found that the ASES and the WORC MIDs in patients with rotator cuff tears is different from that previously reported, and that the operative group change was greater than the non-operative group change. This information will directly improve our ability to: (1) Determine when patients with RCTs are changing in a meaningful manner; (2) Accurately power clinical studies using these outcome measures; (3) Make more informed choices of treatments in these patients. This is the first study to report MIDs for the ASES and WORC

  6. Intra-articular changes precede extra-articular changes in the biceps tendon following rotator cuff tears in a rat model

    PubMed Central

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

    2011-01-01

    Background Biceps tendon pathology is common with rotator cuff tears. The mechanisms for biceps changes, and therefore its optimal treatment, are unknown. Our objective was to determine the effect of rotator cuff tears on regional biceps tendon pathology. We hypothesized that histological and compositional changes would appear before organizational changes, both would appear before mechanical changes, and changes would begin at the tendon’s insertion site. Methods Sixty-five Sprague-Dawley rats received either detachment of supraspinatus and infraspinatus tendons or sham surgery. Rats were sacrificed at 1, 4 or 8 weeks for regional measurements of histological, compositional, organizational (1, 4 and 8 weeks) or mechanical properties (4 and 8 weeks only). Results One week following tendon detachments, decreased organization and more rounded cell shape were found in the intra-articular space of the biceps tendon. Aggrecan expression was increased along the entire length of the tendon while all other compositional changes were at the tendon’s proximal insertion into bone only. With time, this disorganization and more rounded cell shape extended the length of the tendon. Organizational and cell shape changes also preceded detrimental mechanical changes, as decreased modulus in the intra-articular space was found after 8 weeks. Conclusions Results support a degenerative component to pathology in the biceps tendon. Additionally, changes resembling a tendon exposed to compressive loading occurring first in the intra-articular space indicate that the biceps tendon plays an increased role as a load bearing structure against the humeral head in the presence of rotator cuff tears. PMID:21816629

  7. Free biceps tendon autograft to augment arthroscopic rotator cuff repair.

    PubMed

    Obma, Padraic R

    2013-01-01

    Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while one is performing rotator cuff surgery. A subpectoral biceps tenodesis provides a source of autograft to augment rotator cuff repairs of all sizes. Two techniques are presented to augment rotator cuff repairs with a free biceps tendon autograft. This is a novel idea in an attempt to improve healing rates and long-term results of rotator cuff repairs of all sizes. PMID:24400197

  8. High-Grade Articular, Bursal, and Intratendinous Partial-Thickness Rotator Cuff Tears: A Retrospective Study Comparing Functional Outcomes After Completion and Repair.

    PubMed

    Donohue, Nicholas K; Nickel, Brian T; Grindel, Steven I

    2016-01-01

    We conducted a study to assess the impact of tear location on functional outcomes in high-grade partial-thickness rotator cuff tears (PTRCTs) after arthroscopic completion and repair. Retrospectively, we evaluated the preoperative and postoperative findings of 60 patients who underwent arthroscopic completion and repair of Ellman grade 3 partial-thickness tears of the supraspinatus. The 60 patients were grouped by tear subtype (20 articular, 20 bursal, 20 intratendinous) as identified by preoperative imaging and confirmed at time of surgery. After surgery, the 3 subtypes showed similar significant (P < .001) improvements in American Shoulder and Elbow Surgeons scores (articular, 46.9, 85.1; bursal, 44.3, 80.3; intratendinous, 43.6, 86.1), Constant scores (articular, 54.3, 79.4; bursal, 49.9, 75.0; intratendinous, 56.8, 80.9), and visual analog scale scores (articular, 5.1, 1.2; bursal, 5.8, 1.6; intratendinous, 6.0, 1.2). Our study findings validate use of the current algorithm for Ellman grade 3 PTRCTs of the supraspinatus and advocate their completion and repair, regardless of tear location. PMID:27552462

  9. Clinical Examination of the Rotator Cuff

    PubMed Central

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

    2013-01-01

    Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability accounting 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 using a goniometer, strength testing 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 be typically 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 diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology. PMID:23332909

  10. Current Biomechanical Concepts for Rotator Cuff Repair

    PubMed Central

    2013-01-01

    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

  11. Rotator Cuff Injuries.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    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…

  12. Biological aspects of rotator cuff healing

    PubMed Central

    Wildemann, Britt; Klatte, Franka

    2011-01-01

    Summary Tendon tears of the rotator cuff show a high prevalence in today’s population. Patients suffer from permanent pain and disability, and surgical reconstruction may be the only possibility for abatement. The complex process of tendon-bone healing leads to mechanically inferior scar-tissue, which often results in retears or non-healing. In the current literature, factors such as patients age, sex and fatty muscle infiltration are highly correlated to the presence of rotator cuff tears and the incidence of retears. To improve the tendon tissue quality after surgical reconstructions biologically based strategies with use of growth factors arouse more and more interest in the last years. However, to optimize the treatment of rotator cuff tears the biological background of tears and retears must be investigated in more detail. This article will elucidate different aspects that have an impact on rotator cuff healing and give a brief insight in tendon/ligament cell culture and animal studies focusing on growth factor treatments. PMID:23738265

  13. Treatment options for irreparable postero-superior cuff tears in young patients

    PubMed Central

    Galasso, Olimpio; Familiari, Filippo; Gasparini, Giorgio

    2015-01-01

    Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management. PMID:26601058

  14. Treatment options for irreparable postero-superior cuff tears in young patients.

    PubMed

    Galasso, Olimpio; Familiari, Filippo; Gasparini, Giorgio

    2015-11-18

    Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management. PMID:26601058

  15. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear—A Meta-Analysis

    PubMed Central

    Woodmass, Jarret M.; Bois, Aaron J.; Boorman, Richard S.; Thornton, Gail M.

    2016-01-01

    Articular surface partial-thickness rotator cuff tears (PTRCTs) are commonly repaired using two different surgical techniques: transtendon repair or repair after completion of the tear. Although a number of studies have demonstrated excellent clinical outcomes, it is unclear which technique may provide superior clinical outcomes and tendon healing. The purpose was to evaluate and compare the clinical outcomes following arthroscopic repair of articular surface PTRCT using a transtendon technique or completion of the tear. A systematic review of the literature was performed following PRISMA guidelines and checklist. The objective outcome measures evaluated in this study were the Constant Score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, physical examination, and complications. Three studies met our criteria. All were prospective randomized comparative studies with level II evidence and published from 2012 to 2013. A total of 182 shoulders (mean age 53.7 years; mean follow-up 40.5 months) were analyzed as part of this study. Both procedures provided excellent clinical outcomes with no significant difference in Constant Score and other measures between the procedures. Both procedures demonstrated improved clinical outcomes. However, there were no significant differences between each technique. Further studies are required to determine the long-term outcome of each technique.

  16. Biologics in rotator cuff surgery

    PubMed Central

    Schär, Michael O; Rodeo, Scott A

    2014-01-01

    Pathologies of the rotator cuff are by far the most common cause of shoulder dysfunction and pain. Even though reconstruction of the rotator cuff results in improved clinical outcome scores, including decreased pain, several studies report high failure rates. Orthopaedic research has therefore focused on biologically augmenting the rotator cuff reconstruction and improving tendon–bone healing of the rotator cuff. This biological augmentation has included the application of different platelet concentrates containing growth factors, mesenchymal stem cells, scaffolds and a combination of the above. The present review provides an overview over the biological augmentation options based upon current evidence.

  17. Can self-report instruments of shoulder function capture functional differences in older adults with and without a rotator cuff tear?

    PubMed

    Vidt, Meghan E; Santago, Anthony C; Hegedus, Eric J; Marsh, Anthony P; Tuohy, Christopher J; Poehling, Gary G; Freehill, Michael T; Miller, Michael E; Saul, Katherine R

    2016-08-01

    Rotator cuff tears (RCT) are prevalent in older individuals and may compound age-associated functional declines. Our purpose was to determine whether self-report measures of perceived functional ability are valid for older patients with RCT. Twenty five subjects participated (12M/13F; age=63.9±3.0years); 13 with RCT and 12 controls (CON). Participants completed self-report measures of shoulder function (SST, ASES, WORC) and health-related quality of life (SF-36). Isometric joint moment and range of motion (ROM) were measured at the shoulder. Relationships among functional self-reports, and between these measures and joint moment and ROM were assessed; group differences for total and subcategory scores were evaluated. There were significant correlations among self-reports (rs=0.62-0.71, p⩽0.02). For RCT subjects, ASES was associated with all joint moments except adduction (p⩽0.02); SST, ASES, and WORC were associated with abduction and external rotation ROM (p⩽0.04). For RCT subjects, SST and WORC were associated with SF-36 physical function subcategory scores (p⩽0.05). The RCT group scored worse than CON on all functional self-reports (p<0.01) and WORC and ASES subcategories (p<0.01). In conclusion, SST, ASES, and WORC demonstrate utility and discriminant validity for older individuals by distinguishing those with RCT, but this work suggests prioritizing ASES given its stronger association with functional group strength. PMID:26208428

  18. Improved apparatus for predictive diagnosis of rotator cuff disease

    NASA Astrophysics Data System (ADS)

    Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

    2014-03-01

    Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

  19. Rotator cuff repair - series (image)

    MedlinePlus

    ... shoulder and arm bones. The tendons can be torn from overuse or injury. ... Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure is less predictable at returning strength ...

  20. Rotator cuff - self-care

    MedlinePlus

    ... tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and remain stable. Common rotator cuff ... can help when you feel pain in your shoulder. An ice pack applied to the shoulder 20 ...

  1. Do partial thickness, bursal side cuff tears affect outcome following arthroscopic subacromial decompression? A prospective comparative cohort study

    PubMed Central

    Al-Maiyah, Mohammed; Goodchild, Lorna; Fourie, J M Brendan; Finn, Paul; Rangan, Amar

    2014-01-01

    Background: The present study aimed to compare medium-term clinical outcomes of patients following arthroscopic subacromial decompression (ASAD): those with intact rotator cuff with two groups of increasing size of partial thickness bursal-side tears. Methods: Patients undergoing shoulder arthroscopy by a single surgeon had pre- and postoperative Constant scores prospectively recorded. Arthroscopic surgery included the assessment of any supraspinatus tears using the Ellman criteria, as well as ASAD and cuff debridement. Groups were created based on the status of rotator cuff and size of bursal tear. Outcome in these patient groups was then compared and analyzed Results: Seventy-four patients were suitable for inclusion in the study: 32 patients without a cuff tear; 21 patients with a cuff tear of 9 mm or less in length; and 21 patients with a cuff tear of 10 mm or more in length. Baseline characteristics of the three groups were similar. All three groups showed a significant improvement in their Constant scores following surgery. There was, however, no significant difference in Constant scores between the three groups. Conclusions: The results of the present study show that patients with varying sizes of bursal-side tears respond to ASAD as well as those with no rotator cuff tear.

  2. A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair

    PubMed Central

    Yi, Anthony; Villacis, Diego; Yalamanchili, Raj; Hatch, George F. Rick

    2015-01-01

    Context: Despite the significant attention directed toward optimizing arthroscopic rotator cuff repair, there has been less focus on rehabilitation after rotator cuff repair surgery. Objective: To determine the effect of different rehabilitation protocols on clinical outcomes by comparing early versus late mobilization approaches and continuous passive mobilization (CPM) versus manual therapy after arthroscopic rotator cuff repair. Data Sources: PubMed was searched for relevant articles using the keywords rotator cuff, rotator, cuff, tears, lacerations, and rehabilitation to identify articles published from January 1980 to March 2014. Study Selection: Inclusion criteria consisted of articles of level 1 or 2 evidence, written in the English language, and with reported outcomes for early versus late mobilization or rehabilitation with CPM versus manual therapy after primary arthroscopic rotator cuff repair. Exclusion criteria consisted of articles of level 3, 4, or 5 evidence, non-English language, and those with significantly different demographic variables between study groups. Included studies were evaluated with the Consolidated Standards of Reporting Trials criteria. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: Level of evidence, study type, number of patients enrolled, number of patients at final follow-up, length of follow-up, age, sex, rotator cuff tear size, surgical technique, and concomitant operative procedures were extracted from included articles. Postoperative data included clinical outcome scores, visual analog score for pain, shoulder range of motion, strength, and rotator cuff retear rates. Results: A total of 7 studies met all criteria and were included in the final analysis. Five studies compared early and late mobilization. Two studies compared CPM and manual therapy. Conclusion: In general, current data do not definitively demonstrate a significant difference between postoperative rotator cuff rehabilitation

  3. Biomechanical comparison of expanded polytetrafluoroethylene (ePTFE) and PTFE interpositional patches and direct tendon-to-bone repair for massive rotator cuff tears in an ovine model

    PubMed Central

    McKeown, Andrew DJ; Beattie, Rebekah F; Murrell, George AC

    2015-01-01

    Background Massive irreparable rotator cuff tears are a difficult problem. Modalities such as irrigation and debridement, partial repair, tendon transfer and grafts have been utilized with high failure rates and mixed results. Synthetic interpositional patch repairs are a novel and increasingly used approach. The present study aimed to examine the biomechanical properties of common synthetic materials for interpositional repairs in contrast to native tendon. Methods Six ovine tendons, six polytetrafluoroethylene (PTFE) felt sections and six expanded PTFE (ePTFE) patch sections were pulled-to-failure to analyze their biomechanical and material properties. Six direct tendon-to-bone surgical method repairs, six interpositional PTFE felt patch repairs and six interpositional ePTFE patch repairs were also constructed in ovine shoulders and pulled-to-failure to examine the biomechanical properties of each repair construct. Results Ovine tendon had higher load-to-failure (591 N) and had greater stiffness (108 N/mm) than either PTFE felt (296 N, 28 N/mm) or ePTFE patch sections (323 N, 34 N/mm). Both PTFE felt and ePTFE repair techniques required greater load-to-failure (225 N and 177 N, respectively) than direct tendon-to-bone surgical repairs (147 N) in ovine models. Conclusions Synthetic materials lacked several biomechanical properties, including strength and stiffness, compared to ovine tendon. Interpositional surgical repair models with these materials were significantly stronger than direct tendon-to-bone model repairs. PMID:27582997

  4. Augmentation of Rotator Cuff Repair With Soft Tissue Scaffolds

    PubMed Central

    Thangarajah, Tanujan; Pendegrass, Catherine J.; Shahbazi, Shirin; Lambert, Simon; Alexander, Susan; Blunn, Gordon W.

    2015-01-01

    Background Tears of the rotator cuff are one of the most common tendon disorders. Treatment often includes surgical repair, but the rate of failure to gain or maintain healing has been reported to be as high as 94%. This has been substantially attributed to the inadequate capacity of tendon to heal once damaged, particularly to bone at the enthesis. A number of strategies have been developed to improve tendon-bone healing, tendon-tendon healing, and tendon regeneration. Scaffolds have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects but may not possess situation-specific or durable mechanical and biological characteristics. Purpose To provide an overview of the biology of tendon-bone healing and the current scaffolds used to augment rotator cuff repairs. Study Design Systematic review; Level of evidence, 4. Methods A preliminary literature search of MEDLINE and Embase databases was performed using the terms rotator cuff scaffolds, rotator cuff augmentation, allografts for rotator cuff repair, xenografts for rotator cuff repair, and synthetic grafts for rotator cuff repair. Results The search identified 438 unique articles. Of these, 214 articles were irrelevant to the topic and were therefore excluded. This left a total of 224 studies that were suitable for analysis. Conclusion A number of novel biomaterials have been developed into biologically and mechanically favorable scaffolds. Few clinical trials have examined their effect on tendon-bone healing in well-designed, long-term follow-up studies with appropriate control groups. While there is still considerable work to be done before scaffolds are introduced into routine clinical practice, there does appear to be a clear indication for their use as an interpositional graft for large and massive retracted rotator cuff tears and when repairing a poor-quality degenerative tendon. PMID:26665095

  5. Efficacy of Different Rotator Cuff Repair Techniques.

    PubMed

    Gurnani, Navin; van Deurzen, Derek Friedrich Petrus; Flipsen, Mark; Raven, Eric Ernest Joseph; van den Bekerom, Michel Pieter Jozef

    2015-05-01

    The purpose of this review article is to describe the currently used techniques for rotator cuff repair and after treatment. The literature was searched for the different surgical techniques and additional treatment including: [1] full arthroscopic and arthroscopic assisted rotator cuff repair, [2] acromioplasty as an additional treatment to rotator cuff repair, [3] the use of plasma rich platelets (PRP) after rotator cuff repair, [4] the single and double row fixation techniques, [5] long head of the biceps brachii tenotomy or tenodesis with rotator cuff repair, [6] scaffolds in rotator cuff surgery, and [7] early motion or immobilization after rotator cuff repair. The rationale, the results, and the scientific evidence were reported for the eligible procedures. PMID:26055023

  6. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

    PubMed Central

    Tempelaere, Christine; Pierrart, Jérome; Lefèvre-Colau, Marie-Martine; Vuillemin, Valérie; Cuénod, Charles-André; Hansen, Ulrich; Mir, Olivier; Skalli, Wafa; Gregory, Thomas

    2016-01-01

    Background MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases. Methods Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI. Results The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05). Conclusion The Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position. PMID:27434235

  7. Acellular Dermal Matrix in Rotator Cuff Surgery.

    PubMed

    Cooper, Joseph; Mirzayan, Raffy

    2016-01-01

    The success of rotator cuff repair (RCR) surgery can be measured clinically (validated outcome scores, range of motion) as well as structurally (re-tear rates using imaging studies). Regardless of repair type or technique, most studies have shown that patients do well clinically. However, multiple studies have also shown that structurally, the failure rate can be very high. A variety of factors, including poor tendon quality, age over 63 years, smoking, advanced fatty infiltration into the muscle, and the inability of the tendon to heal to bone, have been implicated as the cause of the high re-tear rate in RCRs. The suture-tendon interface is felt to be the weakest link in the RCR construct, and suture pullout through the tendon is believed to be the most common method of failure. This review of the published literature seeks to determine if there is support for augmentation of RCR with acellular dermal matrices to strengthen the suture-tendon interface and reduce the re-tear rate. PMID:27552454

  8. Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model

    PubMed Central

    Luan, Tammy; Liu, Xuhui; Easley, Jeremiah T.; Ravishankar, Bharat; Puttlitz, Christian; Feeley, Brian T.

    2015-01-01

    Summary Introduction rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Muscle atrophy and fatty infiltration of the muscle are crucial factors that dictate the outcome following rotator cuff surgery. Though less studied in humans, rotator cuff muscle fibrosis has been seen in animal models as well and may influence outcomes as well. The purpose of this study was to determine if the rotator cuff would develop muscle changes even in the setting of an acute repair in a sheep model. We hypothesized that fatty infiltration and fibrosis would be present even after an acute repair six months after initial surgery. Methods twelve female adult sheep underwent an acute rotator cuff tear and immediate repair on the right shoulder. The left shoulder served as a control and did not undergo a tear or a repair. Six months following acute rotator cuff repairs, sheep muscles were harvested to study atrophy, fatty infiltration, and fibrosis by histological analysis, western blotting, and reverse transcription polymerase chain reaction (RT-PCR). Results the repair group demonstrated an increase expression of muscle atrophy, fatty infiltration, and fibrosis related genes. Significantly increased adipocytes, muscle fatty infiltration, and collagen deposition was observed in rotator cuff muscles in the tendon repair group compared to the control group. Conclusions rotator cuff muscle undergoes degradation changes including fatty infiltration and fibrosis even after the tendons are repair immediately after rupture. Level of Evidence Basic Science Study. PMID:26261789

  9. A Survey of Expert Opinion Regarding Rotator Cuff Repair.

    PubMed

    Acevedo, Daniel C; Paxton, E Scott; Williams, Gerald R; Abboud, Joseph A

    2014-07-16

    Many patients with rotator cuff tears have questions for their surgeons regarding the surgical procedure, perioperative management, restrictions, therapy, and ability to work after a rotator cuff repair. The purpose of our study was to determine common clinical practices among experts regarding rotator cuff repair and to assist them in counseling patients. We surveyed 372 members of the American Shoulder and Elbow Surgeons (ASES) and the Association of Clinical Elbow and Shoulder Surgeons (ACESS); 111 members (29.8%) completed all or part of the survey, and 92.8% of the respondents answered every question. A consensus response (>50% agreement) was achieved on 49% (24 of 49) of the questions. Variability in responses likely reflects the fact that clinical practices have evolved over time based on clinical experience. PMID:25031385

  10. Investigation of 3D glenohumeral displacements from 3D reconstruction using biplane X-ray images: Accuracy and reproducibility of the technique and preliminary analysis in rotator cuff tear patients.

    PubMed

    Zhang, Cheng; Skalli, Wafa; Lagacé, Pierre-Yves; Billuart, Fabien; Ohl, Xavier; Cresson, Thierry; Bureau, Nathalie J; Rouleau, Dominique M; Roy, André; Tétreault, Patrice; Sauret, Christophe; de Guise, Jacques A; Hagemeister, Nicola

    2016-08-01

    Rotator cuff (RC) tears may be associated with increased glenohumeral instability; however, this instability is difficult to quantify using currently available diagnostic tools. Recently, the three-dimensional (3D) reconstruction and registration method of the scapula and humeral head, based on sequences of low-dose biplane X-ray images, has been proposed for glenohumeral displacement assessment. This research aimed to evaluate the accuracy and reproducibility of this technique and to investigate its potential with a preliminary application comparing RC tear patients and asymptomatic volunteers. Accuracy was assessed using CT scan model registration on biplane X-ray images for five cadaveric shoulder specimens and showed differences ranging from 0.6 to 1.4mm depending on the direction of interest. Intra- and interobserver reproducibility was assessed through two operators who repeated the reconstruction of five subjects three times, allowing defining 95% confidence interval ranging from ±1.8 to ±3.6mm. Intraclass correlation coefficient varied between 0.84 and 0.98. Comparison between RC tear patients and asymptomatic volunteers showed differences of glenohumeral displacements, especially in the superoinferior direction when shoulder was abducted at 20° and 45°. This study thus assessed the accuracy of the low-dose 3D biplane X-ray reconstruction technique for glenohumeral displacement assessment and showed potential in biomechanical and clinical research. PMID:26350569

  11. Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

    PubMed

    Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

    2016-01-01

    Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears. PMID:26761928

  12. Arthroscopic Transosseous Rotator Cuff Repair: Technical Note, Outcomes, and Complications

    PubMed Central

    Black, Eric M.; Lin, Albert; Srikumaran, Uma; Jain, Nitin; Freehill, Michael T.

    2016-01-01

    The goal of this study was to review the authors’ initial experience with arthroscopic transosseous rotator cuff repair. Thirty-one patients with full-thickness rotator cuff tears underwent arthroscopic transosseous rotator cuff repair over a 15-month period. Preoperatively, demographics and subjective scores were recorded. Postoperatively, pain levels, subjective shoulder values, satisfaction scores, American Shoulder and Elbow Surgeons (ASES) scores, complications, and reoperations were noted with a minimum 2-year follow-up. The relationships between pre- and intraoperative variables and outcome scores were determined with univariate analysis. Average patient age was 56 years, and 23 patients (74%) were men. Twenty patients (65%) underwent primary rotator cuff repair, and 11 patients (35%) underwent revision repair. Average time to follow-up was 26 months. Average preoperative pain level and subjective shoulder value were 5.1 of 10 and 35%, respectively. Average postoperative scores included pain level of 0.9 of 10, subjective shoulder value of 84%, satisfaction score of 90.6 of 100, and ASES score of 86.3 of 100. There were 3 (9.7%) major and 2 (6%) minor complications. Patients undergoing revision rotator cuff repair had significantly worse outcomes (pain level, subjective shoulder value, ASES score; P<.05) compared with those undergoing primary repair, and cortical augmentation did not significantly affect outcome. Overall, outcomes after arthroscopic transosseous rotator cuff repair are good, although patients undergoing revision repair do not have the same outcomes as those undergoing primary cuff repair. The procedure is not without complications (9.7% major, 6% minor complications). Cortical augmentation may be used to supplement fixation, although it does not necessarily affect outcomes. Patients without such augmentation may be at increased risk for suture cutout through the bone. PMID:25970360

  13. Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

    PubMed Central

    Flanagin, Brody A.; Garofalo, Raffaele; Lo, Eddie Y.; Feher, LeeAnne; Castagna, Alessandro; Qin, Huanying; Krishnan, Sumant G.

    2016-01-01

    Purpose: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student's t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique leads to

  14. Teres Minor Hypertrophy is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair

    PubMed Central

    Tokish, John M.; Thigpen, Charles A.; Kissenberth, Michael J.; Hunt, Quinn; Tolan, Stefan John; Swinehart, S. Dane; Shelley, Christina; Hawkins, Richard J.

    2016-01-01

    Objectives: The teres minor has received increased attention in its role as a rotator cuff muscle, particularly in the setting of large infraspinatus tears. Studies have shown that it plays an important beneficial role after total (TSA) and reverse (RSA) shoulder arthroplasty, as well as in maintenance of function in the setting of infraspinatus wasting in patients with large rotator cuff tears. No study, however, has investigated how often teres minor hypertrophy occurs in a population of rotator cuff tears, whether it occurs in the absence of infraspinatus tearing, or whether it is a positive or negative prognostic indicator on outcomes after rotator cuff repair. The purpose of this study was to determine the prevalence of teres minor hypertrophy in a cohort of patients undergoing rotator cuff repair, and to determine its prognostic effect, if any, on outcomes after surgical repair. Methods: Over a 3 year period, all rotator cuff repairs performed in a single practice by 3 American Shoulder and Elbow Society (ASES) member surgeons were collected. One hundered forty-four patients who had preoperative and postoperative (ASES) outcomes (minimum 2 year), and preoperative Magnetic Resonance Imaging (MRI) were included in the study. All MRIs were evaluated for rotator cuff tear tendon involvement, tear size, and Goutallier changes of each muscle. In addition, occupational ratios were determined for the supraspinatus, infraspinatus, and teres minor muscles. Patients were divided into 2 groups, based upon whether they had teres minor hypertrophy or not, based on a previously established definition. A 2 way univariate ANOVA was used to determine the effect of teres minor hypertrophy(tear size by hypertrophy) and Goutallier changes(tear size by fatty infiltration) on ASES change scores(α=0.05) Results: Teres minor hypertrophy was a relatively common finding in this cohort of rotator cuff patients, with 51% of all shoulders demonstrating hypertrophy. Interestingly, in

  15. Management of failed rotator cuff repair: a systematic review

    PubMed Central

    Lädermann, Alexandre; Denard, Patrick J; Burkhart, Stephen S

    2016-01-01

    Importance Recurrent tear after rotator cuff repair (RCR) is common. Conservative, and open and arthroscopic revisions, have been advocated to treat these failures. Aim or objective The purpose of this systematic review was to evaluate the different options for managing recurrent rotator cuff tears. Evidence review A search was conducted of level I through 4 studies from January 2000 to October 2015, to identify studies reporting on failed RCR. 10 articles were identified. The overall quality of evidence was very low. Findings Mid-term to long-term follow-up of patients treated conservatively revealed acceptable results; a persistent defect is a well-tolerated condition that only occasionally requires subsequent surgery. Conservative treatment might be indicated in most patients, particularly in case of posterosuperior involvement and poor preoperative range of motion. Revision surgery might be indicated in a young patient with a repairable lesion, a 3 tendon tear, and in those with involvement of the subscapularis. Conclusions and relevance The current review indicates that arthroscopic revision RCR can lead to improvement in functional outcome despite a high retear rate. Further studies are needed to develop specific rehabilitation in the case of primary rotator cuff failure, to better understand the place of each treatment option, and, in case of repair, to optimise tendon healing. PMID:27134759

  16. REHABILITATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: CURRENT CONCEPTS REVIEW AND EVIDENCE-BASED GUIDELINES

    PubMed Central

    Westgard, Paul; Chandler, Zachary; Gaskill, Trevor R.; Kokmeyer, Dirk; Millett, Peter J.

    2012-01-01

    Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion. Methods: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities. Results: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data. Conclusion: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation. PMID:22530194

  17. Investigating the cellular origin of rotator cuff muscle fatty infiltration and fibrosis after injury

    PubMed Central

    Liu, Xuhui; Ning, Anne Y.; Chang, Nai Chen; Kim, Hubert; Nissenson, Robert; Wang, Liping; Feeley, Brian T.

    2016-01-01

    Summary Background rotator cuff muscle atrophy, fibrosis and fatty infiltration are common complications after large and massive rotator cuff tears. Currently, there are no effective treatments for these muscle pathologies after injury. Furthermore, the cellular source for fibrotic and adipose tissues in rotator cuff muscle after injury remains unknown. In this study, we proposed that two groups of muscle resident progenitors, Tie2+ muscle mesenchymal progenitors and PDGFRα+ fibro/adipogenic progenitor cells (FAPs), contribute significantly to rotator cuff muscle fibrosis and fatty infiltration. Methods we tested our hypothesis using reporter mice. Rotator cuff muscles from Tie2-GFP and PDGFRα-GFP reporter mice were harvested at 2 and 6 weeks after unilateral massive rotator cuff tear surgeries. Immunofluorescent staining for fibroblast and adipocyte markers was conducted. Results our results showed significant co-localization of Tie2+ cells with fibrotic markers vimentin and αSMA. In the PDGFRα-GFP reporter mice, GFP signal was seen in only a small fraction of cells staining positive for vimentin and αSMA. However, PDGFRα showed significant co-localization with adipocyte markers, including PPAR-γ, adiponectin, and perilipin A. Oil red O staining confirmed that the mature adipocytes appearing in rotator cuff muscles after injury are also PDGFRα+. Conclusion these data demonstrated that the Tie2+ muscle mesenchymal progenitors are the major source of fibroblasts while PDGFRα+ FAPs are the major source of adipocytes in rotator cuff muscle fatty infiltration. Basic Science Study. PMID:27331027

  18. Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

    PubMed Central

    Lee, Kwang Won; Bae, Kyoung Wan; Choy, Won Sik

    2013-01-01

    Background We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. Results Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and

  19. Measurement of migration of soft tissue by modified Roentgen stereophotogrammetric analysis (RSA): validation of a new technique to monitor rotator cuff tears.

    PubMed

    Cashman, P M M; Baring, T; Reilly, P; Emery, R J H; Amis, A A

    2010-04-01

    The purpose of this study was to develop a technique to use Roentgen stereophotogrammetric analysis (RSA) to measure migration of soft-tissue structures after rotator cuff repair. RSA stereo films were obtained; images were analysed using a semi-automatic software program allowing 3D viewing of results. RSA imaging experiments were performed to validate the technique, using a glass phantom with implanted RSA beads and an animal model with steel sutures as RSA markers which were moved known distances. Repeated measurements allowed assessment of inter- and intra-observer variability at a maximum of 1.06 mm. RSA analysis of the phantom showed a variation up to 0.22 mm for static and 0.28 mm for dynamic studies. The ovine tissue specimen demonstrated that using steel sutures as RSA markers in soft tissue is feasible, although less accurate than when measuring bone motion. This novel application of RSA to measure soft tissue migration is practicable and can be extended to in vivo studies. PMID:20143960

  20. Editorial Commentary: Reflections From a Mature Arthroscopic Shoulder Surgeon on the History and Current Benefits of Augmentation for the Revision of a Massive Rotator Cuff Tear Using Acellular Human Dermal Matrix Allograft.

    PubMed

    Snyder, Stephen J

    2016-09-01

    Acellular human dermal matrix allografts are now being used to augment and sometimes replace severely damaged rotator cuff tissue. I have been interested in this important aspect of orthopaedics for 15 years and am pleased to have the opportunity to share my personal reflections of some of the highlights in science and the literature that helped get to the point now where we can expect greater than 80% healing even in these difficult cases of revision after massive failed cuff repair. The field of tissue engineering will certainly be a critical part of our rotator cuff surgical future. PMID:27594327

  1. Imaging of the Rotator Cuff With Optical Coherence Tomography.

    PubMed

    Hartshorn, Timothy; Ren, Jian; Vangsness, C Thomas

    2015-09-01

    This study evaluated the utility of optical coherence tomography (OCT) in imaging porcine and human rotator cuff (RTC) tissue, analyzed its effectiveness in identifying clinical pathology, and correlated these findings with histologic examination. Twelve human cadaveric and 6 porcine shoulders were evaluated. Six-millimeter-wide bone sections were harvested from the proximal humerus of each specimen, with each containing the entire enthesis of the respective RTC tendon, as well as 2 cm of tendon medial to the enthesis. Only the supraspinatus tendon was evaluated in the human specimens, whereas the enthesis of multiple RTC tendons were evaluated in the porcine model. All specimens were imaged using OCT and correlated with histologic evaluation. Optical coherence tomography evaluation of macroscopically healthy tissue consistently showed an easily identifiable banding pattern (birefringence) in contrast to a disorganized, homogeneous appearance in grossly diseased tissue. Optical coherence tomography was more effective for qualitative evaluation of RTC tissue, identification of bursal-sided RTC tears, and localization of calcific deposits, whereas intrasubstance tendon delaminations and partial articular-sided tendon avulsion lesions were relatively more difficult to identify. Optical coherence tomography correlated well with histologic evaluation in all specimens. Optical coherence tomography provides high-resolution, subsurface imaging of rotator cuff tissue in real-time to a depth of up to 4 mm with excellent correlation to histology in a cadaveric model. Optical coherence tomography could be an effective adjunctive tool for the identification and localization of rotator cuff pathology. The use of OCT in arthroscopic shoulder surgery potentially provides a minimally invasive modality for qualitative assessment of rotator cuff pathology. This may allow for a decrease in soft tissue dissection, improved qualitative assessment of cuff tissue, and improved patient

  2. Delivered growth factor therapy to improve healing after rotator cuff repair

    PubMed Central

    Cheung, Emilie V; Silverio, Luz; Yao, Jeffrey

    2010-01-01

    Background Degenerative rotator cuff tears are a significant cause of shoulder pain in the aging population. Rotator cuff repair surgery may be more successful when growth factors are delivered to the repair site. This study was designed to determine the cellular processes involved in normal bone-to-tendon healing and the current approaches used for biologic augmentation of rotator cuff repair. Methods This review focuses on animal studies of rotator cuff repair and early human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is markedly different from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for endogenous fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells. However, research in extracellular matrices is not conclusive due to intermanufacturer variation and the lack of human subject research. Growth factors and platelet-rich plasma are established in other fields of research and show promise, but have not yet been rigorously tested in rotator cuff repair augmentation. Conclusions Rotator cuff repair can benefit from biologic augmentation. However, research in this field is still young and has not yet demonstrated that the benefits in healing rates are significant enough to merit regular clinical use. Randomized controlled trials will elucidate the use of biologic augmentation in rotator cuff repairs. PMID:24198519

  3. FATTY MUSCLE INFILTRATION IN CUFF TEAR: PRE AND POST OPERATIVE EVALUATION BY MRI

    PubMed Central

    Miyazaki, Alberto Naoki; Santos, Pedro Doneux; da Silva, Luciana Andrade; Sella, Guilherme do Val; Miranda, Eduardo Régis de Alencar Bona; Zampieri, Rodrigo

    2015-01-01

    ABSTRACT Objective: To evaluate the fatty infiltration and atrophy of the supraespinatus in the pre- and postoperative of a rotator cuff lesion (RCL), by MRI. Methods: Ten patients with full-thickness rotator cuff tears who had undergone surgical arthroscopic rotator cuff repair between September and December 2011 were included. This is a prospective study, with analysis and comparison of fatty infiltration and atrophy of the supraespinatus. The occupation ratio was measured using the magic selection tool in Adobe Photoshop CS3(r) on T1 oblique sagittal Y-view MRI. Through Photoshop, the proportion occupied by the muscle belly regarding its fossae was calculated. Results: There was a statistically significant increase in the muscle ratio (p=0.013) comparing images pre and postoperative, analyzed by the Wilcoxon T test. Conclusion: The proportion of the supraspinal muscle above the pit increases in the immediate postoperative period, probably due to the traction exerted on the tendon at the time of repair. Level of Evidence II, Cohort Study. PMID:26981032

  4. Rotator cuff biology and biomechanics: a review of normal and pathological conditions.

    PubMed

    Huegel, Julianne; Williams, Alexis A; Soslowsky, Louis J

    2015-01-01

    The glenohumeral joint is a complex anatomic structure commonly affected by injury such as tendinopathy and rotator cuff tears. This review presents an up-to-date overview of research on tendon biology and structure, shoulder joint motion and stability, tendon healing, and current and potential future repair strategies. Recent studies have provided information demonstrating the serious impact on uninjured tissues after a rotator cuff tear or other cause of altered shoulder joint mechanics. Another major focus of recent research is biological augmentation of rotator cuff repair with the goal of successfully reinstating normal tendon-to-bone structure. To effectively treat shoulder pathologies, clinicians need to understand normal tendon biology, the healing process and environment, and whole shoulder stability and function. PMID:25475598

  5. Treatment of lesions of the rotator cuff.

    PubMed

    Saggini, R; Cavezza, T; Di Pancrazio, L; Pisciella, V; Saladino, G; Zuccaro, M C; Bellomo, R G

    2010-01-01

    The impingement syndrome and tendinopathy of the rotator cuff are the most common causes (complaints) of pain and disability of the shoulder. The aim of this study is to evaluate the efficacy of a specific rehabilitative protocol, integrated with the administration of a nutritional supplement, in the conservative rehabilitative treatment, as well as in post-surgery, of patients with lesions of the rotator cuff. Two groups with syndrome of the rotator cuff were formed to follow different therapeutic courses, in relation to the choice of each subject to undergo the conservative treatment (Arm A) or the surgical one (Arm B). In Arm A the study included the association of therapy with ESWT (shock waves) with the proprioceptive Multi Joint System, for rehabilitating joint movement and muscle strength of the shoulder, and a specific nutritional supplement to reduce the pain and conserve the cartilage tissue. Between February 2009 and June 2009, we enrolled 30 subjects (randomized into three homogenous groups A1, A2, A3), average age 45±10 years, with rotator cuff syndrome with calcification of the shoulder, diagnosed through clinical examination and investigative instruments (X-ray, echography or NMR). In Arm B, from September 2009 to January 2010, we enrolled 50 patients (randomized into two groups, B1 and B2), 24 male (average age 58.4: min 28 and max 78) and 26 females (average age 59.5: min 30 and max 80), who had undergone rotator cuff operations and acromionplasty for non-massive lesions without important gleno-humeral instability, with either open or arthroscopic procedures. The analysis of the results of Arm A highlights that in terms of reducing pain the main benefits were found in Group A1 where the supplement was given. From the analysis of the data of Arm B, in both groups an improvement of the first 4 items evaluated was evident. In Group B1, 84 percent of the patients declared to be satisfied and improved and 16 percent were dissatisfied; in Group B2

  6. Tissue Engineering for Rotator Cuff Repair: An Evidence-Based Systematic Review

    PubMed Central

    Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Spiezia, Filippo; Denaro, Vincenzo

    2012-01-01

    The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month follow up. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup. PMID:25098365

  7. Anomalous biceps origin from the rotator cuff

    PubMed Central

    Banerjee, Samik; Patel, Vipul R

    2015-01-01

    Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. PMID:25593361

  8. Vitamin D and the immunomodulation of rotator cuff injury

    PubMed Central

    Dougherty, Kaitlin A; Dilisio, Matthew F; Agrawal, Devendra K

    2016-01-01

    Tendon-to-bone healing after rotator cuff repair surgery has a failure rate of 20%–94%. There has been a recent interest to determine the factors that act as determinants between successful and unsuccessful rotator cuff repair. Vitamin D level in patients is one of the factors that have been linked to bone and muscle proliferation and healing, and it may have an effect on tendon-to-bone healing. The purpose of this article is to critically review relevant published research that relates to the effect of vitamin D on rotator cuff tears and subsequent healing. A review of the literature was conducted to identify all studies that investigate the relationship between vitamin D and tendon healing, in addition to its mechanism of action. The data were then analyzed in order to summarize what is currently known about vitamin D, rotator cuff pathology, and tendon-to-bone healing. The activated metabolite of vitamin D, 1α,25-dihydroxyvitamin D3, affects osteoblast proliferation and differentiation. Likewise, vitamin D plays a significant role in the tendon-to-bone healing process by increasing the bone mineral density and strengthening the skeletal muscles. The 1α,25-dihydroxyvitamin D3 binds to vitamin D receptors on myocytes to stimulate growth and proliferation. The form of vitamin D produced by the liver, calcifediol, is a key initiator of the myocyte healing process by moving phosphate into myocytes, which improves function and metabolism. Investigation into the effect of vitamin D on tendons has been sparse, but limited studies have been promising. Matrix metalloproteinases play an active role in remodeling the extracellular matrix (ECM) of tendons, particularly deleterious remodeling of the collagen fibers. Also, the levels of transforming growth factor-β3 positively influence the success of the surgery for rotator cuff repair. In the tendon-to-bone healing process, vitamin D has been shown to successfully influence bone and muscle healing, but more research is

  9. Rehabilitation following rotator cuff repair: a survey of current UK practice

    PubMed Central

    Bateman, Marcus

    2015-01-01

    Background Rotator cuff disorders, including rotator cuff tears, are common and can be treated conservatively or surgically. Data suggest that the incidence of surgery to repair the rotator cuff is rising. Despite this rise, the most effective approach to postoperative rehabilitation, a critical component of the recovery process, is not well developed. The present study aimed to describe current practice in the UK in relation to rehabilitation following rotator cuff repair. Methods An electronic survey was developed and disseminated to UK based physiotherapists and surgeons involved with rotator cuff repair. Results One hundred valid responses were received. Although there is a degree of variation, current practice for the majority of respondents consists of sling immobilization for 4 weeks to 6 weeks. During this time, passive movement would be commenced before active movement is introduced towards the end of this phase. Resisted exercise begins 7 weeks to 12 weeks postoperatively, alongside return to light work. A progressive resumption of function, including manual work and sport, is advised from approximately 13 weeks. Conclusions In the context of the current literature, it might be suggested that the current approach to rehabilitation following rotator cuff repair for the majority of respondents is somewhat cautious and has not progressed for over a decade.

  10. A New Technique for Patch Augmentation of Rotator Cuff Repairs

    PubMed Central

    Mihara, Shuzou; Ono, Teruyasu; Inoue, Hirofumi; Kisimoto, Tetsurou

    2014-01-01

    Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small- to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. PMID:25126505

  11. Tendon graft substitutes-rotator cuff patches.

    PubMed

    Coons, David A; Alan Barber, F

    2006-09-01

    Over the past few years, many biologic patches have been developed to augment repairs of large or complex tendon tears. These patches include both allograft and xenografts. Regardless of their origins, these products are primarily composed of purified type I collagen. Many factors should be considered when choosing an augmentation patch including tissue origin, graft processing, cross-linking, clinical experience, and physical properties. The purpose of this article is to familiarize the sports medicine community with several tendon augmentation grafts: GraftJacket (Wright Medical Technology, Arlington, TN), CuffPatch (Organogenesis, Canton, MA, licensed to Arthrotek, Warsaw, IN), Restore (Depuy, Warsaw, IN), Zimmer Collagen Repair (Permacol) patch (Tissue Science Laboratories Covington, GA, licensed to Zimmer, Warsaw, IN), TissueMend (TEI Biosciences, Boston, MA, licensed to Stryker Howmedica Osteonics, Kalamazoo, MI), OrthoADAPT (Pegasus Biologics, Irvine, CA), and BioBlanket (Kensey Nash, Exton, PA). PMID:17135966

  12. Synthetic Patch Rotator Cuff Repair: A 10-year Follow-Up

    PubMed Central

    Shepherd, Henry M.; Lam, Patrick H.; Murrell, George A. C.

    2013-01-01

    Background The present study aimed to determine the long-term outcome as a result of the use of synthetic patches as tendon substitutes to bridge massive irreparable rotator cuff defects. Methods All patients who previously had a rotator cuff repair with a synthetic patch (2-mm Gore DUALMESH ePTFE patch; Gore, Flagstaff, AZ, USA; or a 2.87-mm Bard PTFE Felt pledgets; CR Bard, Warwick, RI, USA) were followed-up at a minimum of 8.5 years postoperatively. Assessment of shoulder pain, function, range of motion, strength and imaging was performed. Results Six patients had an interpositional repair with a synthetic patch. One patient had died. In the remaining five patients, the mean tear size at repair was 27 cm2. At 9.7 years postoperatively, all the patches remained in situ and no patient required further surgery. The repair was intact in four out of five patients. Patients had improved external rotation and abduction compared to before surgery (p < 0.02). Conclusions We describe the long-term outcomes of patients who had undergone synthetic patch rotator cuff repair for an irreparable rotator cuff tear. At 9.7 years postoperatively, patients reported less severe and more infrequent pain, as well as greater overall shoulder function, compared to before surgery. Patients also had increased passive external rotation and abduction. All the patches remain in situ and there have been no further operations on these shoulders. PMID:27582907

  13. Postoperative pain control after arthroscopic rotator cuff repair.

    PubMed

    Uquillas, Carlos A; Capogna, Brian M; Rossy, William H; Mahure, Siddharth A; Rokito, Andrew S

    2016-07-01

    Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction. PMID:27079219

  14. Prognostic factors for clinical outcomes after rotator cuff repair

    PubMed Central

    Pécora, José Otávio Reggi; Malavolta, Eduardo Angeli; Assunção, Jorge Henrique; Gracitelli, Mauro Emílio Conforto; Martins, João Paulo Sobreiro; Ferreira, Arnaldo Amado

    2015-01-01

    OBJECTIVE: To identify prognostic factors of postoperative functional outcomes. METHODS: Retrospective case series evaluating patients undergoing rotator cuff repair, analyzed by the UCLA score (pre and 12-month postoperative) and Magnetic Resonance Imaging (preoperative). Patients' intrinsic variables related to the injury and intervention were evaluated. Multivariate linear regression analysis was performed to determine variables impact on postoperative functional assessment. RESULTS: 131 patients were included. The mean UCLA score increased from 13.17 ± 3.77 to 28.73 ± 6.09 (p<0,001). We obtained 65.7% of good and excellent results. Age (r= 0.232, p= 0.004) and reparability of posterosuperior injuries (r= 0.151, p= 0.043) correlated with the functional assessment at 12 months. After multivariate linear regression analysis, only age was associated (p = 0.008). CONCLUSIONS: The surgical treatment of rotator cuff tears lead to good and excellent results in 65.6% of patients. Age was an independent predictor factor with better clinical outcomes by UCLA score in older patients. Level of Evidence IV, Case Series. PMID:26207092

  15. TGF-β Small Molecule Inhibitor SB431542 Reduces Rotator Cuff Muscle Fibrosis and Fatty Infiltration By Promoting Fibro/Adipogenic Progenitor Apoptosis

    PubMed Central

    Lee, Lawrence; Laron, Dominique; Ning, Anne Y.; Kim, Hubert T.; Feeley, Brian T.

    2016-01-01

    Rotator cuff tears represent a large burden of muscle-tendon injuries in our aging population. While small tears can be repaired surgically with good outcomes, critical size tears are marked by muscle atrophy, fibrosis, and fatty infiltration, which can lead to failed repair, frequent re-injury, and chronic disability. Previous animal studies have indicated that Transforming Growth Factor-β (TGF-β) signaling may play an important role in the development of these muscle pathologies after injury. Here, we demonstrated that inhibition of TGF-β1 signaling with the small molecule inhibitor SB431542 in a mouse model of massive rotator cuff tear results in decreased fibrosis, fatty infiltration, and muscle weight loss. These observed phenotypic changes were accompanied by decreased fibrotic, adipogenic, and atrophy-related gene expression in the injured muscle of mice treated with SB431542. We further demonstrated that treatment with SB431542 reduces the number of fibro/adipogenic progenitor (FAP) cells—an important cellular origin of rotator cuff muscle fibrosis and fatty infiltration, in injured muscle by promoting apoptosis of FAPs. Together, these data indicate that the TGF-β pathway is a critical regulator of the degenerative muscle changes seen after massive rotator cuff tears. TGF-β promotes rotator cuff muscle fibrosis and fatty infiltration by preventing FAP apoptosis. TGF-β regulated FAP apoptosis may serve as an important target pathway in the future development of novel therapeutics to improve muscle outcomes following rotator cuff tear. PMID:27186977

  16. Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting.

    PubMed

    Arce, Guillermo; Bak, Klaus; Bain, Gregory; Calvo, Emilio; Ejnisman, Benno; Di Giacomo, Giovanni; Gutierrez, Vicente; Guttmann, Dan; Itoi, Eiji; Ben Kibler, W; Ludvigsen, Tom; Mazzocca, Augustus; de Castro Pochini, Alberto; Savoie, Felix; Sugaya, Hiroyuki; Uribe, John; Vergara, Francisco; Willems, Jaap; Yoo, Yon Sik; McNeil, John W; Provencher, Matthew T

    2013-11-01

    The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented. PMID:24041864

  17. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

    PubMed

    Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

    2014-06-28

    Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report. PMID:24976930

  18. Rotator Cuff Disease and Injury--Evaluation and Management.

    ERIC Educational Resources Information Center

    Williams, Randy

    This presentation considers the incidence, evaluation, and management of rotator cuff disease and injury. Pathogenesis, symptoms, physical findings, treatment (therapeutic and surgical), and prevention are discussed. It is noted that rotator cuff problems, common in athletes, are usually related to an error in training or lack of training. They…

  19. Rat rotator cuff tendon-to-bone healing properties are adversely affected by hypercholesterolemia

    PubMed Central

    Beason, David P.; Tucker, Jennica J.; Lee, Chang Soo; Edelstein, Lena; Abboud, Joseph A.; Soslowsky, Louis J.

    2014-01-01

    Background Rotator cuff tendon tears represent a major component of reported orthopaedic injuries. In addition, more than one quarter of U.S. adults either currently have high cholesterol levels or have reduced their previously high cholesterol levels through the use of pharmaceuticals. Our clinical data have already linked hypercholesterolemia to full-thickness rotator cuff tears, and experimental data from our laboratory have shown effects on native tendon properties in multiple species. The objective of this study was to evaluate healing of supraspinatus tendons in our rat rotator cuff injury model. We hypothesized that tendon healing would be inferior in rats receiving a high-cholesterol diet for 6 months compared with those receiving standard chow. Methods All animals were subjected to a unilateral supraspinatus detachment and repair surgery, with contralateral limbs serving as within-animal comparative data. Animals continued their respective diet courses, and their supraspinatus tendons were biomechanically or histologically evaluated at 2, 4, and 8 weeks postoperatively. Results Biomechanical testing revealed a significant reduction in normalized stiffness in hypercholesterolemic rats compared with controls at 4 weeks after injury, whereas histologic analyses showed no significant differences in collagen organization, cellularity, or cell shape between groups. Conclusion On the basis of our findings, hypercholesterolemia may have a detrimental biomechanical effect on tendon healing in our rat rotator cuff injury and repair model. Level of evidence Basic Science Study, Animal Model. PMID:24295837

  20. Repair Integrity and Clinical Outcomes Following Arthroscopic Rotator Cuff Repair

    PubMed Central

    Williams, Ariel A.; Mark, P.; DiVenere, Jessica Megan; Klinge, Stephen Austin; Arciero, Robert A.; Mazzocca, Augustus D.

    2016-01-01

    Objectives: To prospectively evaluate the effect of early versus delayed motion on repair integrity on 6-month postoperative magnetic resonance imaging (MRI) scans following rotator cuff repair, and to correlate repair integrity with clinical and functional outcomes. We hypothesized that repair integrity would differ between the early and delayed groups and that patients with repair failures would have worse clinical and functional outcomes. Methods: This was a prospective, randomized, single blinded clinical trial comparing an early motion (post-op day 2-3) to a delayed motion (post-op day 28) rehabilitation protocol following arthroscopic repair of isolated supraspinatus tears. All patients underwent MRI at 6 months post-operatively as part of the study protocol. A blinded board-certified and fellowship-trained orthopaedic surgeon (not part of the surgical team) reviewed operative photos and video to confirm the presence of a full thickness supraspinatus tear and to ensure an adequate and consistent repair. The same surgeon along with a blinded sports medicine fellowship-trained musculoskeletal radiologist independently reviewed all MRIs to determine whether the repair was intact at 6 months. Outcome measures were collected by independent evaluators who were also blinded to group assignment. These included the Western Ontario Rotator Cuff (WORC) index, Single Assessment Numeric Evaluation (SANE) ratings, pain scores, sling use, and physical exam data. Enrolled patients were followed at 6 weeks, 6 months, and 1 year. Results: From October 2008 to April 2012, 73 patients met all inclusion criteria and were willing to participate. 36 patients were randomized to delayed motion and 37 were randomized to early motion. The final study group at 6 months consisted of 58 study participants. Postoperative MRIs were obtained on all of these patients at 6 months regardless of whether or not they were progressing as expected. These MRIs demonstrated an overall failure rate of

  1. Interposition Porcine Acellular Dermal Matrix Xenograft Successful Alternative in Treatment for Massive Rotator Cuff

    PubMed Central

    Neumann, Julie; Zgonis, Miltiadis H.; Reay, Kathleen Dolores; Mayer, Stephanie W.; Boggess, Blake; Toth, Alison P.

    2016-01-01

    Objectives: Despite advances in the surgical techniques of rotator cuff repair (RCR), the management of massive rotator cuff tears in shoulders without glenohumeral arthritis poses a difficult problem for surgeons. Failure of massive rotator cuff repairs range from 20-90% at one to two years postoperatively using arthrography, ultrasound, or magnetic resonance imaging. Additionally, there are inconsistent outcomes reported with debridement alone of massive rotator cuff tears as well as limitations seen with other current methods of operative intervention including arthroplasty and tendon transfers. The purpose of this prospective, comparative study was to determine if the repair of massive rotator cuff tears using an interposition porcine acellular dermal matrix xenograft improves subjective function, pain, range of motion, and strength at greater than two years follow-up. To our knowledge, this is the largest prospective series reporting outcomes of using porcine acellular dermal matrix xenograft as an interposition graft. Methods: Thirty-seven patients (37 shoulders) with an average age of 66 years (range 51-80 years) were prospectively followed for 33 months (range 23-48) following massive RCR using porcine acellular dermal matrix interposition xenograft. Subjective outcomes were measured using the Visual Analog Scale (VAS) pain score (0-10, 0 = no pain), Modified American Shoulder and Elbow Score (M-ASES), and Short-Form12 (SF-12) scores. Preoperative and postoperative objective outcome measures included active range of motion and supraspinatus and infraspinatus manual muscle strength. Postoperative outcome measures included quantitative muscle strength using a dynamometer and static and dynamic ultrasonography to assess the integrity of the repair. Results: Average VAS pain score decreased from 4.5 to 1.1 (P<0.001). Average postoperative M-ASES was 89.23. Average postoperative SF-12 was 52.6. Mean forward flexion, external and internal rotation significantly

  2. Management of Rotator Cuff and Impingement Injuries in the Athlete

    PubMed Central

    Williams, Gerald R.; Kelley, Martin

    2000-01-01

    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. PMID:16558644

  3. Management of complications after rotator cuff surgery.

    PubMed

    Parada, Stephen A; Dilisio, Matthew F; Kennedy, Colin D

    2015-03-01

    Rotator cuff repair (RCR) is a common procedure performed by orthopedic surgeons via arthroscopic, open, or mini-open techniques. While this surgery is considered to be of low morbidity, several potential complications can arise either intraoperatively or during the postoperative time period. Some of these complications are related to the surgical approach (arthroscopic or open), while others are patient dependent. Many of these complications can be managed through nonoperative means; however, early recognition and timely treatment is essential in limiting the long-term sequela and improving patient outcome. There are several different ways to classify complications after RCR repair: timing, severity, preventability, whether or not the pathology is intra- or extra-articular, and the type of treatment necessary. It is essential that the surgeon is cognizant of the etiology contributing to the failed RCR surgery in order to provide timely and proper management. PMID:25532916

  4. Rotator Cuff Damage: Reexamining the Causes and Treatments.

    ERIC Educational Resources Information Center

    Nash, Heyward L.

    1988-01-01

    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)

  5. Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?☆

    PubMed Central

    Miyazaki, Alberto Naoki; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Checchia, Sérgio Luiz; Yonamine, Alexandre Maris

    2015-01-01

    Objective To evaluate whether the good and excellent functional results from arthroscopic repair of massive rotator cuff tears are maintained over the long term. Methods From the sample of the study conducted by our group in 2006, in which we evaluated the functional results from arthroscopic repair of massive rotator cuff tears, 35 patients were reassessed, 8 years after the first evaluation. The inclusion criteria were that these patients with massive rotator cuff tears operated by means of an arthroscopic technique, who participated in the previous study and achieved good or excellent outcomes according to the UCLA criteria. Patients whose results were not good or excellent in the first evaluation according to the UCLA criteria were excluded. Results Among the 35 patients reassessed, 91% of them continued to present good and excellent results (40% excellent and 51% good), while 3% presented fair results and 6% poor results. The time interval between the first and second evaluations was 8 years and the minimum length of follow-up since the immediate postoperative period was 9 years (range: 9–17 years), with an average of 11.4 years. Conclusion The good and excellent results from arthroscopic repair of massive rotator cuff tears were mostly maintained (91%), with the same level of function and satisfaction, even though 8 years had passed since the first assessment, with a follow-up period averaging 11.4 years. PMID:26962491

  6. Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 2: Rotator Cuff.

    PubMed

    Murray, Iain R; LaPrade, Robert F; Musahl, Volker; Geeslin, Andrew G; Zlotnicki, Jason P; Mann, Barton J; Petrigliano, Frank A

    2016-03-01

    Rotator cuff tears are common and result in considerable morbidity. Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing. Tears often progress without intervention, and current surgical treatments are inadequate. Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears. The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function after surgery. This article presents a review of current and emerging biologic approaches to augment rotator cuff tendon and muscle regeneration focusing on the scientific rationale, preclinical, and clinical evidence for efficacy, areas for future research, and current barriers to advancement and implementation. PMID:27099865

  7. Age-related changes of mitochondrial transcription factor a expression in rotator cuff degeneration

    PubMed Central

    Ichiseki, Toru; Ueda, Shusuke; Ueda, Yoshimichi; Kaneuji, Ayumi; Kawahara, Norio; Matsumoto, Tadami

    2015-01-01

    One cause of rotator cuff tears is thought to be age-related degenerative changes occurring in the rotator cuff. Using Rat rotator cuff we determined age-related changes in mitochondrial transcription factor A (TFAM) expression in rotator cuff degeneration to clarify the presence/absence of mitochondrial stress. The materials used were rotator cuffs (supraspinatus) of 5-, 24-, 48-, and 100-week-old Wistar Rats (five animals each). Histopathological study revealed a 4-layer structure consisting of a bone layer, calcified cartilage layer, non-calcified cartilage layer, and tendinous component), with age-related narrowing of the non-calcified cartilage layer confirmed to be present. In an immunohistochemical TFAM study positive findings of the non-calcified cartilage layer were less prominent in the 100-week-old group. In an Enzyme-Linked Immunosorbent Assay (ELISA) study, these were more prominent in the 5-week-old to 24-week-old groups, and slightly less so in the 48-week-old group as compared to the 24-week-old one. In the 100-week-old group as compared to the 24-week-old one they were significantly less prominent (p<0.05). The non-calcified cartilage layer is a major site for the dispersion of mechanical energy, and the change in TFAM expression noted at the same site in the present study and the results of ELISA suggest that age-related changes in mitochondrial stress may be one cause of rotator cuff degeneration. PMID:26692954

  8. Arthroscopic technique for patch augmentation of rotator cuff repairs.

    PubMed

    Labbé, Marc R

    2006-10-01

    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

  9. Tests for diagnosing subacromial impingement syndrome and rotator cuff disease

    PubMed Central

    2014-01-01

    Clinical examination techniques need to allow the physician to determine the underlying pathology of a patient’s condition with confidence. This review examines the evidence for two common conditions: impingement and rotator cuff disease

  10. Physiotherapy assessment of patients with rotator cuff pathology

    PubMed Central

    2014-01-01

    Pathology of the rotator cuff and sub-acromial bursa are considered to be the main cause of shoulder pain and dysfunction. In the absence of trauma, conservative care, including physiotherapy is the primary treatment. This paper aims to present the key features of a physiotherapy assessment, excluding diagnostic tests for rotator cuff pathology. It describes and explores how assessment can be used to direct management options and develop a treatment plan.

  11. A comparison of prospective and retrospective assessment of functional outcome after rotator cuff repair.

    PubMed

    Tashjian, Robert Z; Bradley, Michael P; Tocci, Stephen; Henn, Ralph F; Rey, Jesus; Green, Andrew

    2008-01-01

    Prospective outcome studies are generally considered to be better than retrospective studies. The purpose of this study was to assess correlations between prospective and retrospective outcome assessment after rotator cuff repair. One-hundred and twelve patients (118 shoulders) with chronic rotator cuff tears were evaluated at a mean of 54 months (34-85) after rotator cuff repair, using several outcome measures including a retrospective assessment of improvement. The retrospective assessment of post-operative pain, function, and quality of life had fair correlations with the prospectively determined improvement (R = .23-.25, P < .01). Post-operative patient satisfaction was more highly correlated with all retrospective evaluations than with the prospective improvement in all functional outcome measures. Retrospective and prospective evaluations of the outcome of rotator cuff repair are different. Patient satisfaction has a greater correlation with retrospective outcomes. Retrospective evaluation may aid in supplementing prospective evaluations, as it may better reflect a patient's perception of the success after surgery. PMID:18693118

  12. Do Outcomes Differ after Rotator Cuff Repair for Patients Receiving Workers’ Compensation?

    PubMed Central

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

    2008-01-01

    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. PMID:18784971

  13. Quantitative Analysis of Three-Dimensional Distribution and Clustering of Intramuscular Fat in Muscles of the Rotator Cuff.

    PubMed

    Santago, Anthony C; Vidt, Meghan E; Tuohy, Christopher J; Poehling, Gary G; Freehill, Michael T; Jordan, Jennifer H; Kraft, Robert A; Saul, Katherine R

    2016-07-01

    The purpose of this study was to (1) develop and present a technique to quantitatively assess three-dimensional distribution and clustering of intramuscular fat and (2) use the technique to compare spatial characteristics of intramuscular fat in rotator cuff muscles of older adults with and without a supraspinatus tear. Moran's Index (I), an existing quantitative measure of clustering, was extended for use with MRI to allow comparisons across individuals with different size muscles. Sixteen older adults (>60 years) with (N = 6) and without (N = 10) a degenerative supraspinatus tear participated. Following 3D Dixon MRIs of the shoulder, which separates fat from water, rotator cuff muscles were segmented and sectioned and fat% and Moran's I were calculated to assess distribution and clustering, respectively. Moran's I ranged was 0.40-0.92 and 0.39-0.76 for the tear and control subjects, respectively. Compared to uninjured controls, tear subjects demonstrated increased fat distribution (p = 0.036) and clustering (p = 0.020) distally in the supraspinatus. Tear subjects had more pronounced distribution (p < 0.001) and clustering distally (p < 0.001) than proximally. Other rotator cuff muscles exhibited different patterns of fat clustering and distribution. This technique, which we applied to quantify spatial characteristics of intramuscular fat, can be applied to assess clustering of fat in other pathologies and tissues. PMID:26514349

  14. Rehabilitation following rotator cuff repair: a systematic review

    PubMed Central

    Bateman, Marcus; Clark, David; Selfe, James; Watkinson, Duncan; Walton, Mike; Funk, Lennard

    2015-01-01

    Background The aim of this systematic review was to evaluate the effectiveness of rehabilitation programmes following surgical repair of the rotator cuff with emphasis upon length of immobilisation and timing of introduction of load. Methods An electronic search of CENTRAL, MEDLINE and PEDro was undertaken to August 2014 and supplemented by hand searching. Randomised controlled trials were included, quality appraised using the PEDro scale and synthesised via meta-analysis or narrative synthesis, based upon levels of evidence, where appropriate. Results Twelve studies were included. There is strong evidence that early initiation of rehabilitation does not adversely affect clinical outcome but there is a marginally higher, statistically non-significant, incidence of tendon re-tear (OR 1.3; 95% CI 0.72 to 2.2). There is strong evidence that initiation of functional loading early in the rehabilitation programme does not adversely affect clinical outcome. Discussion Concern about early initiation of rehabilitation and introduction of gradual functional load does not appear warranted but this should be considered in a context of potential for Type II error. There is further need to evaluate approaches that foster early initiation of rehabilitation and gradual introduction of functional load as well as considering key outcomes such as return to work.

  15. Assessment and characterization of in situ rotator cuff biomechanics

    NASA Astrophysics Data System (ADS)

    Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

    2013-03-01

    Rotator cuff disease is a degenerative disorder that is a common, costly, and often debilitating, ranging in severity from partial thickness tear, which may cause pain, to total rupture, leading to loss in function. Currently, clinical diagnosis and determination of disease extent relies primarily on subjective assessment of pain, range of motion, and possibly X-ray or ultrasound images. The final treatment plan however is at the discretion of the clinician, who often bases their decision on personal experiences, and not quantitative standards. The use of ultrasound for the assessment of tissue biomechanics is established, such as in ultrasound elastography, where soft tissue biomechanics are measured. Few studies have investigated the use of ultrasound elastography in the characterization of musculoskeletal biomechanics. To assess tissue biomechanics we have developed a device, which measures the force applied to the underlying musculotendentious tissue while simultaneously obtaining the related ultrasound images. In this work, the musculotendinous region of the infraspinatus of twenty asymptomatic male organized baseball players was examined to access the variability in tissue properties within a single patient and across a normal population. Elastic moduli at percent strains less than 15 were significantly different than those above 15 percent strain within the normal population. No significant difference in tissue properties was demonstrated within a single patient. This analysis demonstrated elastic moduli are variable across individuals and incidence. Therefore threshold elastic moduli will likely be a function of variation in local-tissue moduli as opposed to a specific global value.

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

    PubMed Central

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

    1994-01-01

    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

  17. Predictors of Outcomes after Arthroscopic Double-row Rotator Cuff Repair in 155 Cases

    PubMed Central

    Katthagen, Jan Christoph; Millett, Peter J.; Espinoza-Ervin, Christopher; Horan, Marilee P.; Ho, Charles P.; Warth, Ryan J.; Dornan, Grant

    2016-01-01

    Objectives: The purpose of this study was to analyze predictors of clinical outcomes of knotted versus knotless double-row self-reinforcing rotator cuff repairs of full-thickness rotator cuff tears with propensity score matching. Methods: Patients with arthroscopic repair of full-thickness rotator cuff tears involving the supraspinatus tendon using either a knotted or knotless linked, self-reinforcing double-row technique were included in the study. Preoperative subjective evaluation was performed using the ASES and SF-12 PCS scores. After a minimum two-year follow-up period, ASES and SF-12 PCS scores were collected again along with the SANE score, the QuickDASH score, and patient satisfaction. All data were collected prospectively and retrospectively reviewed. Postoperative ASES and SF-12 PCS scores were then modeled using inverse propensity score weighting in a multiple linear regression model (MLR) with multiple imputations. Age, sex, baseline ASES score, length of follow-up, number of anchors, worker’s compensation, previous cuff repair, and double-row repair technique (knotted or knotless) were the covariates used in this model. Results: 155 shoulders in 151 patients (109 men, 42 women; mean age at time of surgery 59±10 years) were eligible for inclusion. Outcomes data were available for 130 of 148 shoulders (87.8%) after exclusion of seven shoulders (4.5%) that underwent revision rotator cuff repair before final follow up (n=33/39 in the knotted group [84.6%]; n=97/109 [88.9%] in the knotless group).The mean follow-up was 2.9 years (range, 2.0-5.4 years). Overall, postoperative outcomes scores were significantly improved when compared to preoperative baselines (p<0.05), with a median postoperative ASES score of 97 for the entire cohort. Our model showed that previous rotator cuff repair had a significant negative effect on postoperative ASES (β = -12.7, p<0.001) and SF-12 PCS scores (β = -5.0, p = 0.036). A workers’ compensation claim (β = -10.6, p

  18. The temporal outcomes of open versus arthroscopic knotted and knotless rotator cuff repair over 5 years

    PubMed Central

    Lucena, Thomas R; Lam, Patrick H; Millar, Neal L

    2015-01-01

    Background The present study aimed to determine how repair technique influenced structural and clinical outcomes at 5 years post-surgery. Methods Three cohorts of patients had repair of a symptomatic rotator cuff tear using (i) an open double-row mattress repair technique (n = 25); (ii) arthroscopic single-row simple suture knotted technique (n = 25); or (iii) arthroscopic single-row inverted mattress knotless technique (n = 36) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained pre-operatively and postoperatively with a validated protocol, ultrasound were also performed at the same time. Results Retear occurred more often after open repair (48%) at 5 years than after arthroscopic knotted (33%) and arthroscopic knotless (26%) repair. Retear was associated with increasing age, pre-operative tear size and weaker pre-operative and 5 years postoperative cuff strength. Between 2 years and 5 years, the open repair group experienced an increase in the frequency of pain during activity, as well as in the difficulty experienced and the severity of pain during overhead activities (p < 0.05) and, at 5 years, also experienced more difficulty with overhead activities, compared to the arthroscopic knotless repair group. Conclusions At 5-year follow-up, arthroscopic rotator cuff repair techniques resulted in fewer retears and better outcomes compared to an open double-row technique.

  19. Calcific tendinitis of the rotator cuff.

    PubMed

    ElShewy, Mohamed Taha

    2016-01-18

    Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or "minimally invasive" techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary. PMID

  20. Calcific tendinitis of the rotator cuff

    PubMed Central

    ElShewy, Mohamed Taha

    2016-01-01

    Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or “minimally invasive” techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary. PMID

  1. Computer-Aided Diagnosis of Different Rotator Cuff Lesions Using Shoulder Musculoskeletal Ultrasound.

    PubMed

    Chang, Ruey-Feng; Lee, Chung-Chien; Lo, Chung-Ming

    2016-09-01

    The lifetime prevalence of shoulder pain approaches 70%, which is mostly attributable to rotator cuff lesions such as inflammation, calcific tendinitis and tears. On clinical examination, shoulder ultrasound is recommended for the detection of lesions. However, there exists inter-operator variability in diagnostic accuracy because of differences in the experience and expertise of operators. In this study, a computer-aided diagnosis (CAD) system was developed to assist ultrasound operators in diagnosing rotator cuff lesions and to improve the practicality of ultrasound examination. The collected cases included 43 cases of inflammation, 30 cases of calcific tendinitis and 26 tears. For each case, the lesion area and texture features were extracted from the entire lesions and combined in a multinomial logistic regression classifier for lesion classification. The proposed CAD achieved an accuracy of 87.9%. The individual accuracy of this CAD system was 88.4% for inflammation, 83.3% for calcific tendinitis and 92.3% for tears. Cohen's k was 0.798. On the basis of its diagnostic performance, clinical use of this CAD technique has promise. PMID:27381057

  2. [Bony avulsions of the rotator cuff : Arthroscopic concepts].

    PubMed

    Greiner, S; Scheibel, M

    2011-01-01

    Bony avulsions of the rotator cuff and isolated greater or lesser tuberosity fractures are rare injuries and a clear consensus regarding classification and therapy does not yet exist. Conservative therapy is limited, especially in injuries with displaced fragments and in these cases surgical treatment is frequently indicated. The ongoing development of arthroscopic techniques has led to quite a number of reports about arthroscopically assisted or total arthroscopic techniques in the treatment of these injuries. The advantages and disadvantages of arthroscopic concepts for the treatment of bony avulsions of the rotator cuff are presented with reference to the current literature. PMID:21153534

  3. Reliability of Magnetic Resonance Imaging Assessment of Rotator Cuff: The ROW Study

    PubMed Central

    Jain, Nitin B.; Collins, Jamie; Newman, Joel S.; Katz, Jeffrey N.; Losina, Elena; Higgins, Laurence D.

    2014-01-01

    Background Physiatrists encounter patients with rotator cuff disorders and imaging is frequently an important component of their diagnostic assessment. However, there is paucity of literature on reliability of MRI assessment between shoulder specialists and musculoskeletal radiologists. Objective We assessed inter- and intra-rater reliability of MRI characteristics of the rotator cuff. Design Cross-sectional secondary analyses in a prospective cohort study Setting Academic tertiary care centers Patients Subjects with shoulder pain recruited from orthopedic and physiatry clinics Methods Two shoulder fellowship trained physicians (a physiatrist and a shoulder surgeon) jointly performed a blinded composite MRI review by consensus on 31 subjects with shoulder pain. Subsequently, MRI was reviewed by one fellowship trained musculoskeletal radiologist. Main Outcome Measures We calculated Cohen’s kappa coefficients and percent agreement among the two reviews (composite review of two shoulder specialists versus that of the musculoskeletal radiologist). Intra-rater reliability was assessed among the shoulder specialists by performing a repeat blinded composite MRI review. In addition to this repeat composite review, only one of the physiatry shoulder specialists performed an additional review. Results Inter-rater reliability (shoulder specialists versus musculoskeletal radiologist) was substantial for the presence or absence of tear (kappa=0.90; 95% CI=0.72, 1.00), tear-thickness (kappa=0.84;95% CI=0.70, 0.99), longitudinal size of tear (kappa=0.75;95% CI=0.44, 1.00), fatty infiltration (kappa=0.62; 95% CI=0.45, 0.79), and muscle atrophy (kappa=0.68; 95% CI=0.50, 0.86). There was only fair inter-rater reliability of transverse size of tear (kappa=0.20; 95% CI=0.00, 0.51). The kappa for intra-rater reliability was high for tear thickness (0.88; 95% CI=0.72, 1.00), longitudinal tear size (0.61; 95% CI=0.22, 0.99), fatty infiltration (0.89; 95% CI=0.80, 0.98), and muscle

  4. Towards predictive diagnosis and management of rotator cuff disease: using curvelet transform for edge detection and segmentation of tissue

    NASA Astrophysics Data System (ADS)

    Pai Raikar, Vipul; Kwartowitz, David M.

    2016-04-01

    Degradation and injury of the rotator cuff is one of the most common diseases of the shoulder among the general population. In orthopedic injuries, rotator cuff disease is only second to back pain in terms of overall reduced quality of life for patients. Clinically, this disease is managed via pain and activity assessment and diagnostic imaging using ultrasound and MRI. Ultrasound has been shown to have good accuracy for identification and measurement of rotator cuff tears. In our previous work, we have developed novel, real-time techniques to biomechanically assess the condition of the rotator cuff based on Musculoskeletal Ultrasound. Of the rotator cuff tissues, supraspinatus is the first that sees degradation and is the most commonly affected. In our work, one of the challenges lies in effectively segmenting and characterizing the supraspinatus. We are exploring the possibility of using curvelet transform for improving techniques to segment tissue in ultrasound. Curvelets have been shown to give optimal multi-scale representation of edges in images. They are designed to represent edges and singularities along curves in images which makes them an attractive proposition for use in ultrasound segmentation. In this work, we present a novel approach to the possibility of using curvelet transforms for automatic edge and feature extraction for the supraspinatus.

  5. Superior labrum anterior to posterior tears in throwing athletes.

    PubMed

    Lintner, David M

    2013-01-01

    Superior labrum anterior to posterior (SLAP) tears and partial undersurface tears of the rotator cuff are common in experienced throwers, may be adaptive, and are only occasionally symptomatic. Pain in the shoulder of a throwing athlete with an MRI-documented SLAP tear or partial undersurface tear of the rotator cuff can be managed nonsurgically, with attention to posterior capsular contracture, scapular dyskinesia, and rotator cuff strength. The results of the surgical repair of SLAP lesions in the throwing athlete, with or without rotator cuff repair, are inferior to those of nonsurgical treatment. The cause of pain in the throwing athlete must be accurately diagnosed without reliance on MRI findings. PMID:23395053

  6. Rotator cuff injuries: current perspectives and trends for treatment and rehabilitation☆

    PubMed Central

    Vieira, Fabio Antonio; Olawa, Paul Juma; Belangero, Paulo Santoro; Arliani, Gustavo Gonçalves; Figueiredo, Eduardo Antônio; Ejnisman, Benno

    2015-01-01

    Objective To map out the approaches used by Brazilian orthopedists in treating complete tears of the rotator cuff. Methods A multiple-choice questionnaire was handed out to 232 orthopedists at the 45th Brazilian Congress of Orthopedics and Traumatology. Of these, 207 were returned but five were incomplete and were excluded. Thus, 202 questionnaires were used. Results Among the orthopedists who answered the questionnaires, around 60% were from the southeastern region and 46% were shoulder and elbow surgeons. There was a significant association (p < 0.05) between length of experience and number of rotator cuff repairs performed per year. There was also a significant association (p < 0.05) between shoulder specialty and the following variables: arthroscopic technique, use of anchors in a single-row configuration, mean time taken for an indication for surgery to be made in cases of traumatic and degenerative lesions, use of a specific protocol for postsurgical rehabilitation, return to sport and indication of irreparable injuries. Conclusions Brazilian shoulder surgeons have well-established approaches toward treating rotator cuff injuries. Most of these approaches differ significantly from those of other specialties. This shows the importance of placing value on training in preparing shoulder specialists in this country. PMID:27218075

  7. Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency

    PubMed Central

    Al-Hadithy, Nawfal; Furness, Nicholas; Patel, Ronak; Jonas, Sam; Jobbagy, Attila; Lowdon, Ian

    2015-01-01

    Background Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears. Methods 41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n = 21) and cuff-deficient shoulders (n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography. Results Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly. Conclusions CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation.

  8. Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

    PubMed Central

    Pawaskar, Aditya C; Kekatpure, Aashay; Cho, Nam-Su; Rhee, Yong-Girl; Jeon, In-Ho

    2015-01-01

    Background: Little is known about the bioabsorbable, anchor related postoperative changes in rotator cuff surgery, which has become more popular recently. The purpose of the present study was to use magnetic resonance imaging (MRI) to analyze the degradation of bioabsorbable anchors and to determine the incidences and characteristics of early postoperative reactions around the anchors and their mechanical failures. Materials and Methods: Postoperative MRIs of 200 patients who underwent arthroscopic rotator cuff repair were retrospectively analyzed. The tissue reactions around the bioanchors included fluid accumulations around the anchor, granulation tissue formation and changes in the condition of the surrounding osseous structure. The condition of the bioanchor itself was also examined, including whether the bioanchor failed mechanically. In the case of mechanical failure, the location of the failure was noted. Serial MRIs of 18 patients were available for analysis. Results: The total number of medial row bioanchors was 124, while that of the lateral row was 338. A low signal intensity rim suggestive of sclerosis surrounded all lateral row bioanchors. Ninety three lateral row bioanchors (27%) showed a rim with signal intensity similar to or less than that of surrounding bone, which was granulation tissue or foreign body reaction (FBR). Similar signal intensity was seen around nine medial row bioanchors (7%). Fluid accumulation was seen around 4 lateral row bioanchors (1%) and around 14 medial row bioanchors (11%). Five lateral row bioanchors showed the breakage, while there was none in the medial row bioanchors. There were nine cases with a cuff re-tear (4.5%). There was no evidence of affection of glenohumeral articular surfaces or of osteolysis around any bioanchor. In serial MRI, there was no change in appearance of the bioanchors, but the granulation tissue or FBR around four bioanchors and the fluid around one bioanchor showed a decrease in successive MRI

  9. EXTENSIVE ROTATOR CUFF INJURIES: AN EVALUATION OF ARTHROSCOPIC REPAIR OUTCOMES

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; Silva, Luciana Andrade; Eduardo, Cesar Moreira Mariz Pinto Rodrigo Tormin Ortiz; Checchia, Sergio Luiz

    2015-01-01

    To assess the outcomes of the surgical treatment of extensive rotator cuff injuries through arthroscopy. Methods: Between June 1998 and October 2006, 61 patients with extensive rotator cuff injuries and submitted to surgical arthroscopy technique by the Shoulder and Elbow Group of the Department of Orthopaedics and Traumatology, Santa Casa de Misericórdia Medical School were reassessed. The study included all patients with at least two tendons affected or with retraction at least on two tendons up to the glenoidal cavity edge and with at least 12 months of follow-up. Results: According to UCLA's evaluation criteria, 54 (89%) patients showed excellent or good outcomes; no fair outcome in none of the patients; and seven (11%) poor outcomes. A satisfaction rate of 92% was reported. Postoperative joint motion went from a mean lifting value of 93° to 141°, the mean lateral rotation went from 32° to 48° and the mean medial rotation went from L1 to T10. These differences were regarded as statistically significant. Conclusion: The arthroscopic repair of extensive rotator cuff injuries leads to satisfactory outcomes for most of the patients, with a high satisfaction degree. PMID:26998466

  10. Early rehabilitation affects functional outcomes and activities of daily living after arthroscopic rotator cuff repair: a case report

    PubMed Central

    Shimo, Satoshi; Sakamoto, Yuta; Tokiyoshi, Akinari; Yamamoto, Yasuhiro

    2016-01-01

    [Purpose] The effect of early rehabilitation protocols after arthroscopic rotator cuff repair is currently unknown. We examined short-term effects of early rehabilitation on functional outcomes and activities of daily living after arthroscopic rotator cuff repair. [Subject and Methods] An 82-year-old male fell during a walk, resulting in a supraspinatus tear. Arthroscopic rotator cuff repair was performed using a single-row technique. He wore an abduction brace for 6 weeks after surgery. [Results] From day 1 after surgery, passive range of motion exercises, including forward flexion and internal and external rotation were performed twice per day. Starting at 6 weeks after surgery, active range of motion exercises and muscle strengthening exercises were introduced gradually. At 6 weeks after surgery, his active forward flexion was 150°, UCLA shoulder rating scale score was 34 points, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire disability/symptom score was 36 points. At 20 weeks after surgery, his active forward flexion was 120°, UCLA shoulder rating scale score was 34 points, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire disability/symptom score was 0 points. [Conclusion] These protocols are recommended to physical therapists during rehabilitation for arthroscopic rotator cuff repair to support rapid reintegration into activities of daily living. PMID:27064886

  11. Early rehabilitation affects functional outcomes and activities of daily living after arthroscopic rotator cuff repair: a case report.

    PubMed

    Shimo, Satoshi; Sakamoto, Yuta; Tokiyoshi, Akinari; Yamamoto, Yasuhiro

    2016-01-01

    [Purpose] The effect of early rehabilitation protocols after arthroscopic rotator cuff repair is currently unknown. We examined short-term effects of early rehabilitation on functional outcomes and activities of daily living after arthroscopic rotator cuff repair. [Subject and Methods] An 82-year-old male fell during a walk, resulting in a supraspinatus tear. Arthroscopic rotator cuff repair was performed using a single-row technique. He wore an abduction brace for 6 weeks after surgery. [Results] From day 1 after surgery, passive range of motion exercises, including forward flexion and internal and external rotation were performed twice per day. Starting at 6 weeks after surgery, active range of motion exercises and muscle strengthening exercises were introduced gradually. At 6 weeks after surgery, his active forward flexion was 150°, UCLA shoulder rating scale score was 34 points, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire disability/symptom score was 36 points. At 20 weeks after surgery, his active forward flexion was 120°, UCLA shoulder rating scale score was 34 points, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire disability/symptom score was 0 points. [Conclusion] These protocols are recommended to physical therapists during rehabilitation for arthroscopic rotator cuff repair to support rapid reintegration into activities of daily living. PMID:27064886

  12. Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

    PubMed Central

    Rubenis, Imants; Lam, Patrick H.; Murrell, George A.C.

    2015-01-01

    Background: Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty. Purpose: To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair. Results: At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001). Conclusion: Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of

  13. Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair

    PubMed Central

    Ye, Hee-Uk; Jung, Jae-Won; Lee, Young-Kuk

    2015-01-01

    Background The literature does not provide consistent information on the impact of patients' gender on recovery after rotator cuff repair. The purpose of this study was to determine whether gender affects pain and functional recovery in the early postoperative period after rotator cuff repair. Methods Eighty patients (40 men and 40 women) were prospectively enrolled. Pain intensity and functional recovery were evaluated, using visual analog scale (VAS) pain score and range of motion on each of the first 5 postoperative days, at 2 and 6 weeks and at 3, 6, and 12 months after surgery. Perioperative medication-related adverse effects and postoperative complications were also assessed. Results The mean VAS pain score was significantly higher for women than men at 2 weeks after surgery (p = 0.035). For all other periods, there was no significant difference between men and women in VAS pain scores, although women had higher scores than men. Mean forward flexion in women was significantly lower than men at 6 weeks after surgery (p = 0.033) and the mean degree of external rotation in women was significantly lower than men at 6 weeks (p = 0.007) and at 3 months (p = 0.017) after surgery. There was no significant difference in medication-related adverse effects or postoperative complications. Conclusions Women had more pain and slower recovery of shoulder motion than men during the first 3 months after rotator cuff repair. These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair. PMID:26217471

  14. Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome after Rotator Cuff Repair?

    PubMed Central

    Kirsch, Jacob Matthew; Nathani, Amit; Robbins, Christopher; Gagnier, Joel Joseph; Bedi, Asheesh; Miller, Bruce S.

    2016-01-01

    Objectives: Variations in scapular morphology have been associated with the development of atraumatic rotator cuff tears (RCT). Current theories suggest a morphologic predisposition for altered shoulder biomechanics favoring the development of RCTs. The critical shoulder angle (CSA) is a radiographic measure that accounts for both glenoid inclination and lateral extension of the acromion, and angles >35 degrees are reported to be correlated with the development of degenerative RCTs. The impact of the CSA on outcomes following rotator cuff repair (RCR) has not previously been investigated. The purpose of this study was to investigate the relationship between the CSA and clinical outcomes after rotator cuff repair. Methods: As part of a prospective observational cohort study we obtained CSA measurements for 144 patients with documented full-thickness RCTs who were followed up for a minimum of 48 weeks. Patients were then stratified based on RCT etiology and treatment. Demographic data as well as The Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score and Visual Analog Scale (VAS) for pain were collected at baseline, four, eight, 16, 32 and 48 weeks. The CSA for all of the patients was measured retrospectively, with all assessors being blinded to the data and we calculated interclass correlation coefficients (ICC) to measure agreement. The statistical analysis included longitudinal multilevel regression modeling to investigate the association of the CSA and the WORC, ASES and VAS for pain. Results: Controlling for demographic and clinical characteristics, patients with CSAs less than 38 degrees reported better outcome scores over time compared to those with CSAs greater than 38 degrees (WORC: B=-106.6, p=0.025, ASES: B=4.83, p=0.0001, VAS: B=-12.99, p=0.0001). Interobserver and intraobserver reliability for CSA measurements resulted in an ICC of 0.969 and 0.982 respectively, indicating excellent agreement. Conclusion: We found

  15. Shoulder Impingement/Rotator Cuff Tendinitis

    MedlinePlus

    .org Shoulder Impingement/Rotator Cuff Tendinitis Page ( 1 ) One of the most common physical complaints is shoulder pain. Your shoulder is made up of several ... is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the ...

  16. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair.

    PubMed

    Thigpen, Charles A; Shaffer, Michael A; Gaunt, Bryce W; Leggin, Brian G; Williams, Gerald R; Wilcox, Reg B

    2016-04-01

    This is a consensus statement on rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The purpose of this statement is to aid clinical decision making during the rehabilitation of patients after arthroscopic rotator cuff repair. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. This statement describes a rehabilitation framework that includes a 2-week period of strict immobilization and a staged introduction of protected, passive range of motion during weeks 2-6 postoperatively, followed by restoration of active range of motion, and then progressive strengthening beginning at postoperative week 12. When appropriate, rehabilitation continues with a functional progression for return to athletic or demanding work activities. This document represents the first consensus rehabilitation statement developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients after arthroscopic rotator cuff repair. PMID:26995456

  17. Evaluation of Internet Information About Rotator Cuff Repair.

    PubMed

    Lawson, Kevin A; Codella, Stephen; Ciccotti, Michael G; Kane, Patrick W; Duncan, Ian C; Cohen, Steven B

    2016-01-01

    The content and quality of Internet websites are not governed or regulated. Therefore, patients who consult the Internet may receive outdated or incorrect medical information. Researchers have analyzed the quality of web information about various orthopedic surgeries, but no such analysis has been performed on websites covering rotator cuff repair. We conducted a study to evaluate and analyze rotator cuff repair information available to the general public through the Internet; to assess changes in the quality of information over time; to determine if sites sponsored by academic institutions offered higher-quality information; and to assess whether the readability of the material varied according to DISCERN scores. Two Internet searches were conducted, in 2011 and 2014. The 3 most commonly used search engines were used to search for rotator cuff repair. The first 50 websites from each search engine were evaluated for authorship and content. The DISCERN instrument was used to analyze the quality of each website's health information. The 2011 search revealed 21% of websites were associated with an academic institution, 38% were authored by a hospital or physician group, and 11.5% were industry-sponsored. The 2014 search revealed a similar distribution of contributors. The highest DISCERN scores were given to academic institution websites (51.6) and public education websites (49). There was no correlation between readability and DISCERN scores. Websites associated with academic institutions produced the highest-quality medical information. Over the past few years, authorship and content have changed little with respect to Internet information about rotator cuff repair. PMID:26991581

  18. Arthroscopic fixation with a minimally invasive axillary approach for latissimus dorsi transfer using an endobutton in massive and irreparable postero-superior cuff tears

    PubMed Central

    Goldstein, Yariv; Grimberg, Jean; Valenti, Philippe; Chechik, Ofir; Drexler, Michael; Kany, Jean

    2013-01-01

    Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to primary repair due to fatty changes in the muscle tissue, or that have failed previous repair attempts. This procedure offers immediate and dramatic pain relief and is not as technically demanding as one might think. Understanding and respecting the principles of tendon transfer is a key to the success of this procedure. PMID:23960367

  19. Biologic and pharmacologic augmentation of rotator cuff repairs.

    PubMed

    Edwards, Sara L; Lynch, T Sean; Saltzman, Matthew D; Terry, Michael A; Nuber, Gordon W

    2011-10-01

    As rotator cuff repair techniques have improved, failure of the tendon to heal to the proximal humerus is less likely to occur from weak tendon-to-bone fixation. More likely causes of failure include biologic factors such as intrinsic tendon degeneration, fatty atrophy, fatty infiltration of muscle, and lack of vascularity of the tendons. High failure rates have led to the investigation of biologic augmentation to potentially enhance the healing response. Histologic studies have shown that restoration of the rotator cuff footprint during repair can help reestablish the enthesis. In animal models, growth factors and their delivery scaffolds as well as tissue engineering have shown promise in decreasing scar tissue while maintaining biomechanical strength. Platelet-rich plasma may be a safe adjuvant to rotator cuff repair, but it has not been shown to improve healing or function. Many of these strategies need to be further defined to permit understanding of, and to optimize, the biologic environment; in addition, techniques need to be refined for clinical use. PMID:21980023

  20. COMPARATIVE ANALYSIS ON THE RESULT FOR ARTHROSCOPIC ROTATOR CUFF SUTURE BETWEEN SMOKING AND NON-SMOKING PATIENTS

    PubMed Central

    Almeida, Alexandre; Valin, Márcio Rangel; Zampieri, Rodrigo; Almeida, Nayvaldo Couto de; Roveda, Gilberto; Agostini, Ana Paula

    2015-01-01

    Objective: To comparatively analyze the results from arthroscopic rotator cuff suture between smoking and non-smoking patients. Methods: A group of 286 patients who underwent arthroscopic suturing of primary rotator cuff injuries between June 12, 2002, and May 14, 2008, was analyzed. The patients included in the study were evaluated using the UCLA scale, with a minimum follow-up of 12 months and average of 56.52 months. The variables studied were age, sex, side operated, dominance, profile of cigarette use and UCLA index. Results: This study evaluated a total of 205 patients. Mean age (p = 0.289) and sex (p = 0.124) were analyzed statistically between the smoking and non-smoking patients and the two groups were considered to be similar. The average UCLA score for the non-smoking patients (143) was 34 (32 to 35). The average UCLA score for the smoking patients (51) was 33 (29 to 35). There was no statistically significant difference in UCLA score (p = 0.123) between the smoking and non-smoking patients. For the purposes of statistical analysis, we grouped the small and medium tears (107) and compared these with the large and extensive tears (80), between smokers and non-smokers. There was no statistically significant difference using the Mann-Whitney test regarding the small and medium tears (p = 818). There was a statistically significant difference using the Mann-Whitney test regarding the large and extended tears, between the smoking and non-smoking patients, such that the non-smokers showed better UCLA scores (p = 0.038). Conclusion: The results from arthroscopic suturing of large and extensive rotator cuff injuries are inferior among smoking patients. PMID:27027006

  1. Proteomics Perspectives in Rotator Cuff Research: A Systematic Review of Gene Expression and Protein Composition in Human Tendinopathy

    PubMed Central

    Sejersen, Maria Hee Jung; Frost, Poul; Hansen, Torben Bæk; Deutch, Søren Rasmussen; Svendsen, Susanne Wulff

    2015-01-01

    Background Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics – the comprehensive study of protein composition - in tendon research. Materials and Methods We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue. Results We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro. Conclusions Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus

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

    PubMed Central

    2013-01-01

    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

  3. MRI-Arthroscopic Correlation in Rotator Cuff Tendon Pathologies; A Comparison between Various Centers

    PubMed Central

    Sefidbakht, Sepideh; Momenzadeh, Omid Reza; Dehghani, Sakineh; Gerami, Hadi

    2016-01-01

    Background: Magnetic resonance imaging (MRI) has long been considered a perfect imaging study for evaluation of shoulder pathologies despite occasional discrepancies between MR reports and arthroscopic findings. In this study we aim to evaluate impact of imaging center as an indicator of image quality on accuracy of MRI reports in diagnosis of rotator cuff tendon pathologies. Methods: We reviewed MR reports of 64 patients who underwent arthroscopy in university center hospital. MRIs were done in various centers including both university-affiliated and out-centers. All studies were reported by two radiologists in consensus unaware of the arthroscopic results or previous reports. An inter-observer agreement analysis using the kappa statistics was performed to determine consistency among imaging and surgical reports. Results: Kappa values for out-centers were as follows: 0.785 for biceps, 0.469 for suscapularis, 0.846 for supraspinatus and 0.785 for infraspinatus tendons. In university centers values were 0.799 for biceps, 0.802 for suscapularis, 0.789 for supraspinatus and 0.770 for infraspinatus tendons. Conclusion: Image reporting in university centers with proficient sequences increased accuracy of diagnosis in 3/4 of evaluated features and showed subtle decreased inter-observer agreement in 1/4 of features. Uniformity of the scanners and protocols as well as evaluation on a workstation rather than hard copies cumulatively resulted in a meaningful increase in the accuracy of the same radiologists in diagnosis of rotator cuff tendon tear. PMID:27200392

  4. Stem cell therapy in the management of shoulder rotator cuff disorders

    PubMed Central

    Mora, Maria Valencia; Ibán, Miguel A Ruiz; Heredia, Jorge Díaz; Laakso, Raul Barco; Cuéllar, Ricardo; Arranz, Mariano García

    2015-01-01

    Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy. PMID:26029341

  5. Effects of corticosteroids and hyaluronic acid on torn rotator cuff tendons in vitro and in rats.

    PubMed

    Nakamura, Hidehiro; Gotoh, Masafumi; Kanazawa, Tomonoshin; Ohta, Keisuke; Nakamura, Keiichirou; Honda, Hirokazu; Ohzono, Hiroki; Shimokobe, Hisao; Mitsui, Yasuhiro; Shirachi, Isao; Okawa, Takahiro; Higuchi, Fujio; Shirahama, Masahiro; Shiba, Naoto; Matsueda, Satoko

    2015-10-01

    Corticosteroids (CS) or hyaluronic acid (HA) is used in subacromial injection for the conservative treatment of rotator cuff tears (RCT); this study addresses the question of how CS and HA affect the tendon tissue and fibroblasts in vitro and in rats. Cell proliferation assays were performed in human tendon fibroblasts from RCT. Rats underwent surgery to create RCT, and the surgical sites were injected with CS or HA. The rotator cuff tendons were subjected to biomechanical testing, microscopic and immunohistochemical analysis of proliferating cell nuclear antigen (PCNA), and ultrastructural analysis. Cell proliferation was significantly decreased with CS in vitro (p < 0.05). Maximal load of CS-treated tendons was significantly decreased compared with that of HA-treated tendons (p < 0.05), as well as PCNA(+) cells at 2 weeks (p < 0.05). Ultrastructural observations of the CS-treated rats detected apoptosis of tendon fibroblasts 24 h after surgery. Histological and biomechanical data 4 weeks after surgery were not significant among the three groups. Unlike HA, CS caused cell death, and inhibition of the proliferation of tendon fibroblasts, leading to a delay of tendon healing involved and a subsequent decrease of biomechanical strength at the surgical site. PMID:26174562

  6. The response of tenocytes to commercial scaffolds used for rotator cuff repair.

    PubMed

    Smith, R D; Carr, A; Dakin, S G; Snelling, S J; Yapp, C; Hakimi, O

    2016-01-01

    Surgical repairs of rotator cuff tears have high re-tear rates and many scaffolds have been developed to augment the repair. Understanding the interaction between patients' cells and scaffolds is important for improving scaffold performance and tendon healing. In this in vitro study, we investigated the response of patient-derived tenocytes to eight different scaffolds. Tested scaffolds included X-Repair, Poly-Tape, LARS Ligament, BioFiber (synthetic scaffolds), BioFiber-CM (biosynthetic scaffold), GraftJacket, Permacol, and Conexa (biological scaffolds). Cell attachment, proliferation, gene expression, and morphology were assessed. After one day, more cells attached to synthetic scaffolds with dense, fine and aligned fibres (X-Repair and Poly-Tape). Despite low initial cell attachment, the human dermal scaffold (GraftJacket) promoted the greatest proliferation of cells over 13 days. Expression of collagen types I and III were upregulated in cells grown on non-cross-linked porcine dermis (Conexa). Interestingly, the ratio of collagen I to collagen III mRNA was lower on all dermal scaffolds compared to synthetic and biosynthetic scaffolds. These findings demonstrate significant differences in the response of patient-derived tendon cells to scaffolds that are routinely used for rotator cuff surgery. Synthetic scaffolds promoted increased cell adhesion and a tendon-like cellular phenotype, while biological scaffolds promoted cell proliferation and expression of collagen genes. However, no single scaffold was superior. Our results may help understand the way that patients' cells interact with scaffolds and guide the development of new scaffolds in the future. PMID:26815643

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

    PubMed Central

    Littlewood, Chris

    2012-01-01

    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. PMID:24179329

  8. Interrater reproducibility of clinical tests for rotator cuff lesions

    PubMed Central

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

    2004-01-01

    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 κ 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%) κ 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. PMID:15361389

  9. Calcific tendinitis of the rotator cuff: a review.

    PubMed

    Kachewar, Sushil G; Kulkarni, Devidas S

    2013-07-01

    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

  10. Calcific Tendinitis of the Rotator Cuff: A Review

    PubMed Central

    Kachewar, Sushil G; Kulkarni, Devidas S

    2013-01-01

    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

  11. Tissue discrimination in magnetic resonance imaging of the rotator cuff

    NASA Astrophysics Data System (ADS)

    Meschino, G. J.; Comas, D. S.; González, M. A.; Capiel, C.; Ballarin, V. L.

    2016-04-01

    Evaluation and diagnosis of diseases of the muscles within the rotator cuff can be done using different modalities, being the Magnetic Resonance the method more widely used. There are criteria to evaluate the degree of fat infiltration and muscle atrophy, but these have low accuracy and show great variability inter and intra observer. In this paper, an analysis of the texture features of the rotator cuff muscles is performed to classify them and other tissues. A general supervised classification approach was used, combining forward-search as feature selection method with kNN as classification rule. Sections of Magnetic Resonance Images of the tissues of interest were selected by specialist doctors and they were considered as Gold Standard. Accuracies obtained were of 93% for T1-weighted images and 92% for T2-weighted images. As an immediate future work, the combination of both sequences of images will be considered, expecting to improve the results, as well as the use of other sequences of Magnetic Resonance Images. This work represents an initial point for the classification and quantification of fat infiltration and muscle atrophy degree. From this initial point, it is expected to make an accurate and objective system which will result in benefits for future research and for patients’ health.

  12. Gene polymorphism of IL-6 and MMP-3 decreases passive range of motion after rotator cuff repair

    PubMed Central

    Ling, Yan; Peng, Cheng; Liu, Chenguang; Zhang, Na; Yue, Shouwei

    2015-01-01

    Objectives: Post-operative stiffness is common after rotator cuff repair, given the difference in susceptibility and severity, the genetic factors may be involved. Interleukin 6 (IL-6) and Matrix metalloproteinases 3 (MMP-3) were previous found as key cytokines in the pathologies of adhesive capsulitis. The present study aims to investigate whether variants within the IL-6 and MMP-3 gene contributed to post-operative stiffness in a Chinese Han population. Methods: A total of 188 patients diagnosed with rotator cuff tears treated with mini-open surgery were enrolled in this study, among which 87 patients were diagnosed as post-operative stiffness and the remaining 101 patients as controls. All subjects were genotyped for IL-6 and MMP-3 SNPs. Results: The rs1800796 of IL-6 and rs679620 of MMP-3 were found significantly associated with increased susceptibility and severity of post-operative stiffness. Conclusion: The rs1800796 SNP of IL-6 and rs650108 SNP of MMP-3 were associated with increased risk of post-operative stiffness susceptibility and severity. This finding can be used in guiding the rehabilitation procedure after rotator cuff surgery, in another word, those with the genetic susceptibility factors should receive a more radical rehabilitation procedure and those without the susceptibility factors can be more conservative. PMID:26191285

  13. The Role of the Peripheral and Central Nervous Systems in Rotator Cuff Disease

    PubMed Central

    Bachasson, Damien; Singh, Anshuman; Shah, Sameer; Lane, John G.; Ward, Samuel R.

    2015-01-01

    Rotator cuff (RC) disease is an extremely common condition associated with shoulder pain, reduced functional capacities and impaired quality of life. It primarily involves alterations in tendon health and mechanical properties that can ultimately lead to tendon failure. RC tendon tears induce progressive muscular changes that negatively impact surgical reparability of the RC tendons and clinical outcomes. At the same time, a significant base of clinical data suggests a relatively weak relationship between RC integrity and clinical presentation, emphasizing the multifactorial aspects of RC disease. This review aims to summarize the potential contribution of peripheral, spinal and supraspinal neural factors that may: (i) exacerbate structural and functional muscle changes induced by tendon tear, (ii) compromise the reversal of these changes during surgery and rehabilitation, (iii) contribute to pain generation and persistence of pain, iv) impair shoulder function through reduced proprioception, kinematics and muscle recruitment, and iv) help to explain interindividual differences and response to treatment. Given the current clinical and scientific interest in peripheral nerve injury in the context of RC disease and surgery, we carefully reviewed this body of literature with a particular emphasis for suprascapular neuropathy that has generated a large number of studies in the past decade. Within this process, we highlight the gaps in current knowledge and suggest research avenues for scientists and clinicians. PMID:26189809

  14. Labrum and rotator cuff injuries in the throwing athlete.

    PubMed

    Menge, Travis J; Byram, Ian R; Boykin, Robert E; Bushnell, Brandon D

    2015-02-01

    The large amount of force imparted across the shoulder during the act of throwing makes the glenohumeral joint highly susceptible to injury in the athlete performing overhead throwing motions. The bony incongruity of the shoulder enables greater range of motion than any other joint in the body, but it also results in significant strain on the surrounding soft tissues during the throwing motion. Throwers can present with acute injuries, but more commonly they suffer from chronic overuse conditions resulting from repetitive overload. Proper management requires early recognition with treatment directed toward the athlete's safe return to sports. Failure to institute an appropriate management strategy may result in significant complications, including prolonged disability, progression of symptoms, and further injury. We discuss the functional anatomy, pathophysiology, clinical presentation, evaluation, and treatment of common injuries of the glenoid labrum and rotator cuff in the overhead throwing athlete. PMID:25599876

  15. Patient Reported Outcomes for Rotator Cuff Disease - Which PRO Should You Use?

    PubMed Central

    Makhni, Eric Chugh; Hamamoto, Jason Taizo; Higgins, John; Patterson, Taylor; Romeo, Anthony A.; Verma, Nikhil N.

    2016-01-01

    present. The American Shoulder and Elbow Surgeons score (ASES), Constant score, Simple Shoulder Test (SST), 36 item Short Form Health Survey (SF-36), and Shoulder Pain and Disability Index (SPADI) had an overall comprehensiveness score of 0.80. The remaining PROs had a score of 0.60 or less. The highest scoring PROs for efficiency were UCLA, Constant, and Marx with scores of 1.00, 0.50, and 0.43 respectively. The UCLA, DASH, PENN, and SRQ had the highest pain comprehensiveness score of 0.60. The ASES, SST, WORC, DASH, Quick DASH, PENN, and SRQ had the highest activity comprehensiveness score of 1.00. The three highest averages of overall comprehensiveness, overall efficiency, pain comprehensiveness, and activity comprehensiveness were the UCLA, SRQ, and PENN PROs with averages of 0.78, 0.71, and 0.70 respectively. Conclusion: This is the first study to quantitatively assess quality and efficiency of patient reported outcomes for rotator cuff tears. The UCLA shoulder score was determined to be the most comprehensive and efficient when compared to fourteen other shoulder PROs in regards to the domains of pain, strength, activity, motion, and quality of life. Clinicians should consider these metrics when incorporating these tools in everyday clinical practice and research.

  16. MR patterns of rotator cuff and labral lesions: comparison between low-field and high-field images.

    PubMed

    Shih, T T; Chen, W G; Su, C T; Huang, K M; Ericson, F; Chiu, L C

    1993-02-01

    Eighteen people (10 men, 8 women) were examined on a 0.3-T (low-field) imager with T1-weighted axial and coronal images and either axial or coronal T2-weighted images. Thirty-two people (22 men, 10 women) were examined on a 1.5-T (high-field) imager with axial T1-weighted images and coronal, sagittal dual-echo images. Rotator cuff lesions were diagnosed by the following findings: abnormal signal in the tendon, irregularity or discontinuity at the musculo-tendinous junction, or muscle abnormality. Glenoid labrum tears were considered if one or more of the following criteria were present: labral deformity of unusual size, focal defect, amputation or displacement with fluid, or capsular stripping. Comparison between the high-field and low-field MR images in the evaluation of rotator cuff lesions suggests that the high-field imager is better than the low-field imager in the differentiation of tendinitis from tears, in the confirmation of bursitis and in detection of subscapularis lesions. A higher contrast-to-noise ratio (CNR), less time consumption, and more section planes (especially, sagittal sections) appear to be the main reasons for this. As far as labral lesions are concerned, the performances of the high-field imagers and low-field imagers were almost equal. The artifact of greater chemical shift with a high-field imager would more or less, we assume, degrade the better CNR achievable in the diagnosis of labral lesions. PMID:8101743

  17. The geyser sign and torn rotator cuff: clinical significance and pathomechanics.

    PubMed

    Craig, E V

    1984-12-01

    The geyser radiographic sign on shoulder arthrogram is characterized by leakage of dye from the glenohumeral joint into the subdeltoid bursa. The dye outlines the acromioclavicular joint. It is usually an indication of a full-thickness cuff tear of long duration. The clinical occurrence and pathomechanics of this finding indicate that repair is generally difficult. PMID:6499313

  18. Capstan screw rotator cuff repair: a novel two-row mini-open technique

    PubMed Central

    Goubran, Alex; Jaques, Aishling; Smith, Christopher; Bunker, Tim

    2014-01-01

    Background Prospective data collection occurred between 2000 and 2010 on 143 consecutive patients with symptomatic rotator cuff tears, aiming to examine the end-result of a new technique of mini-open double row repair: the Capstan screw technique. Methods All patients had a pre- and postoperative Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES) score and range of movement measurements. All were followed up for a minimum of 1 year with an exit questionnaire. Subscapularis repairs, small (<1 cm) and massive (>5 cm) supraspinatus repairs were excluded. Ninety-nine patients fitted the inclusion and exclusion criteria of whom 87 had a complete data set. Results The mean (SD) pre-operative OSS was 21.85 (8.6) and the mean (SD) postoperative OSS was 44.58 (5.2) (p < 0.0001). The mean (SD) pre-operative ASES score was 51.5 (19.4) and the mean (SD) postoperative ASES score was 86.42 (17.06) (p < 0.0001). Flexion improved from a mean of 119° to 170° (p < 0.0001). The clinical re-tear rate was 3.4% and the imaged re-tear rate was 6.8%. In total, 91% of patients were satisfied with the procedure. There were no deep infections and two (2%) minor wound infections. There was no single instance of deltoid dysfunction. Conclusions The Capstan screw technique represents a simple, rapid, strong and reliable mini-open technique.

  19. Influence of toroidal rotation on resistive tearing modes in tokamaks

    NASA Astrophysics Data System (ADS)

    Wang, S.; Ma, Z. W.

    2015-12-01

    Influence of toroidal equilibrium plasma rotation on m/n = 2/1 resistive tearing modes is studied numerically using a 3D toroidal MHD code (CLT). It is found that the toroidal rotation with or without shear can suppress the tearing instability and the Coriolis effect in the toroidal geometry plays a dominant role on the rotation induced stabilization. For a high viscosity plasma (τR/τV ≫ 1, where τR and τV represent resistive and viscous diffusion time, respectively), the effect of the rotation shear combined with the viscosity appears to be stabilizing. For a low viscosity plasmas (τR/τV ≪ 1), the rotation shear shows a destabilizing effect when the rotation is large.

  20. Influence of toroidal rotation on resistive tearing modes in tokamaks

    SciTech Connect

    Wang, S.; Ma, Z. W.

    2015-12-15

    Influence of toroidal equilibrium plasma rotation on m/n = 2/1 resistive tearing modes is studied numerically using a 3D toroidal MHD code (CLT). It is found that the toroidal rotation with or without shear can suppress the tearing instability and the Coriolis effect in the toroidal geometry plays a dominant role on the rotation induced stabilization. For a high viscosity plasma (τ{sub R}/τ{sub V} ≫ 1, where τ{sub R} and τ{sub V} represent resistive and viscous diffusion time, respectively), the effect of the rotation shear combined with the viscosity appears to be stabilizing. For a low viscosity plasmas (τ{sub R}/τ{sub V} ≪ 1), the rotation shear shows a destabilizing effect when the rotation is large.

  1. Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant: a 2-year MRI follow-up

    PubMed Central

    Bokor, Desmond John; Sonnabend, David; Deady, Luke; Cass, Ben; Young, Allan; Van Kampen, Craig; Arnoczky, Steven

    2015-01-01

    Summary Background the inability to restore the normal tendon footprint and limit strains on the repair site are thought to contribute to re-tearing following rotator cuff repair. The purpose of this study was to use a collagen implant to augment rotator cuff repairs through the restoration of the native tendon footprint and the induction of new tissue to decrease overall tendon strain. Methods repairs of full-thickness rotator cuff lesions in 9 adult patients were augmented with a novel collagen implant placed over the bursal surface of the repair. Tendon thickness and footprint anatomy were evaluated using MRI at 3, 6, 12, and 24 months. Clinical results were assessed using standard outcome metrics. Mean follow-up for all patients was 25.8 months. Results the implant induced significant new tissue formation in all patients by 3 months. This tissue matured over time and became indistinguishable from the underlying tendon. At 24 months all repairs remained intact and normal footprint anatomy of the tendon was restored in all patients. All clinical scores improved significantly over time. Conclusion the ability of a collagen implant to induce new host tissue formation and restore the normal footprint anatomy may represent a significant advancement in the biological augmentation and ultimate durability of rotator cuff repairs. PMID:26605186

  2. ARTHROSCOPIC TREATMENT OF CALCIFYING TENDINITIS OF THE ROTATOR CUFF

    PubMed Central

    Neto, Arnaldo Amado Ferreira; Trevizani, Cassio Silva; Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emílio Conforto; Bitar, Alexandre Carneiro; Neto, Francisco José dos Santos

    2015-01-01

    To evaluate the clinical and radiographic results from arthroscopic surgical treatment of the rotator cuff in patients with calcifying tendinitis. Method: A retrospective study was conducted on twenty patients who underwent arthroscopic treatment for calcifying tendinitis of the shoulder between March 1999 and November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) were male. The right side was affected in 10 cases (71%) and the left in four cases (29%). Nine cases (64%) had calcification in the supraspinatus tendon, two (14%) in the infraspinatus tendon, and three (21%) in both tendons. Results: In all cases, resection of the calcium deposits was performed by means of a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) underwent subacromial decompression, and one (7%) underwent excision of the distal clavicle. A tendon-tendon suture was performed in three shoulders (21%). None of the patients underwent tendon-bone reinsertion. The mean score obtained on the UCLA scale was 33 points (26-35), thus indicating that a majority of patients had good results. In the final radiographic evaluation, none of the patients showed signs of calcification. Conclusion: Arthroscopic treatment of calcifying tendinitis of the shoulder safely allows excision of the calcification, leading to good results in relation to shoulder pain and function. PMID:27022591

  3. Influence of prosthetic humeral head size and medial offset on the mechanics of the shoulder with cuff tear arthropathy: a numerical study.

    PubMed

    Lemieux, P O; Tétreault, P; Hagemeister, N; Nuño, N

    2013-02-22

    This numerical study assesses the influence of an oversized humeral hemiprosthesis with a larger medial offset on the mechanics of the shoulder with cuff tear arthropathy (CTA). Shoulder elevation in the scapular plane is performed, and a Seebauer Type IIa CTA is simulated: a massive rotator cuff tear, a proximal and static migration of the humeral head, and two contacts with friction (glenohumeral and acromiohumeral). The CTA model without a prosthesis (friction coefficient 0.3) is evaluated first as a reference model. Then, three humeral head prosthetic geometries (friction coefficient 0.15) are evaluated: anatomical head, oversized head, and oversized head with a large medial offset. The function of the middle deltoid (i.e. moment arm, applied force, and strength), the contact forces, and the range of motion are studied. The anatomical head, which reduces friction by half, decreases the middle deltoid force (25%) and the contact forces (glenoid 7%; acromion 25%), and increases the range of motion from 41 to 54°. The oversized head increases the moment arm (15%) and the middle deltoid strength (13%), which further decreases the deltoid force (7%) and the contact forces (glenoid 7%; acromion 17%), and increases the range of motion from 54° to 69°. The oversized head with a large medial offset enhances these effects: the moment arm increases by another 3.1%, the deltoid force decreases by another 5% and the acromiohumeral contact force by another 12%, and the range of motion increases from 69° to 84°. These results suggest that increasing the medial offset and oversizing the hemiprosthetic head improve the function of the deltoid, reduce acromial solicitation, and restore elevation to almost 90°. PMID:23219280

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

    PubMed Central

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

    2009-01-01

    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

  5. Architectural and Biochemical Adaptations in Skeletal Muscle and Bone Following Rotator Cuff Injury in a Rat Model

    PubMed Central

    Sato, Eugene J.; Killian, Megan L.; Choi, Anthony J.; Lin, Evie; Choo, Alexander D.; Rodriguez-Soto, Ana E.; Lim, Chanteak T.; Thomopoulos, Stavros; Galatz, Leesa M.; Ward, Samuel R.

    2015-01-01

    Background: Injury to the rotator cuff can cause irreversible changes to the structure and function of the associated muscles and bones. The temporal progression and pathomechanisms associated with these adaptations are unclear. The purpose of this study was to investigate the time course of structural muscle and osseous changes in a rat model of a massive rotator cuff tear. Methods: Supraspinatus and infraspinatus muscle architecture and biochemistry and humeral and scapular morphological parameters were measured three days, eight weeks, and sixteen weeks after dual tenotomy with and without chemical paralysis via botulinum toxin A (BTX). Results: Muscle mass and physiological cross-sectional area increased over time in the age-matched control animals, decreased over time in the tenotomy+BTX group, and remained nearly the same in the tenotomy-alone group. Tenotomy+BTX led to increased extracellular collagen in the muscle. Changes in scapular bone morphology were observed in both experimental groups, consistent with reductions in load transmission across the joint. Conclusions: These data suggest that tenotomy alone interferes with normal age-related muscle growth. The addition of chemical paralysis yielded profound structural changes to the muscle and bone, potentially leading to impaired muscle function, increased muscle stiffness, and decreased bone strength. Clinical Relevance: Structural musculoskeletal changes occur after tendon injury, and these changes are severely exacerbated with the addition of neuromuscular compromise. PMID:25834081

  6. Tears

    MedlinePlus

    ... from the glands to the surface of your eye. Problems with the tear system can include too many tears, too few tears, or problems with the tear ducts. Treatment of the problem depends on the cause.

  7. Do changes in hand grip strength correlate with shoulder rotator cuff function?

    PubMed Central

    Herrington, Lee; Hoyle, Rebecca; Prescott, Evie; Bellamy, Nathan

    2016-01-01

    Background Shoulder pain as a result of rotator cuff pathology is one of the most common musculoskeletal complaints presenting within primary care. Assessment of hand grip strength has been proposed as an indicator of rotator cuff function. This experimental study assessed the relationship between grip strength and shoulder lateral rotator muscle strength in a number of different shoulder positions, aiming to investigate whether such a relationship existed and whether grip strength could be used as a functional assessment tool for the posterior cuff. Methods Twenty-seven healthy, physically active, volunteers (19 males, eight females) with no history of shoulder, upper limb or neck injury comprised the study group. The mean (SD) age was 19.8 (5.7) years (range 18 years to 23 years). Grip strength (measured with hand grip dynamometer) and lateral rotator strength (measured with a hand held dynamometer) was measured at neutral, 90° abduction, and 90° abduction with 90° external rotation. Results The correlation between grip strength and shoulder lateral rotation strength ranged between r = 0.91 (r2 = 0.84) and r = 0.72 (r2 = 0.52) across all positions. Conclusions A strong correlation between grip strength and lateral rotator strength was shown at all positions for both left and right hands, suggesting that assessment of grip strength could be used as a rotator cuff monitor of recruitment function. PMID:27583010

  8. Biological augmentation of rotator cuff repair using bFGF-loaded electrospun poly(lactide-co-glycolide) fibrous membranes.

    PubMed

    Zhao, Song; Zhao, Jingwen; Dong, Shikui; Huangfu, Xiaoqiao; Li, Bin; Yang, Huilin; Zhao, Jinzhong; Cui, Wenguo

    2014-01-01

    Clinically, rotator cuff tear (RCT) is among the most common shoulder pathologies. Despite significant advances in surgical techniques, the re-tear rate after rotator cuff (RC) repair remains high. Insufficient healing capacity is likely the main factor for reconstruction failure. This study reports on a basic fibroblast growth factor (bFGF)-loaded electrospun poly(lactide-co-glycolide) (PLGA) fibrous membrane for repairing RCT. Implantable biodegradable bFGF-PLGA fibrous membranes were successfully fabricated using emulsion electrospinning technology and then characterized and evaluated with in vitro and in vivo cell proliferation assays and repairs of rat chronic RCTs. Emulsion electrospinning fabricated ultrafine fibers with a core-sheath structure which secured the bioactivity of bFGF in a sustained manner for 3 weeks. Histological observations showed that electrospun fibrous membranes have excellent biocompatibility and biodegradability. At 2, 4, and 8 weeks after in vivo RCT repair surgery, electrospun fibrous membranes significantly increased the area of glycosaminoglycan staining at the tendon-bone interface compared with the control group, and bFGF-PLGA significantly improved collagen organization, as measured by birefringence under polarized light at the healing enthesis compared with the control and PLGA groups. Biomechanical testing showed that the electrospun fibrous membrane groups had a greater ultimate load-to-failure and stiffness than the control group at 4 and 8 weeks. The bFGF-PLGA membranes had the highest ultimate load-to-failure, stiffness, and stress of the healing enthesis, and their superiority compared to PLGA alone was significant. These results demonstrated that electrospun fibrous membranes aid in cell attachment and proliferation, as well as accelerating tendon-bone remodeling, and bFGF-loaded PLGA fibrous membranes have a more pronounced effect on tendon-bone healing. Therefore, augmentation using bFGF-PLGA electrospun fibrous

  9. The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors

    PubMed Central

    Hawi, Nael; Krettek, Christian; Hawi, Ahmed; Meller, Rupert

    2015-01-01

    The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization. PMID:26258030

  10. Complications of rotator cuff surgery—the role of post-operative imaging in patient care

    PubMed Central

    Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M

    2014-01-01

    When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935

  11. Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy

    PubMed Central

    Leong, Hio Teng; Hug, François; Fu, Siu Ngor

    2016-01-01

    Although excessive tension of the upper trapezius (UT) is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1) to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2) to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years) participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002), regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001). When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008) and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002) was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001). Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy. PMID:27159276

  12. Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy.

    PubMed

    Leong, Hio Teng; Hug, François; Fu, Siu Ngor

    2016-01-01

    Although excessive tension of the upper trapezius (UT) is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1) to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2) to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years) participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002), regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001). When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008) and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002) was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001). Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy. PMID:27159276

  13. Tears

    MedlinePlus

    ... as those salty drops that fall from your eyes when you cry. Actually, your tears clean your eyes every time you blink. Tears also keep your eyes moist, which is important for your vision. Tear ...

  14. Do Matrix Metalloproteases and Tissue Inhibitors of Metalloproteases in Tenocytes of the Rotator Cuff Differ with Varying Donor Characteristics?

    PubMed Central

    Klatte-Schulz, Franka; Aleyt, Thomas; Pauly, Stephan; Geißler, Sven; Gerhardt, Christian; Scheibel, Markus; Wildemann, Britt

    2015-01-01

    An imbalance between matrix metalloproteases (MMPs) and the tissue inhibitors of metalloproteases (TIMPs) may have a negative impact on the healing of rotator cuff tears. The aim of the project was to assess a possible relationship between clinical and radiographic characteristics of patients such as the age, sex, as well as the degenerative status of the tendon and the MMPs and TIMPs in their tenocyte-like cells (TLCs). TLCs were isolated from ruptured supraspinatus tendons and quantitative Real-Time PCR and ELISA was performed to analyze the expression and secretion of MMPs and TIMPs. In the present study, MMPs, mostly gelatinases and collagenases such as MMP-2, -9 and -13 showed an increased expression and protein secretion in TLCs of donors with higher age or degenerative status of the tendon. Furthermore, the expression and secretion of TIMP-1, -2 and -3 was enhanced with age, muscle fatty infiltration and tear size. The interaction between MMPs and TIMPs is a complex process, since TIMPs are not only inhibitors, but also activators of MMPs. This study shows that MMPs and TIMPs might play an important role in degenerative tendon pathologies. PMID:26068238

  15. Effect of methylprednisolone use on the rotator cuff in rats: biomechanical and histological study☆

    PubMed Central

    Ghellioni, Gustavo Vinícius; da Silva, Lucas Souto; Piovezan, Anna Paula; Martins, Rafael Olívio

    2015-01-01

    Objective To evaluate the influence of treatment with different doses of methylprednisolone on the mechanical resistance and possible histological alterations of the rotator cuff tendon in rats. Methods Male Wistar rats were divided randomly into four treatment groups: sham, vehicle or 0.6 mg/kg or 6.0 mg/kg of methylprednisolone. Changes to mechanical resistance (in N) and histological parameters (fibrillar appearance, presence of collagen, edema and vascular proliferation) of the rotator cuff tendon were evaluated. The analyses were conducted after administration of one treatment (24 h afterwards), two treatments (7 days afterward) or three treatments (14 days afterwards), into the subacromial space. Results Seven and fourteen days after the treatments were started, it was found that in a dose-dependent manner, methylprednisolone reduced the mechanical resistance of the rotator cuff tendon (p < 0.05 in relation to the vehicle group). Modifications to the histological parameters were observed on the 7th and 14th days after the first infiltration, especially regarding the presence of collagen and vascular proliferation, for the dose of 0.6 mg/kg of methylprednisolone, and also regarding the presence of collagen, edema and vascular proliferation for the dose of 6.0 mg/kg of corticoid. Conclusion The results obtained demonstrated a relationship between methylprednisolone use through infiltration into the subacromial space and reduction of the mechanical resistance of and histological modifications to the rotator cuff tendon in rats. PMID:26229927

  16. Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

    PubMed Central

    Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

    2014-01-01

    Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

  17. Ultrasound Dimensions of the Rotator Cuff and Other Associated Structures in Korean Healthy Adults.

    PubMed

    Kim, Kyeongwon; Kim, Hong Geum; Song, Daeheon; Yoon, Jung Yoon; Chung, Myung Eun

    2016-09-01

    In evaluating patients complaining of shoulder pain, ultrasonography is an emerging imaging tool due to convenience, low cost, high sensitivity and specificity. However, normative values of ultrasound dimensions of the shoulder to be compared with pathologic findings in Korean adults are not provided yet. We evaluated the ultrasound dimensions of the rotator cuff, long head of biceps tendon, deltoid muscle and acromioclavicular joint in Korean healthy adults. Shoulder ultrasonography was performed on 200 shoulders from 100 healthy adults. The dimensions of the thickness of rotator cuff (supraspinatus, infraspinatus, subscapularis tendon), deltoid muscle, long head of biceps tendon, subacromial subdeltoid bursa, and acromioclavicular joint interval were measured in a standardized manner. Differences in measurements among sex, age, and dominant arms were compared. The thickness of rotator cuff tendons (supraspinatus, infraspinatus, subscapularis) and deltoid muscle were significantly different between men and women. The thickness of subacromial subdeltoid bursa was significantly different between men and women for non-dominant side. In rotator cuff tendon measurements, the differences between dominant and non-dominant shoulders were not significant, which means the asymptomatic contralateral shoulder can be used to estimate the normal reference values. When stratified by age divided by 10 years, the measurements of supraspinatus, subscapularis and deltoid thickness showed tendency of increase with the age. The acromioclavicular joint interval, on the other hand, revealed decreasing tendency. This report suggests normative values of ultrasound dimensions of healthy Korean population with varying age, and can be useful as reference values in evaluating shoulder pathology, especially in rotator cuff tendon pathology. PMID:27510393

  18. Partial rotator cuff injury in athletes: bursal or articular?☆

    PubMed Central

    Carvalho, Cassiano Diniz; Cohen, Carina; Belangero, Paulo Santoro; Figueiredo, Eduardo Antônio; Monteiro, Gustavo Cará; de Castro Pochini, Alberto; Andreoli, Carlos Vicente; Ejnisman, Benno

    2015-01-01

    A painful shoulder is a very common complaint among athletes, especially in the case of those in sports involving throwing. Partial lesions of the rotator cuff may be very painful and cause significant functional limitation to athletes’ sports practice. The incidence of partial lesions of the cuff is variable (13–37%). It is difficult to make the clinical and radiological diagnosis, and this condition should be borne in mind in the cases of all athletes who present symptoms of rotator cuff syndrome, including in patients who are diagnosed only with tendinopathy. Objective To evaluate the epidemiological behavior of partial lesions of the rotator cuff in both amateur and professional athletes in different types of sports. Methods We evaluated 720 medical files on athletes attended at the shoulder service of the Discipline of Sports Medicine at the Sports Traumatology Center, Federal University of São Paulo. The majority of them were men (65%). Among all the patients, 83 of them were diagnosed with partial lesions of the rotator cuff, by means of ultrasonography or magnetic resonance, or in some cases using both. We applied the binomial test to compare the proportions found. Result It was observed that intra-articular lesions predominated (67.6%) and that these occurred more frequently in athletes in sports involving throwing (66%). Bursal lesions occurred in 32.4% of the athletes, predominantly in those who did muscle building (75%). Conclusion Intra-articular lesions are more frequent than bursal lesions and they occur predominantly in athletes in sports involving throwing, while bursal lesions were more prevalent in athletes who did muscle building. PMID:26417568

  19. In vitro study comparing two collageneous membranes in view of their clinical application for rotator cuff tendon regeneration.

    PubMed

    Fini, Milena; Torricelli, Paola; Giavaresi, Gianluca; Rotini, Roberto; Castagna, Alessandro; Giardino, Roberto

    2007-01-01

    Tenocytes were isolated from the rotator cuff tendons of healthy (HT) and glucocorticoid (GC)-treated rats (GCT) and were cultured on polystyrene wells (TCP) as control, and on 2 de-cellularized collagen matrices: porcine small intestinal submucosa (SIS), and human dermal matrix (Graftjacket, GJ). At 3 and 7 days cell proliferation and synthesis were evaluated. Proliferation of HT tenocytes increased between experimental times for both tested membranes, but already at 3 days, HT tenocytes cultured on GJ showed the highest WST-1 value. The collagen-I (CICP) synthesis on GJ membrane did not change between experimental times and was significantly higher than TCP and SIS at 7 days. Proteoglycans (PG), and fibronectin (FBN) synthesis increased when HT were cultured on GJ, between experimental times, and both PG and FBN synthesis on GJ membrane were higher than TCP and SIS at 7 days. GC determined decreases in cell proliferation, CICP and PG syntheses at 3 days of culture on TCP when compared to HT tenocytes while a decrease in WST-1 was maintained at 7 days. CICP, PG and FBN (only at 3 days) syntheses were significantly higher in GCT tenocytes cultured on GJ. The negative effects on GC on GCT tenocytes cultured on membrane were particularly evident on SIS for CICP (-18%) and FBN (-67%) synthesis. The obtained results support the conclusion that GJ is more suitable than SIS as a scaffold for in situ tissue engineering and for the in vitro bioengineering of tendons to heal massive tears of the rotator cuff tendon. PMID:17054111

  20. Reverse Shoulder Arthroplasty for Management of Postinfectious Arthropathy With Rotator Cuff Deficiency.

    PubMed

    Morris, Brent J; Waggenspack, Wame N; Laughlin, Mitzi S; Elkousy, Hussein A; Gartsman, Gary M; Edwards, T Bradley

    2015-08-01

    Treatment of patients with rotator cuff deficiency and arthritis in the setting of a prior glenohumeral infection (postinfectious arthropathy) is complex, with little evidence to guide treatment. The current authors present their approach to management of these patients and clinical outcomes after reverse shoulder arthroplasty (RSA). All primary RSAs performed for postinfectious arthropathy and rotator cuff deficiency with native glenohumeral joints were identified in a prospective shoulder arthroplasty registry. Eight patients with a minimum of 2-year follow-up were included in the analysis. Clinical outcomes, including the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Osteoarthritis Shoulder (WOOS) index, the Single Assessment Numeric Evaluation (SANE) score, and range of motion measurements, were assessed preoperatively and at final follow-up. At an average follow-up of 4.4 years, no patient had a clinically detectable recurrence of infection. Significant improvements were noted in all outcome scores from preoperative evaluation to final follow-up after RSA, including Constant score (P=.003), ASES score (P<.001), WOOS index (P=.002), SANE score (P=.025), forward flexion (P<.001), abduction (P<.001), and external rotation (P=.020). Seven of 8 patients reported they were satisfied or very satisfied at final follow-up. Reverse shoulder arthroplasty can be performed in patients without significant medical comorbidities in the setting of postinfectious arthropathy and rotator cuff deficiency with a low risk of recurrence of infection. Significant clinical improvements were noted at short-term follow-up. PMID:26270757

  1. Effects of therapeutic ultrasound and exercise on pain, function, and isokinetic shoulder rotator strength of patients with rotator cuff disease

    PubMed Central

    Analan, Pınar Doruk; Leblebici, Berrin; Adam, Mehmet

    2015-01-01

    [Purpose] The aim of this prospective, double-blind, randomized, placebo-controlled study was to evaluate the effects of therapeutic continuous ultrasound (US) on patients with rotator cuff disease. [Subjects and Methods] Twenty-two patients were treated with a standard physiotherapy program consisting of a hot-pack, transcutaneous electrical nerve stimulation (TENS), exercises, and US that was supervised by the same physiotherapist. The patients were randomly assigned to either a group that received true US (n=11) or one that received sham US (n=11). [Results] There were significant differences between the pre- and post-intervention UCLA Shoulder Rating Scale and Constant-Murley Shoulder Outcome scores, VAS, and external rotation (ER) peak torque 60°/second values for both the true and sham US groups. However, the between-group differences were not statistically significant. [Conclusion] In patients with rotator cuff disease, physiotherapy interventions effectively treat the pain, improve the clinical status, and increase the muscle strength of the shoulder ER at a low constant angular velocity, with functional improvement being seen immediately after treatment. However, at the end of the intervention, the US had yielded no additional efficacy to the physiotherapy treatment regimen of the patients with rotator cuff disease. PMID:26644656

  2. Comparison of rotator cuff muscle architecture between humans and other selected vertebrate species

    PubMed Central

    Mathewson, Margie A.; Kwan, Alan; Eng, Carolyn M.; Lieber, Richard L.; Ward, Samuel R.

    2014-01-01

    In this study, we compare rotator cuff muscle architecture of typically used animal models with that of humans and quantify the scaling relationships of these muscles across mammals. The four muscles that correspond to the human rotator cuff – supraspinatus, infraspinatus, subscapularis and teres minor – of 10 commonly studied animals were excised and subjected to a series of comparative measurements. When body mass among animals was regressed against physiological cross-sectional area, muscle mass and normalized fiber length, the confidence intervals suggested geometric scaling but did not exclude other scaling relationships. Based on the architectural difference index (ADI), a combined measure of fiber length-to-moment arm ratio, fiber length-to-muscle length ratio and the fraction of the total rotator cuff physiological cross-sectional area contributed by each muscle, chimpanzees were found to be the most similar to humans (ADI=2.15), followed closely by capuchins (ADI=2.16). Interestingly, of the eight non-primates studied, smaller mammals such as mice, rats and dogs were more similar to humans in architectural parameters compared with larger mammals such as sheep, pigs or cows. The force production versus velocity trade-off (indicated by fiber length-to-moment arm ratio) and the excursion ability (indicated by fiber length-to-muscle length ratio) of humans were also most similar to those of primates, followed by the small mammals. Overall, primates provide the best architectural representation of human muscle architecture. However, based on the muscle architectural parameters of non-primates, smaller rather than larger mammals may be better models for studying muscles related to the human rotator cuff. PMID:24072803

  3. [Recent experience with reconstruction operations in ruptures of the rotator cuff.].

    PubMed

    Chomiak, J

    1997-01-01

    The author presents his short-term experience with reconstruction operations in ruptures of the rotator cuff which were performed according to principles accepted at present in twenty five patients (26 shoulders) during 1993-1996. Men predominated in the group (16 men) and the majority of patients were in the age bracket from 50-70 years. The follow-up period was 6-36 months. Massive ruptures with a lesion of the cuff exceeding 5 cm (10 times) predominated, followed by ruptures with a lesion under 2 cm (9 times). In the majority of patients the operatoin was made using the Kessel-Gschwend approach. After anterior acromionplasty the tendons of the cuff were released and fixed into the ridge between the articular area of the head of the joint and the large tubercle. The operated extremity was fixed on an abduction splint for 4-6 weeks and this was followed by controlled rehabilitation for 1-2 months. According to Constant's functional score excellent results were achieved in 31 % of the operated patients, a satisfactory result in 11 % and an unsatisfactory result in 23 % of the operated patients. The presented results are consistent above all with the subjective evaluation and evaluation of pain resulting from subacromial decompression. The functional result is consiostent with the achieved extent of mobility of the shoulder. In the majority of patients however marked restriction of strength in abduction persists due to muscular hypotrophy asa result of predominating inveterate massive ruptures. Unsatisfactory results were recorded in six patients in conjunction with the following circumstances: reoperation in the subacromial space, mechanical failure of the suture, deep infection in diabetes mellitus, operation of an occupational injury with attempted compensation and refractory cervicobrachial syndrome with an impact on the shoulder joint. From this initial experience ensues that reconstructions of the rotator cuff are successful provided the indication is correct

  4. COMPARISON OF COMPLEMENTARY EXAMS IN THE DIAGNOSIS OF ROTATOR CUFF INJURIES

    PubMed Central

    El-Kouba, Gabriel; Andreas Huber, Thomas; Freitas, José Renato Wilke; Steglich, Valdir; Ayzemberg, Henrique; Santos, Adriano M.

    2015-01-01

    The aim of this study was to evaluate the accuracy of simple radiography, ultrasound and magnetic resonance imaging (MRI) in diagnosing rotator cuff injuries, comparing their findings with open or arthroscopic surgery findings. Methods: Protocols of the Shoulder and Elbow Surgery Service for patients undergoing surgical treatment for rotator cuff injuries diagnosed by means of radiography, ultrasound and/or MRI between 2002 and 2007 were evaluated. Based on the data gathered, we analyzed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of these complementary examinations, compared with the findings during the surgical procedures. Results: This study included 147 patients with a mean age of 46.09 years. All the patients had undergone a radiography examination, 101 had undergone ultrasound examination and 72 had undergone MRI. We found sensitivity of 13.8%, specificity of 2.6% and accuracy of 30% with radiography; sensitivity of 57.6%, specificity of 29.6% and accuracy of 51.4% with ultrasound; and sensitivity of 86.6%, specificity of 22.2% and accuracy of 63.3% with MRI. Conclusion: Radiography was found to be a specific examination when the mirror sign was present. MRI and ultrasound were shown to be reliable methods with high accuracy for diagnosing rotator cuff injuries. PMID:27022589

  5. A Canine Non-Weight-Bearing Model with Radial Neurectomy for Rotator Cuff Repair

    PubMed Central

    Ji, Xiaoxi; Bao, Nirong; An, Kai-Nan; Amadio, Peter C.; Steinmann, Scott P.; Zhao, Chunfeng

    2015-01-01

    Background The major concern of using a large animal model to study rotator cuff repair is the high rate of repair retears. The purpose of this study was to test a non-weight-bearing (NWB) canine model for rotator cuff repair research. Methods First, in the in vitro study, 18 shoulders were randomized to 3 groups. 1) Full-width transections repaired with modified Mason-Allen sutures using 3-0 polyglactin suture, 2) Group 1 repaired using number 2 (#2) polyester braid and long-chain polyethylene suture, and 3) Partial-width transections leaving the superior 2 mm infraspinatus tendon intact without repair. In the in vivo study of 6 dogs, the infraspinatus tendon was partially transected as the same as the in vitro group 3. A radial neurectomy was performed to prevent weight bearing. The operated limb was slung in a custom-made jacket for 6 weeks. Results In the in vitro study, mean ultimate tensile load and stiffness in Group 2 were significantly higher than Group 1 and 3 (p<0.05). In the in vivo study, gross inspection and histology showed that the preserved superior 2-mm portion of the infraspinatus tendon remained intact with normal structure. Conclusions Based on the biomechanical and histological findings, this canine NWB model may be an appropriate and useful model for studies of rotator cuff repair. PMID:26107616

  6. COMPREHENSIVE STRENGTH TRAINING PROGRAM FOR A RECREATIONAL SENIOR GOLFER 11-MONTHS AFTER A ROTATOR CUFF REPAIR

    PubMed Central

    Meira, Erik P.; En Gilpin, Hui; Brunette, Meredith

    2011-01-01

    Background and Purpose: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. Case Description: The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. Outcomes: The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program. Discussion: The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery. PMID:22163096

  7. RESULTS OF SURGICAL TREATMENT OF DENERATIVE ARTHROPATHY OF THE ROTATOR CUFF USING HEMIARTHROPLASTY- CTA®

    PubMed Central

    Filho, Rômulo Brasil; Ribeiro, Fabiano Rebouças; Tenor, Antonio Carlos; Filho, Cantidio Salvador Filardi; da Costa, Guilherme Barbieri Leme; Storti, Thiago Medeiros; da Costa Garcia, André; Lutfi, Hilton Vargas

    2015-01-01

    Objective: To assess results of CTA® partial shoulder arthroplasty for treatment of degenerative arthropathy of the rotator cuff. Methods: Between December 2006 and June 2009, 23 shoulders of 23 patients were submitted to CTA® type partial shoulder arthroplasty for treatment of arthropathy secondary to rotator cuff injury. Post-operative follow up time ranged from 6 to 35 months. Mean age was 74.1 years. Patients were predominantly female, representing 78.3% of cases. The right limb was affected in 18 patients. All patients had undergone at least 6 months of physiotherapy without improvement of the algetic picture, and being submitted to surgery by the same surgical team. None of the patients had history of surgery on the affected shoulder. The method elected for assessing patients during post-operative follow up was based on UCLA scoring criteria. Results: Improvement in pain was observed in all patients after arthroplasty. Mean UCLA pain score was 9.22 (ranging from 10 to 8). Mean function was 6 (10 to 2). Active frontal flexion was 2.39 (highest score 4 and lowest 0). Mean frontal flexion force was 4.09, maximum was 5 and minimum 3. Mean score on the UCLA was 26.52. 95% were satisfied with the surgery. Conclusion: CTA® type partial shoulder arthroplasty produced satisfactory results in the treatment of degenerative arthropathy of the rotator cuff and had a low rate of complications. PMID:27028431

  8. The development and validation of a questionnaire for rotator cuff disorders: The Functional Shoulder Score

    PubMed Central

    Ibrahim, Edward F; Petrou, Charalambos; Galanos, Antonis

    2015-01-01

    Background The purpose of the present study was to validate the Functional Shoulder Score (FSS), a new patient-reported outcome score specifically designed to evaluate patients with rotator cuff disorders. Methods One hundred and nineteen patients were assessed using two shoulder scoring systems [the FSS and the Constant–Murley Score (CMS)] at 3 weeks pre- and 6 months post-arthroscopic rotator cuff surgery. The reliability, validity, responsiveness and interpretability of the FSS were evaluated. Results Reliability analysis (test–retest) showed an intraclass correlation coefficient value of 0.96 [95% confidence interval (CI) = 0.92 to 0.98]. Internal consistency analysis revealed a Cronbach's alpha coefficient of 0.93. The Pearson correlation coefficient FSS-CMS was 0.782 pre-operatively and 0.737 postoperatively (p < 0.0005). There was a statistically significant increase in FSS scores postoperatively, an effect size of 3.06 and standardized response mean of 2.80. The value for minimal detectable change was ±8.38 scale points (based on a 90% CI) and the minimal clinically important difference for improvement was 24.7 ± 5.4 points. Conclusions The FSS is a patient-reported outcome measure that can easily be incorporated into clinical practice, providing a quick, reliable, valid and practical measure for rotator cuff problems. The questionnaire is highly sensitive to clinical change.

  9. EVALUATION OF THE RESULTS FROM REOPERATIONS ON PATIENTS WITH ROTATOR CUFF LESIONS

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Santos, Ruy Mesquita Maranhão; de Souza, Adriano; Estelles, José Renato Depari; Checchia, Sérgio Luiz

    2015-01-01

    Objectives: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. Methods: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow-up. Results: According to the UCLA evaluation criteria, 21 patients (70%) showed excellent or good outcomes; and nine patients (30%) showed fair or poor outcomes. Conclusion: Open or arthroscopic surgical treatment of recurrent rotator cuff injuries tended to present worse results than from the primary repair. In this study, we found that 70% of the results were excellent and good. The presence of extensive injuries in the reoperation tended to evolve with larger numbers of unsatisfactory results. In our study, we obtained better results from arthroscopic surgery than from open surgery. PMID:27026985

  10. Cross-Sectional Area of the Rotator Cuff Muscles in MRI – Is there Evidence for a Biomechanical Balanced Shoulder?

    PubMed Central

    Bouaicha, Samy; Slankamenac, Ksenija; Moor, Beat K.; Tok, Sina; Andreisek, Gustav; Finkenstaedt, Tim

    2016-01-01

    Objective To provide in-vivo evidence for the common biomechanical concept of transverse and craniocaudal force couples in the shoulder that are yielded by both the rotator cuff muscles (RCM) and the deltoid and to quantitatively evaluate and correlate the cross-sectional areas (CSA) of the corresponding RCM as a surrogate marker for muscle strength using MRI. Materials and Methods Fifty patients (mean age, 36 years; age range, 18–57 years; 41 male, 9 female) without rotator cuff tears were included in this retrospective study. Data were assessed by two readers. The CSA (mm2) of all rotator cuff muscles was measured on parasagittal T1-weighted FSE sequence at two different positions (at the established “y-position” and at a more medial slice in the presumably maximal CSA for each muscle, i.e., the “set position”). The CSA of the deltoid was measured on axial intermediate-weighted FSE sequences at three positions. CSA measurements were obtained using 1.5 Tesla MR-arthrographic shoulder. Pearson’s correlation for the corresponding CSA of the force couple as well as was the intraclass correlation coefficient for the inter- and intra-reader agreement was calculated. Results The mean CSA was 770 mm2 (±167) and 841 mm2 (±191) for the supraspinatus (in the y- and set-positions, respectively) and 984 mm2 (±241) and 1568 mm2 (±338) for the infraspinatus. The mean CSA was 446 mm2 (±129) and 438 mm2 (±128) for the teres minor (in the y- and set-positions, respectively) and 1953 mm2 (±553) and 2343 mm2 (±587) for the subscapularis. The three measurements of the deltoid revealed a CSA of 3063 mm2 (±839) for the upper edge, 3829 mm2 (±836) for the lower edge and 4069 mm2 (±937) for the middle of the glenoid. At the set position Pearson’s correlation of the transverse force couple (subscapularis/infraspinatus) showed a moderate positive correlation of r = 0.583 (p<0.0001) and a strong correlation when the CSA of the teres minor was added to the

  11. Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis

    PubMed Central

    Kim, Moon-Hwan; Oh, Jae-Seop

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis. PMID:25642053

  12. Low-term results from non-conventional partial arthroplasty for treating rotator cuff arthroplasthy☆

    PubMed Central

    Tenor Júnior, Antônio Carlos; de Lima, José Alano Benevides; de Vasconcelos, Iúri Tomaz; da Costa, Miguel Pereira; Filho, Rômulo Brasil; Ribeiro, Fabiano Rebouças

    2015-01-01

    Objective To evaluate the evolution of the functional results from CTA® hemiarthroplasty for surgically treating degenerative arthroplathy of the rotator cuff, with a mean follow-up of 5.4 years. Methods Eighteen patients who underwent CTA® partial arthroplasty to treat degenerative arthroplathy of the rotator cuff between April 2007 and June 2009 were reevaluated, with minimum and mean follow-ups of 4.6 years and 5.4 years, respectively. Pre and postoperative parameters for functionality and patient satisfaction were used (functional scale of the University of California in Los Angeles, UCLA). All the patients underwent prior conservative treatment for 6 months and underwent surgical treatment because of the absence of satisfactory results. Patients were excluded if they presented any of the following: previous shoulder surgery; pseudoparalysis; insufficiency of the coracoacromial arch (type 2 B in Seebauer's classification); neurological lesions; or insufficiency of the deltoid muscle and the subscapularis muscle. Results With a mean follow-up of 5.4 years, 14 patients considered that they were satisfied with the surgery (78%); the mean range of joint motion for active elevation improved from 55.8° before the operation to 82.0° after the operation; the mean external rotation improved from 18.9° before the operation to 27.3° after the operation; and the mean medial rotation remained at the level of the third lumbar vertebra. The mean UCLA score after the mean follow-up of 5.4 years was 23.94 and this was an improvement in comparison with the preoperative mean and the mean 1 year after the operation. Conclusion The functional results from CTA® hemiarthroplasty for treating rotator cuff arthroplasty in selected patients remained satisfactory after a mean follow-up of 5.4 years. PMID:26229938

  13. Suprascapular Nerve: Is It Important in Cuff Pathology?

    PubMed Central

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

    2012-01-01

    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

  14. Effects of Preoperative Non-Steroidal Anti-Inflammatory Drugs on Pain Mitigation and Patients' Shoulder Performance Following Rotator Cuff Repair

    PubMed Central

    Rouhani, Alireza; Tabrizi, Ali; Elmi, Asghar; Abedini, Naghi; Mirza Tolouei, Fardin

    2014-01-01

    Purpose: Pain is one of the most important factors adversely affecting clinical outcomes of operated patients. The present study aims at evaluating effects of preoperative COX2 non-steroidal anti-inflammatory inhibitors on pain mitigation and performance of patients with shoulder rotator cuff tear. Methods: This case-control study was conducted on 60 patients suffering from rotator cuff injury candidate for arthroscopic repair. The patients were classified in two parallel and matched groups. One group (case group) was treated using Celecoxib (200mg/12h) started 48 hours before surgery and continued for 10 days after operation. In the control group, the placebo was prescribed in the same way. Postoperative pain, side effects, sleep disturbance, and short-term outcomes were compared between two groups using DASH questionnaire. Results: Postoperative pain in the Celecoxib group significantly decreased in comparison with the control one. The difference was statistically meaningful (P<0.001). Well motion ability was seen in 80% of patients of the Celecoxib group. It was 26.6% in the placebo group since pain inhibited them from exercising more motions. In this regard, there was a statistically meaningful difference between these two groups (P=0.02). Sleep disturbance was meaningfully at higher levels in the placebo group (P=0.001). Following up the patients for three months, it was made clear that performance of the Celecoxib group was better than that of the placebo one. Conclusion: COX2 inhibitors are well efficient in patients' pain management after arthroscopic rotator cuff repair surgery. It results in less life complications, less sleep disturbances, improvement of patients' short-term clinical outcome, and more quick recovery. PMID:25436192

  15. Endoscopic Repair of a Gluteus Medius Tear at the Musculotendinous Junction

    PubMed Central

    Yanke, Adam B.; Hart, Michael A.; McCormick, Frank; Nho, Shane J.

    2013-01-01

    Abductor tendon tears are an increasingly recognized clinical entity in patients with lateral thigh pain and weakness. These “rotator cuff tears of the hip” typically result from chronic, nontraumatic rupture of the anterior fibers of the gluteus medius. Although the abductor tendon typically tears from the osseous insertion, the case discussed here ruptured at the musculotendinous junction. This is the first report of this abductor tear subtype and its endoscopic repair. PMID:23875152

  16. Effectiveness of Subacromial Anti-Adhesive Agent Injection after Arthroscopic Rotator Cuff Repair: Prospective Randomized Comparison Study

    PubMed Central

    Oh, Chung Hee; Oh, Joo Han; Kim, Sae Hoon; Cho, Jae Hwan; Yoon, Jong Pil

    2011-01-01

    Background Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. Methods Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. Results The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. Conclusions A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on

  17. Platelets and plasma stimulate sheep rotator cuff tendon tenocytes when cultured in an extracellular matrix scaffold.

    PubMed

    Kelly, Brian A; Proffen, Benedikt L; Haslauer, Carla M; Murray, Martha M

    2016-04-01

    The addition of platelet-rich plasma (PRP) to rotator cuff repair has not translated into improved outcomes after surgery. However, recent work stimulating ligament healing has demonstrated improved outcomes when PRP or whole blood is combined with an extracellular matrix carrier. The objective of this study was to evaluate the effect of three components of blood (plasma, platelets, and macrophages) on the in vitro activity of ovine rotator cuff cells cultured in an extracellular matrix environment. Tenocytes were obtained from six ovine infraspinatus tendons and cultured over 14 days in an extracellular matrix scaffold with the following additives: (1) plasma (PPP), (2) plasma and platelets (PAP), (3) plasma and macrophages (PPPM), (4) plasma, platelets and macrophages (PAPM), (5) phosphate buffered saline (PBS), and (6) PBS with macrophages (PBSM). Assays measuring cellular metabolism (AlamarBlue), proliferation (Quantitative DNA assay), synthesis of collagen and cytokines (SIRCOL, TNF-α and IL-10 ELISA, and MMP assay), and collagen gene expression (qPCR) were performed over the duration of the experiment, as well as histology at the conclusion. Plasma was found to stimulate cell attachment and spreading on the scaffold, as well as cellular proliferation. Platelets also stimulated cell proliferation, cellular metabolism, transition of cells to a myofibroblast phenotype, and contraction of the scaffolds. The addition of macrophages did not have any significant effect on the sheep rotator cuff cells in vitro. In vivo studies are needed to determine whether these changes in cellular function will translate into improved tendon healing. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:623-629, 2016. PMID:26419602

  18. EVALUATION OF THE RESULTS FROM ARTHROSCOPIC REPAIR ON ROTATOR CUFF INJURIES AMONG PATIENTS UNDER 50 YEARS OF AGE

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Santos, Ruy Mesquita Maranhão; de Souza, Adriano; Checchia, Sérgio Luiz

    2015-01-01

    Objective: To assess the results from arthroscopic surgical treatment of rotator cuff injuries among patients under 50 years of age. Methods: Sixty-three patients with rotator cuff injuries who underwent arthroscopic surgical treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, in the Fernandinho Simonsen wing of Santa Casa Medical School, São Paulo, between August 1998 and December 2007, were reassessed. The study included all patients with rotator cuff injuries who were under 50 years of age and had been followed up postoperatively for at least 24 months. Results: According to the UCLA evaluation criteria, 59 patients (92%) showed excellent and good results; five (8%) showed fair results; and none showed poor results. The postoperative evaluation showed that the mean range of motion was 145° for elevation, 47° for lateral rotation and T10 for medial rotation. Unsatisfactory results were associated with prolonged duration of the injury, with a statistically significant relationship. Conclusion: Arthroscopic repair of rotator cuff injuries in young patients produces excellent or good results for most patients. PMID:27047819

  19. The efficacy of therapeutic ultrasound for rotator cuff tendinopathy: A systematic review and meta-analysis.

    PubMed

    Desmeules, François; Boudreault, Jennifer; Roy, Jean-Sébastien; Dionne, Clermont; Frémont, Pierre; MacDermid, Joy C

    2015-08-01

    A systematic review and meta-analysis on the efficacy of therapeutic ultrasound (US) in adults suffering from rotator cuff tendinopathy. A literature search was conducted in four databases for randomized controlled trials (RCT) published until 12/2013, comparing the efficacy of US to any other interventions in adults suffering from rotator cuff tendinopathy. The Cochrane Risk of Bias tool was used to evaluate the risk of bias of included studies. Data were summarized qualitatively or quantitatively. Eleven RCTs with a low mean methodological score (50.0% ± 15.6%) were included. Therapeutic US did not provide greater benefits than a placebo intervention or advice in terms of pain reduction and functional improvement. When provided in conjunction with exercise, US therapy is not superior to exercise alone in terms of pain reduction and functional improvement (pooled mean difference of the Constant-Murley score: -0.26 with 95% confidence interval of -3.84 to 3.32). Laser therapy was found superior to therapeutic US in terms of pain reduction. Based on low to moderate level evidence, therapeutic US does not provide any benefit compared to a placebo or advice, to laser therapy or when combined to exercise. More methodologically sound studies on the efficacy of therapeutic US are warranted. PMID:25824429

  20. Antioxidant's cytoprotective effects on rotator cuff tenofibroblasts exposed to aminoamide local anesthetics.

    PubMed

    Kim, Ra Jeong; Hah, Young-Sool; Kang, Jae-Ran; Park, Hyung Bin

    2015-07-01

    Local anesthetics (LA) are among the drugs most frequently used for musculoskeletal problems, in procedures ranging from diagnosis to postoperative pain control. The cytotoxicity of LA is an emerging area of concern. The purpose of this study was to determine whether cyanidin, an antioxidant, exerts cytoprotective effects against tenofibroblast death induced by LA. Primary cultured human rotator cuff tenofibroblasts were used to evaluate the cytotoxicity of these LA: Ropivacaine (0.075%), Bupivacaine (0.05%), and Lidocaine (0.2%). The effects of cyanidin (100 μg/ml) on the cytotoxicity induced by these LA were investigated. Cell viability, ROS production, caspase-3/7 activity, and expressions of phospho-extracellular signal-regulated kinases (ERK), phospho-p38, phospho-c-Jun N-terminal kinase (JNK), and cleaved PARP-1 were evaluated. Exposure to LA significantly induced cell death (p < 0.001), ROS production (p ≤ 0.04), the activation of caspase-3/7 (p < 0.001), and the increased expressions of phospho-ERK, phospho-p38, phospho-JNK, and cleaved PARP-1. These LA-induced cytotoxic effects were reduced by cyanidin. These data indicate that cyanidin, an antioxidant, has cytoprotective effects against LA-induced cytotoxicity to rotator cuff tenofibroblasts. PMID:25639557

  1. Effect of a Sleep Aid in Analgesia after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Cho, Chul-Hyun; Lee, Young-Kuk; Shin, Hong-Kwan; Hwang, Ilseon

    2015-01-01

    Purpose The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. Materials and Methods Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. Results The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1±2.0 in the zolpidem group and 3.3±2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. Conclusion The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group. PMID:25837184

  2. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis

    PubMed Central

    Roy, Jean-Sébastien; Braën, Caroline; Leblond, Jean; Desmeules, François; Dionne, Clermont E; MacDermid, Joy C; Bureau, Nathalie J; Frémont, Pierre

    2015-01-01

    Background Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists. Methods A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies. Results Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67–0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it. Conclusions Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option. PMID:25677796

  3. Quantitative Assessment of Fat Infiltration in the Rotator Cuff Muscles using water-fat MRI

    PubMed Central

    Nardo, Lorenzo; Karampinos, Dimitrios C.; Lansdown, Drew A.; Carballido-Gamio, Julio; Lee, Sonia; Maroldi, Roberto; Ma, C. Benjamin; Link, Thomas M.; Krug, Roland

    2013-01-01

    Purpose To evaluate a chemical shift-based fat quantification technique in the rotator cuff muscles in comparison with the semi-quantitative Goutallier fat infiltration classification (GC) and to assess their relationship with clinical parameters. Materials and Methods The shoulders of 57 patients were imaged using a 3T MR scanner. The rotator cuff muscles were assessed for fat infiltration using GC by two radiologists and an orthopedic surgeon. Sequences included oblique-sagittal T1-, T2- and proton density-weighted fast spin echo, and six-echo gradient echo. The iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) was used to measure fat fraction. Pain and range of motion of the shoulder were recorded. Results Fat fraction values were significantly correlated with GC grades (p< 0.0001, kappa>0.9) showing consistent increase with GC grades (grade=0, 0%–5.59%; grade=1, 1.1%–9.70%; grade=2, 6.44%–14.86%; grade=3, 15.25%–17.77%; grade=4, 19.85%–29.63%). A significant correlation between fat infiltration of the subscapularis muscle quantified with IDEAL versus a) deficit in internal rotation (Spearman Rank Correlation Coefficient=0.39, 95% CI 0.13–0.60, p<0.01) and b) pain (Spearman Rank Correlation coefficient=0.313, 95% CI 0.049–0.536, p=0.02) was found but was not seen between the clinical parameters and GC grades. Additionally, only quantitative fat infiltration measures of the supraspinatus muscle were significantly correlated with a deficit in abduction (Spearman Rank Correlation Coefficient=0.45, 95% CI 0.20–0.60, p<0.01). Conclusion We concluded that an accurate and highly reproducible fat quantification in the rotator cuff muscles using water-fat MRI techniques is possible and significantly correlates with shoulder pain and range of motion. PMID:24115490

  4. Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Mifune, Yutaka; Inui, Atsuyuki; Nagura, Issei; Sakata, Ryosuke; Muto, Tomoyuki; Harada, Yoshifumi; Takase, Fumiaki; Kurosaka, Masahiro; Kokubu, Takeshi

    2015-01-01

    Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair. Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded. Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision). Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds. PMID:26157522

  5. EVALUATION OF ANATOMICAL INTEGRITY USING ULTRASOUND EXAMINATION, AND FUNCTIONAL INTEGRITY USING THE CONSTANT & MURLEY SCORE, OF THE ROTATOR CUFF FOLLOWING ARTHROSCOPIC REPAIR

    PubMed Central

    Godinho, Glaydson Gomes; França, Flavio de Oliveira; Alves, Freitas José Marcio; Watanabe, Fábio Nagato; Nobre, Leonardo Oliveira; De Almeida Neto, Manoel Augusto; Mendes Da Silva, Marcos André

    2015-01-01

    repair to treat full tear lesions of the rotator cuff. The clinical results from the complete rotator cuff repairs via arthroscopy presented a high level of functional recovery (Constant 83.96), compared with the contralateral shoulder. The postoperative ultrasound reports presented a high percentage of re-rupture (35%). Postoperative strength was greater among the patients aged under 60 years (p = 0.002) and in cases of lesions less than or equal to 3 cm (p = 0.003). PMID:27022538

  6. Forces and moments within layers of driven tearing modes with sheared rotation

    NASA Astrophysics Data System (ADS)

    Cole, A. J.; Finn, J. M.; Hegna, C. C.; Terry, P. W.

    2015-10-01

    For driven low amplitude tearing modes in a plasma with sheared rotation, forces on tearing layers due to Maxwell and Reynolds stresses are calculated. First moments about the center of the tearing layer, also due to Maxwell and Reynolds stresses, are also calculated. The forces tend to cause the tearing mode to lock to the phase of the driving perturbation, and the moments determine the evolution of the rotation shear within the layer. These forces and moments are calculated for two constant-ψ regimes of tearing modes, namely, the viscoresistive (VR) regime and the resistive-inertial (RI) regime, and an ordering in terms of the constant-ψ small parameter ɛ ˜δΔ is introduced, with the velocity shear ordered as ˜ɛ . Here, δ is the layer width and Δ the logarithmic jump in the derivative of the flux function across the layer. The forces and first moments are reported to the lowest nonvanishing order in ɛ. The Reynolds moment is analogous to the effect that can drive zonal flows in other contexts. The treatment of the tearing layers is by means of variational principles using Padé approximants (A. J. Cole and J. M. Finn, Phys. Plasmas 21, 032508 (2014)). The usual result for the Maxwell force without rotation shear is recovered for both regimes. That is, the correction due to velocity shear is small; also, the lowest order contribution to the Reynolds force is zero. In the VR regime, we find no first moments up to second order in the constant-ψ parameter. In the RI regime, we find Nm is zero to at least order ɛ3 /2 . In the RI regime, the Reynolds moment Nr is found to be of order ɛ3 /2 and is proportional to minus the rotation shear in the layer; it thus tends to damp out any velocity shear across the layer.

  7. A randomised controlled feasibility study investigating the use of eccentric and concentric strengthening exercises in the treatment of rotator cuff tendinopathy

    PubMed Central

    Adams, Nicola

    2014-01-01

    Objectives: To conduct a feasibility study to compare concentric and eccentric rotator cuff strengthening exercises for rotator cuff tendinopathy. Methods: A total of 11 patients with rotator cuff tendinopathy who were on the waiting list for arthroscopic subacromial decompression surgery were randomised to perform eccentric rotator cuff strengthening exercises, concentric strengthening exercises or no exercises. Patients were evaluated in terms of levels of pain and function using the Oxford Shoulder Score and a Visual Analogue Scale initially, at 4 weeks and at 8 weeks. Results: The study design was found to be acceptable to patients and achieved a high level of 86% compliance. The drop-out rate was 0%. Two patients performing eccentric strengthening exercises improved sufficiently to cancel their planned surgery. Conclusion: Further research in this area is recommended. The study design was feasible and power calculations have been conducted to aid future research planning. PMID:26770702

  8. Effects of 8 weeks' specific physical training on the rotator cuff muscle strength and technique of javelin throwers.

    PubMed

    Kim, Hyeyoung; Lee, Youngsun; Shin, Insik; Kim, Kitae; Moon, Jeheon

    2014-10-01

    [Purpose] For maximum efficiency and to prevent injury during javelin throwing, it is critical to maintain muscle balance and coordination of the rotator cuff and the glenohumeral joint. In this study, we investigated the change in the rotator cuff muscle strength, throw distance and technique of javelin throwers after they had performed a specific physical training that combined elements of weight training, function movement screen training, and core training. [Subjects] Ten javelin throwers participated in this study: six university athletes in the experimental group and four national-level athletes in the control group. [Methods] The experimental group performed 8 weeks of the specific physical training. To evaluate the effects of the training, measurements were performed before and after the training for the experimental group. Measurements comprised anthropometry, isokinetic muscle strength measurements, the function movement screen test, and movement analysis. [Results] After the specific physical training, the function movement screen score and external and internal rotator muscle strength showed statistically significant increases. Among kinematic factors, only pull distance showed improvement after training. [Conclusion] Eight weeks of specific physical training for dynamic stabilizer muscles enhanced the rotator cuff muscle strength, core stability, throw distance, and flexibility of javelin throwers. These results suggest that specific physical training can be useful for preventing shoulder injuries and improving the performance for javelin throwers. PMID:25364111

  9. Rotator cuff injury in patients over the age of 65 years: evaluation of function, integrity and strength☆

    PubMed Central

    de Castro Veado, Marco Antonio; Prata, Eric Fontes; Gomes, David Correia

    2015-01-01

    Objective To retrospectively evaluate the results from patients who underwent arthroscopic treatment for rotator cuff injuries, among those aged over 65 years, observing integrity, function and strength. Methods Thirty-five shoulders were operated between July 2005 and July 2010, and 28 shoulders were re-evaluated regarding elevation strength and external rotation, using a digital dynamometer. Integrity was evaluated by means of ultrasound examinations. The patients, whose mean age was 70.54 years (ranging from 65 to 82 years), were followed up for a minimum of 26 months and mean of 51.18 months (ranging from 26 to 82 months). To evaluate function, the UCLA score, the Simple Shoulder Test (SST) and a visual analog scale (VAS) for pain were used. Results In analyzing the ultrasound scans, it was observed that the integrity of the rotator cuff was maintained in 75% of the cases at the end of the follow-up, along with the improvement in the UCLA score, which evolved from 17.46 to 32.39, i.e. excellent and good results in 89.28%. The mean SST and VAS indices were 9.86 and 1.5 respectively. Conclusion Arthroscopic surgery to repair rotator cuff injuries in patients over the age of 65 years leads to improved function and pain relief, with maintenance of the integrity of the repair. The data on muscle strength were inconclusive. PMID:26229937

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

    PubMed Central

    Phadke, V; Camargo, PR; Ludewig, PM

    2009-01-01

    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

  11. Histologic evaluation of a biopsy specimen obtained 3 months after rotator cuff augmentation with GraftJacket Matrix.

    PubMed

    Snyder, Stephen J; Arnoczky, Steven P; Bond, James L; Dopirak, Ryan

    2009-03-01

    Understanding the cellular response to a biologic graft used in rotator cuff applications is important because foreign-body reactions and inflammation complications have historically been seen with xenograft-derived grafts. The purpose of this study was to histologically evaluate a biopsy specimen taken from a rotator cuff of a 62-year-old man 3 months after augmentation with an acellular human dermal graft, GraftJacket Matrix-MaxForce Extreme (Wright Medical Technology, Arlington, TN). The graft material was intact and filled with numerous elastic fibers and blood vessels. Extensive host cellular infiltration was evident along the margins of the graft, whereas the more central regions were more sparsely populated. Calcification and infection were not evident. There was little to no inflammatory response. The orientation of the collagen fibers indicated early organization of new tissue. The incorporation of the GraftJacket Matrix-MaxForce Extreme evidenced by cellular infiltration, alignment of collagen fibers, and blood vessel ingrowth shows that this graft exhibits key biologic factors of the remodeling process when used as an augmentation device in rotator cuff repair. PMID:19245998

  12. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series*

    PubMed Central

    Nogueira-Barbosa, Marcello H.; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

    2015-01-01

    Objective The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion. PMID:26811551

  13. OUTCOME OF ROTATOR CUFF REPAIR IN SNYDER TYPE Cl AND C2 LESIONS, CONSIDERING SMOKERS AND NONSMOKERS

    PubMed Central

    Júnior, Sérgio Correa Pinto; Luciano, Lessandro Gesser; Zotto, Crischiman Dal; Vieira, Felipe Fantozzi; Klassen, Ralf; Rodrigues, Airton; Neto, Francisco José dos Santos

    2015-01-01

    Objective: To evaluate the influence of smoking on the results from surgical repair of Snyder type C1 and C2 complete lesions of the rotator cuff. Methods: We evaluated 166 patients who had undergone surgical treatment for Snyder type C1 and C2 complete lesions of the rotator cuff, between June 2002 and December 2006. The inclusion criteria were a minimum follow-up period of 24 months and the absence of previous surgery on the affected shoulder. Patients with other associated injuries were excluded. We evaluated smoking and nonsmoking patients in accordance with the criteria of the World Health Organization (WHO). Female patients (119) predominated over male patients (47), and the mean age was 57 years (38 to 78). Out of the 166 patients evaluated, 21 were classified as smokers and 145 as nonsmokers. The final results were evaluated using the UCLA (University of California at Los Angeles) criteria and statistical analysis was performed using the Epi Info® software. Results: According to the UCLA criteria, smokers had a final average of 32.6 points, while non-smokers had 33.8. Postoperative statistical analysis revealed a difference between the two groups, such that non-smoking patients had a better outcome. Conclusion: Smoking interferes with the final results from repairs of small and medium-sized lesions of the rotator cuff. PMID:27026963

  14. Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia☆

    PubMed Central

    Almeida, Alexandre; Atti, Vinícius; Agostini, Daniel Cecconi; Valin, Márcio Rangel; de Almeida, Nayvaldo Couto; Agostini, Ana Paula

    2015-01-01

    Objective To analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia. Method 138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16); those with osteopenia, group 2 (n = 33); and normal individuals, group 3 (n = 55). Results In analyzing the University of California at Los Angeles (UCLA) scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070). Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027). Conclusion The results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry. PMID:26229899

  15. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis

    PubMed Central

    Mangone, Giuseppe; Veliaj, Altin; Postiglione, Marco; Viliani, Tamara; Pasquetti, Pietro

    2010-01-01

    The objective of the study is to evaluate the effectiveness of Radial Extracorporeal Shock-wave Therapy (RESWT) compared with High Power LASER Therapy (HPLT) for the treatment of patients with Rotator Cuff Calcific Tendinosis (RCCT). RCCT is widely diffused, it is painful and invalidating. It is an important public health problem with social and economic implications. The most common therapeutic approach is a physiotherapic one. Both HPLT and RESWT give positive results. There is a debate on which is to be preferred. Therefore there is need to obtain scientific evidence to support either case. An observational study was carried out in the period between October 2008 and September 2009 in our outpatient clinic with 62 patients, divided into 3 groups: group A 36 patients treated only with RESWT, group B 26 patients treated only with HPLT and group C 16 patients with only short term improvement with HPLT retreated with RESWT. Patients were evaluated with Constant-Murley scale before and after treatment (immediately, 1 month and 3 months) for mean constant score, pain and range of movement. Data were examined statistically with SPSS. Criteria for inclusion and exclusion were defined. Patients treated with HPLT have shown good clinical results but have returned to original syndrome 1 month after treatment. RESWT has given improvement after treatment extended in time (3 months) in terms of pain and recover of functionality with a limited number of applications. The evidence collected indicates that RESWT is the method of choice. PMID:22460011

  16. Comparison of ultrasonic suture welding and traditional knot tying in a rabbit rotator cuff repair model.

    PubMed

    Nho, Shane J; Cole, Brian J; Mazzocca, Augustus D; Williams, James M; Romeo, Anthony A; Bush-Joseph, Charles A; Bach, Bernard R; Hallab, Nadim J

    2006-01-01

    The purpose of this study is to evaluate ultrasonic suture welding of monofilament suture in an animal model of rotator cuff repair with biomechanical and histologic analyses. We randomly assigned 46 shoulders in 23 rabbits to 1 of 3 treatment groups: sham-operated (n = 15), knotted (n = 15), and welded (n = 16). Supraspinatus defects were surgically created and acutely repaired with suture anchors loaded with either No. 2-0 Ethibond for knotted group or No. 2-0 nylon for welded shoulders. Eighteen weeks postoperatively, all animals were killed, and the shoulders underwent either biomechanical testing or histologic analysis. The maximum stress of the sham-operated group (20.6 N/mm2) was significantly greater than that of both the knotted (10.2 N/mm2) and welded (8.3 N/mm2) groups (P < .05), but no differences were observed between the knotted and welded groups. Although some histologic changes were noted, none was considered to be significant to distinguish either group. PMID:16979062

  17. A systematic review of the histological and molecular changes in rotator cuff disease

    PubMed Central

    Dean, B. J. F.; Franklin, S. L.; Carr, A. J.

    2012-01-01

    Introduction The pathogenesis of rotator cuff disease (RCD) is complex and not fully understood. This systematic review set out to summarise the histological and molecular changes that occur throughout the spectrum of RCD. Methods We conducted a systematic review of the scientific literature with specific inclusion and exclusion criteria. Results A total of 101 studies met the inclusion criteria: 92 studies used human subjects exclusively, seven used animal overuse models, and the remaining two studies involved both humans and an animal overuse model. A total of 58 studies analysed supraspinatus tendon exclusively, 16 analysed subacromial bursal tissue exclusively, while the other studies analysed other tissue or varying combinations of tissue types including joint fluid and muscle. The molecular biomarkers that were altered in RCD included matrix substances, growth factors, enzymes and other proteins including certain neuropeptides. Conclusions The pathogenesis of RCD is being slowly unravelled as a result of the significant recent advances in molecular medicine. Future research aimed at further unlocking these key molecular processes will be pivotal in developing new surgical interventions both in terms of the diagnosis and treatment of RCD. PMID:23610686

  18. Braking of tearing mode rotation by ferromagnetic conducting walls in tokamaks

    SciTech Connect

    Fitzpatrick, Richard

    2015-09-15

    An in-depth investigation of the braking of tearing mode rotation in tokamak plasmas via eddy currents induced in external ferromagnetic conducting structures is performed. In general, there is a “forbidden band” of tearing mode rotation frequencies that separates a branch of high-frequency solutions from a branch of low-frequency solutions. When a high-frequency solution crosses the upper boundary of the forbidden band, there is a bifurcation to a low-frequency solution, and vice versa. The bifurcation thresholds predicted by simple torque-balance theory (which takes into account the electromagnetic braking torque acting on the plasma, as well as the plasma viscous restoring torque, but neglects plasma inertia) are found to be essentially the same as those predicted by more complicated time-dependent mode braking theory (which takes inertia into account). Significant ferromagnetism causes otherwise electromagnetically thin conducting structures to become electromagnetically thick and also markedly decreases the critical tearing mode amplitude above which the mode “locks” to the conducting structures (i.e., the high-frequency to low-frequency bifurcation is triggered). On the other hand, if the ferromagnetism becomes too large, then the forbidden band of mode rotation frequencies is suppressed, and the mode frequency consequently varies smoothly and reversibly with the mode amplitude.

  19. Braking of tearing mode rotation by ferromagnetic conducting walls in tokamaks

    NASA Astrophysics Data System (ADS)

    Fitzpatrick, Richard

    2015-09-01

    An in-depth investigation of the braking of tearing mode rotation in tokamak plasmas via eddy currents induced in external ferromagnetic conducting structures is performed. In general, there is a "forbidden band" of tearing mode rotation frequencies that separates a branch of high-frequency solutions from a branch of low-frequency solutions. When a high-frequency solution crosses the upper boundary of the forbidden band, there is a bifurcation to a low-frequency solution, and vice versa. The bifurcation thresholds predicted by simple torque-balance theory (which takes into account the electromagnetic braking torque acting on the plasma, as well as the plasma viscous restoring torque, but neglects plasma inertia) are found to be essentially the same as those predicted by more complicated time-dependent mode braking theory (which takes inertia into account). Significant ferromagnetism causes otherwise electromagnetically thin conducting structures to become electromagnetically thick and also markedly decreases the critical tearing mode amplitude above which the mode "locks" to the conducting structures (i.e., the high-frequency to low-frequency bifurcation is triggered). On the other hand, if the ferromagnetism becomes too large, then the forbidden band of mode rotation frequencies is suppressed, and the mode frequency consequently varies smoothly and reversibly with the mode amplitude.

  20. The effect of radial pressure force on rotating double tearing mode in compressible plasmas

    NASA Astrophysics Data System (ADS)

    Wang, Xian-Qu; Xiong, Guo-Zhen; Li, Xiao-Qing

    2016-05-01

    The role of radial pressure force in the interlocking dynamics of double tearing modes (DTMs) is investigated by force balance analysis based on the compressible magnetohydrodynamics (MHD) model. It is found that the stability of symmetric DTMs is dominated by the radial pressure force rather than the field line bending force. Owing to the compressibility of rotating plasmas, unbalanced radial forces can just result in the rotating islands drift toward each other in the radial direction but do not trigger the explosive growth of the mode in the interlocking process, which is different from that of antisymmetric DTM without flow.

  1. Supraspinatus Intramuscular Calcified Hematoma or Necrosis Associated with Tendon Tear

    PubMed Central

    Lädermann, Alexandre; Genevay, Muriel; Abrassart, Sophie; Schwitzguébel, Adrien Jean-Pierre

    2015-01-01

    Introduction. Rotator cuff intramuscular calcification is a rare condition usually caused by heterotopic ossification and myositis ossificans. Case Presentation. We describe a patient with voluminous calcified mass entrapped in supraspinatus muscle associated with corresponding tendon tear. Histological examination corresponded to a calcified hematoma or necrosis. Patient was surgically managed with open excision of the calcified hematoma and rotator cuff arthroscopic repair. At 6 months, supraspinatus muscle was healed, and functional outcome was good. Discussion and Conclusion. We hypothesized that supraspinatus intramuscular calcified hematoma was responsible for mechanical stress on the tendon. This association has never been described. PMID:26380138

  2. Comparison of the cheese-wiring effects among three sutures used in rotator cuff repair

    PubMed Central

    Lambrechts, Mark; Nazari, Behrooz; Dini, Arash; O'Brien, Michael J.; Heard, Wendell M. R.; Savoie, Felix H.; You, Zongbing

    2014-01-01

    Purpose: The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Materials and Methods: Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire® suture (FiberWire®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. Results: The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord™ and FiberWire® sutures (P = 0.026), but not significant between Orthocord™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire® sutures (P = 0.103). Conclusion: The cheese-wiring effect is less in the Orthocord™ suture than in the FiberWire® suture in human cadaveric supraspinatus tendons. Clinical Relevance: Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection. PMID:25258499

  3. Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies?

    PubMed

    Sansone, Valerio C; Meroni, Roberto; Boria, Paola; Pisani, Salvatore; Maiorano, Emanuele

    2015-02-01

    Calcifying tendinopathy (CT) of the shoulder is a common painful disorder, although the etiology and pathogenesis remain largely unknown. Recent theories about the role of excessive mechanical load in the genesis of CT have been proposed. Driven by the interest for these new theories, we investigated the hypothesis of a relationship between work-related repetitive movements of the upper arm, considered a potential cause of shoulder overload, and the presence of shoulder CT. A secondary aim was to obtain data on CT prevalence in a female sample from the working-age general population, as little data currently exist. 199 supermarket cashiers and 304 female volunteers recruited from the general population underwent a high-resolution ultrasonography of the rotator cuffs of both shoulders, and the presence of tendinopathies, with or without calcification, was recorded. The prevalence of calcific tendinopathy was 22.6 % in the cashiers group and 24.4 % in the control group. There were no statistically significant differences in the prevalence of calcifications between the two groups (p = 0.585), either for the dominant shoulder [OR = 0.841 (95 % CI 0.534-1.326)] or for the non-dominant shoulder [OR = 0.988 (95 % CI 0.582-1.326)]. We observed bilateral calcifications in 8.5 % of cashiers, and 9.6 % of controls, and an increase in prevalence of CT with age in both groups. Work-related repetitive movements of the upper arm did not induce a higher prevalence of shoulder CT compared with the female sample from the general population. If CT etiopathogenesis is related to mechanical load, CT onset may be influenced not only by loading history, but also by individual factors. Level of evidence Prognosis study, Level II. PMID:25000922

  4. Rotator cuff arthropathy: what functional results can be expected from reverse arthroplasty?☆

    PubMed Central

    Fávaro, Rodrigo Caldonazzo; Abdulahad, Michel; Filho, Salim Mussi; Valério, Rafael; Superti, Mauro José

    2015-01-01

    Objective To evaluate the functional results from reverse arthroplasty and its complications and relationships with types of injury. Methods Twenty-seven shoulders (26 women and one man) were treated. The patients were assessed using the UCLA functional scale. The implant used was the Delta Xtend Depuy® model. The injuries were classified using the Seebauer method for the degree of arthroplasty and the Nerot method for notching. Result The mean age was 77.4 years (range: 67–89) and the follow-up was 25.8 months (range: 6–51). The preoperative UCLA score was 10.1 (range: 6–15) and the postoperative UCLA score was 29.8 (range: 22–35), which was a statistically significant improvement (p < 0.001). According to the Seebauer classification, five patients were 1B, 19 were 2A and three were 2B. Fifteen cases presented complications (55.5%) and notching was the commonest of these, occurring in 14 patients (nine with grade 1 and five with grade 2), but this did not cause instability in any of them. Only one patient (3.7%) had a major complication, consisting of dislocation in the immediate postoperative period. Two patients (7.4%) said that they would undergo the procedure again. One patient (3.7%) underwent a revision procedure. Conclusion Reverse arthroplasty was shown to be an excellent option for treating patients with rotator cuff arthropathy, with a low rate of major complications. Notching was a frequent complication, but in the majority of the cases, it did not present clinical repercussions. PMID:26535197

  5. Dose- and time-dependent effects of triamcinolone acetonide on human rotator cuff-derived cells

    PubMed Central

    Harada, Y.; Kokubu, T.; Mifune, Y.; Inui, A.; Sakata, R.; Muto, T.; Takase, F.; Kurosaka, M.

    2014-01-01

    Objectives To investigate the appropriate dose and interval for the administration of triamcinolone acetonide (TA) in treating tendinopathy to avoid adverse effects such as tendon degeneration and rupture. Methods Human rotator cuff-derived cells were cultured using three media: regular medium (control), regular medium with 0.1 mg/mL of TA (low TA group), and with 1.0 mg/mL of TA (high TA group). The cell morphology, apoptosis, and viability were assessed at designated time points. Results In the low TA group, the cells became flattened and polygonal at seven days then returned to normal at 21 days. The cell apoptosis ratio and messenger ribonucleic acid expression of caspase-3, 7, 8, and 9 increased, and viability was reduced in the low and high groups at seven days. In the low TA group, apoptosis and viability returned to normal at 21 days, however, in the high TA group, the cell morphology, apoptosis ratio, caspase-3, 7, 8, and 9 and viability did not return by day 21. Re-administration was performed in the low TA group at 7-, 14-, and 21-day intervals, and cell viability did not return to the control level at the 7- and 14-day intervals. Conclusion A 0.1 mg/mL dose of TA temporarily decreased cell viability and increased cell apoptosis, which was recovered at 21 days, however, 1 mg/mL of TA caused irreversible damage to cell morphology and viability. An interval > three weeks was needed to safely re-administer TA. These findings may help determine the appropriate dose and interval for TA injection therapy. Cite this article: Bone Joint Res 2014;3:328–34. PMID:25477418

  6. Braking of Tearing Mode Rotation by Ferromagnetic Conducting Walls in Tokamaks

    NASA Astrophysics Data System (ADS)

    Fitzpatrick, Richard

    2015-11-01

    An in-depth investigation of the braking of tearing mode rotation in tokamak plasmas via eddy currents induced in external ferromagnetic conducting structures is performed. In general, there is a ``forbidden band'' of tearing mode rotation frequencies that separates a branch of high-frequency solutions from a branch of low-frequency solutions. When a high-frequency solution crosses the upper boundary of the forbidden band there is a bifurcation to a low-frequency solution, and vice versa. The bifurcation thresholds predicted by simple torque-balance theory (which takes into account the electromagnetic braking torque acting on the plasma, as well as the plasma viscous restoring torque, but neglects plasma inertia) are found to be essentially the same as those predicted by more complicated time-dependent mode braking theory (which takes inertia into account). Significant ferromagnetism causes otherwise electromagnetically thin conducting structures to become electromagnetically thick, and also markedly decreases the critical tearing mode amplitude above which the mode ``locks'' to the conducting structures (i.e., the high-frequency to low-frequency bifurcation is triggered). This research was funded by the U.S. Department of Energy under contract DE-FG02-04ER-54742.

  7. Tendon-bone contact pressure and biomechanical evaluation of a modified suture-bridge technique for rotator cuff repair.

    PubMed

    Baums, Mike H; Geyer, Michael; Büschken, Meike; Buchhorn, Gottfried H; Spahn, Gunter; Klinger, Hans-Michael

    2010-07-01

    The aim of the study was to evaluate the time-zero mechanical and footprint properties of a suture-bridge technique for rotator cuff repair in an animal model. Thirty fresh-frozen sheep shoulders were randomly assigned among three investigation groups: (1) cyclic loading, (2) load-to-failure testing, and (3) tendon-bone interface contact pressure measurement. Shoulders were cyclically loaded from 10 to 180 N and displacement to gap formation of 5- and 10-mm at the repair site. Cycles to failure were determined. Additionally, the ultimate tensile strength and stiffness were verified along with the mode of failure. The average contact pressure and pressure pattern were investigated using a pressure-sensitive film system. All of the specimens resisted against 3,000 cycles and none of them reached a gap formation of 10 mm. The number of cycles to 5-mm gap formation was 2,884.5 + or - 96.8 cycles. The ultimate tensile strength was 565.8 + or - 17.8 N and stiffness was 173.7 + or - 9.9 N/mm. The entire specimen presented a unique mode of failure as it is well known in using high strength sutures by pulling them through the tendon. We observed a mean contact pressure of 1.19 + or - 0.03 MPa, applied on the footprint area. The fundamental results of our study support the use of a suture-bridge technique for optimising the conditions of the healing biology of a reconstructed rotator cuff tendon. Nevertheless, an individual estimation has to be done if using the suture-bridge technique clinically. Further investigation is necessary to evaluate the cell biological healing process in order to achieve further sufficient advancements in rotator cuff repair. PMID:19826786

  8. Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review.

    PubMed

    Merolla, Giovanni; Dave, Arpit C; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2015-03-01

    Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed. PMID:25017026

  9. Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

    PubMed

    Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

    2016-08-01

    Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. PMID:26902864

  10. Effect of pain scrambler therapy on shoulder joint pain and range of motion in patients who had undergone arthroscopic rotator cuff repair for the first time

    PubMed Central

    Lee, Dong-Kyu; Kim, Eun-Kyung

    2016-01-01

    [Purpose] This study aimed to determine the effect of pain scrambler therapy on shoulder joint pain and range of motion in patients who had undergone arthroscopic rotator cuff repair for the first time. [Subjects and Methods] Pain scrambler therapy was administered once a day every 40 minutes for 10 days to patients that had undergone arthroscopic rotator cuff repair for the first time. The visual analog scale was used to measure pain, and a goniometer was used to measure shoulder range of motion. [Results] After 10 sessions of pain scrambler therapy, pain was significantly reduced from that before the treatment. In addition, shoulder range of motion was increased after 10 treatment sessions. [Conclusion] Thus, pain scrambler therapy greatly reduced pain and increased should range of motion in the patients who had undergone arthroscopic rotator cuff repair for the first time. PMID:27512291

  11. Influence of rotation on the (m, n) = (3, 2) neoclassical tearing mode threshold in the ASDEX Upgrade

    NASA Astrophysics Data System (ADS)

    Fietz, S.; Maraschek, M.; Zohm, H.; Reich, M.; Barrera, L.; McDermott, R. M.; the ASDEX Upgrade Team

    2013-08-01

    The influence of rotation on the (m, n) = (3, 2) neoclassical tearing mode onset and the marginal point at the ASDEX Upgrade is investigated. In this context, the different trigger mechanisms are identified and the influence of not only the rotation but also the rotation gradient and the differential rotation between the resonant and the triggering surface on the neoclassical tearing mode (NTM) stability is analysed. The existence of an upper NTM onset threshold can be observed in correlation with the rotation normalized to the Alfvén velocity. It can also clearly be verified that at the ASDEX Upgrade the NTM onset threshold increases with co- and counter-current directed rotation and also with positive and negative rotation gradient.

  12. The concentration of stress at the rotator cuff tendon-to-bone attachment site is conserved across species.

    PubMed

    Saadat, Fatemeh; Deymier, Alix C; Birman, Victor; Thomopoulos, Stavros; Genin, Guy M

    2016-09-01

    The tendon-to-bone attachment site integrates two distinct tissues via a gradual transition in composition, mechanical properties, and structure. Outcomes of surgical repair are poor, in part because surgical repair does not recreate the natural attachment, and in part because the mechanical features that are most critical to mechanical and physiological functions have not been identified. We employed allometric analysis to resolve a paradox about how the architecture of the rotator cuff contributes to load transfer: whereas published data suggest that the mean muscle stresses expected at the tendon-to-bone attachment are conserved across species, data also show that the relative dimensions of key anatomical features vary dramatically, suggesting that the amplification of stresses at the interface between tendon and bone should also vary widely. However, a mechanical model that enabled a sensitivity analysis revealed that the degree of stress concentration was in fact highly conserved across species: the factors that most affected stress amplification were most highly conserved across species, while those that had a lower effect showed broad variation across a range of relative insensitivity. Results highlight how micromechanical factors can influence structure-function relationships and cross-species scaling over several orders of magnitude in animal size, and provide guidance on physiological features to emphasize in surgical and tissue engineered repair of the rotator cuff. PMID:27161959

  13. The interaction between plasma rotation, stochastic fields and tearing mode excitation by external perturbation fields

    NASA Astrophysics Data System (ADS)

    DeBock, M. F. M.; Classen, I. G. J.; Busch, C.; Jaspers, R. J. E.; Koslowski, H. R.; Unterberg, B.; TEXTOR Team

    2008-01-01

    For fusion reactors, based on the principle of magnetic confinement, it is important to avoid so-called magnetic islands or tearing modes. They reduce confinement and can be the cause of major disruptions. One class of magnetic islands is that of the perturbation field driven modes. This perturbation field can, for example, be the intrinsic error field. Theoretical work predicts a strong relationship between plasma rotation and the excitation of perturbation field modes. Experimentally, the theory on mode excitation and plasma rotation has been confirmed on several tokamaks. In those experiments, however, the control over the plasma rotation velocity and direction, and over the externally applied perturbation field was limited. In this paper experiments are presented that were carried out at the TEXTOR tokamak. Two tangential neutral beam injectors and a set of helical perturbation coils, called the dynamic ergodic divertor (DED), provide control over both the plasma rotation and the external perturbation field in TEXTOR. This made it possible to set up a series of experiments to test the theory on mode excitation and plasma rotation in detail. The perturbation field induced by the DED not only excites magnetic islands, it also sets up a layer near the plasma boundary where the magnetic field is stochastic. It will be shown that this stochastic field alters both the rotational response of the plasma on the perturbation field and the threshold for mode excitation. It therefore has to be included in an extended theory on mode excitation.

  14. Resistive wall mode and neoclassical tearing mode coupling in rotating tokamak plasmas

    NASA Astrophysics Data System (ADS)

    McAdams, Rachel; Wilson, H. R.; Chapman, I. T.

    2013-08-01

    A model system of equations has been derived to describe a toroidally rotating tokamak plasma, unstable to resistive wall modes (RWMs) and metastable to neoclassical tearing modes (NTMs), using a linear RWM model and a nonlinear NTM model. If no wall is present, the NTM growth shows the typical threshold/saturation island widths, whereas a linearly unstable kink mode grows exponentially in this model plasma system. When a resistive wall is present, the growth of the linearly unstable RWM is accelerated by an unstable island: a form of coupled RWM-NTM mode. Crucially, this coupled system has no threshold island width, giving the impression of a triggerless NTM, observed in high beta tokamak discharges. Increasing plasma rotation at the island location can mitigate its growth, decoupling the modes to yield a conventional RWM with no threshold width.

  15. Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study

    PubMed Central

    Scarpone, Michael; Snell, Edward; DeMeo, Patrick; Ruppert, Kristine; Pritchard, Perry; Arbogast, Gennie; Wilson, John J.; Balzano, John F.

    2013-01-01

    Objective: Assess platelet rich plasma (PRP) injection for rotator cuff tendinopathy (RCT). Design: Prospective open label study with 1-year follow-up. Methods: Participants recruited from an outpatient sports medicine clinic had clinically and magnetic resonance image (MRI)—demonstrated RCT refractory to physical therapy and corticosteroid injection. They received one ultrasound-guided injection of 3.0 mL of 1% xylocaine followed by 3.5 mL of PRP at the lesion and surrounding tendon. Primary outcome: 0–10 visual analog scale (VAS; baseline, 8, 12, and 52 weeks). Secondary outcomes: functional shoulder tests assessing rotator cuff strength and endurance (at baseline and 8 and 12 weeks), MRI severity (1–5 points [at baseline and 4 and 8 weeks]), and patient satisfaction (52 weeks). Results: Eighteen participants with 19 assessed shoulders reported VAS pain score improvement from 7.5 ± 0.3 points to 0.5 ± 0.3 points by week 12 and 0.4 ± 0.2 (P = .0001) points at week 52. Functional outcomes significantly improved; the largest effect was seen in the external rotation test: 33.5 ± 5.7 seconds to 62.6 ± 7.2 seconds at week 12 (P = .0001). MRI appearance improved by 1 to 3 points in 16 of 18 assessed shoulders. Seventeen participants were “completely satisfied” (12) or “satisfied” (5). One participant was “unsatisfied.” Conclusions: A single ultrasound-guided, intralesional injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT. Randomized multidisciplinary effectiveness trials that add ultrasound and validated clinical outcome measures are needed to further assess PRP for RCT. PMID:24416661

  16. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.

    PubMed

    Park, Maxwell C; ElAttrache, Neal S; Tibone, James E; Ahmad, Christopher S; Jun, Bong-Jae; Lee, Thay Q

    2007-01-01

    Rotator cuff repair via transosseous tunnels can improve footprint contact area and pressure when compared with suture anchor techniques. A double-row technique has been used clinically to improve footprint coverage by a repaired tendon. We hypothesized that a transosseous-equivalent rotator cuff repair via tendon suture bridges would demonstrate improved pressurized contact between the tendon and tuberosity when compared with a double-row technique. In 6 fresh-frozen human shoulders, a transosseous-equivalent rotator cuff repair was performed: a suture limb from each of 2 medial anchors was bridged over the tendon and fixed laterally with an interference screw (4 suture bridges). In 6 of the contralateral specimens, two types of repair were performed randomly in each specimen: (1) a double-row repair and (2) a transosseous-equivalent repair with a single screw (2 suture bridges). For all repairs, pressure-sensitive film was placed at the tendon-footprint interface, and software was used to obtain measurements. The mean pressurized contact area between the tendon and insertion was significantly greater for the 4-suture bridge technique (124.2 +/- 16.3 mm2, 77.6% footprint) compared with both the double-row (63.3 +/- 28.5 mm2, 39.6% footprint) and 2-suture bridge (99.7 +/- 22.0 mm2, 62.3% footprint) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was greater for the 4-suture bridge technique (0.27 +/- 0.04 MPa) than for the double-row technique (0.19 +/- 0.01 MPa) (P = .002). The transosseous-equivalent rotator cuff repair technique can improve pressurized contact area and mean pressure between the tendon and footprint when compared with a double-row technique. A transosseous-equivalent technique, using suture bridges, may help optimize the healing biology at a repaired rotator cuff insertion. PMID:17321161

  17. Tendon of the long head of the biceps originating from the rotator cuff – An uncommon anatomical variation: case report☆

    PubMed Central

    Andreoli, Carlos Vicente; Esteves, Leonardo Roure; Figueiredo, Eduardo; Belangero, Paulo Santoro; de Castro Pochini, Alberto; Ejnisman, Benno

    2015-01-01

    Anatomical variations at the origin of the biceps tendon have been described by several authors, but occurrences of an origin in the supraspinatus are rare. It is unclear whether this variation might contribute toward pathological conditions of the shoulder. Our objective here was to describe a case of an anatomical variation in the origin of the tendon of the long head of the biceps. The clinical information, preoperative images and arthroscopic images relating to a patient with an aberrant origin of the long head of the biceps, which was observed during shoulder arthroscopy, were reviewed. In this case study, the origin of the biceps was found in the rotator cuff, without any origin from the supraglenoid tubercle or upper labrum. This variant did not seem to contribute toward the pathological condition of the shoulder, and standard treatment for the concomitant condition was sufficient for treating it. PMID:26962493

  18. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

    PubMed Central

    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Purpose: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. Conclusion: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25767776

  19. Evaluation of the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over☆

    PubMed Central

    Miyazaki, Alberto Naoki; da Silva, Luciana Andrade; Santos, Pedro Doenux; Checchia, Sergio Luiz; Cohen, Carina; Giora, Taís Stedile Busin

    2015-01-01

    Objectives To evaluate the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over. Methods Between 1998 and 2009, 168 patients underwent operations. Five cases were excluded. The remaining 163 patients were stratified according to their age group: 65–69 years (49.1%), 70–74 (26.4%) and 75 years and over (24.5%). Their mean age was 71 years (range: 65–83). There were 63 male patients (38.7%). The mean length of time with pain, from the onset of symptoms to the surgery, was 23 months (range: 2 days to 240 months). Sixty-two patients (38%) reported histories of trauma and 26 (16%) reported that their pain worsened through exertion. Results From the UCLA criteria, 80.4% of the results were excellent, 16% good, 1.8% fair and 1.8% poor. Complications occurred in 11%. The final clinical result did not show any correlation with age progression, injury size or tendons affected. However, there was a significant association (p < 0.001) between the presence of trauma and larger injuries. The length of time between the onset of symptoms and the surgical procedure had a significant relationship (p < 0.027) with the postoperative results: the longer this time was, the worse the results were. Conclusion Arthroscopic treatment of rotator cuff injuries in patients aged 65 years and over presented excellent and good results in 96.4% of the cases, according to the UCLA assessment, with a low complication rate. Advanced age did not show any influence on the postoperative clinical evolution, but the earlier the surgical treatment was instituted, the better the results were. PMID:26229935

  20. Effect of Angiogenesis-Related Cytokines on Rotator Cuff Disease: The Search for Sensitive Biomarkers of Early Tendon Degeneration

    PubMed Central

    Savitskaya, Yulia A.; Izaguirre, Aldo; Sierra, Luis; Perez, Francisco; Cruz, Francisco; Villalobos, Enrique; Almazan, Arturo; Ibarra, Clemente

    2011-01-01

    Background: Hallmarks of the pathogenesis of rotator cuff disease (RCD) include an abnormal immune response, angiogenesis, and altered variables of vascularity. Degenerative changes enhance production of pro-inflammatory, anti-inflammatory, and vascular angiogenesis-related cytokines (ARC) that play a pivotal role in the immune response to arthroscopic surgery and participate in the pathogenesis of RCD. The purpose of this study was to evaluate the ARC profile, ie, interleukin (IL): IL-1β, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and angiogenin (ANG), in human peripheral blood serum and correlate this with early degenerative changes in patients with RCD. Methods: Blood specimens were obtained from 200 patients with RCD and 200 patients seen in the orthopedic clinic for nonrotator cuff disorders. Angiogenesis imaging assays was performed using power Doppler ultrasound to evaluate variables of vascularity in the rotator cuff tendons. Expression of ARC was measured by commercial Bio-Plex Precision Pro Human Cytokine Assays. Results: Baseline concentrations of IL-1β, IL-8, and VEGF was significantly higher in RCD patients than in controls. Significantly higher serum VEGF levels were found in 85% of patients with RCD, and correlated with advanced stage of disease (r = 0.75; P < 0.0005), average microvascular density (r = 0.68, P < 0.005), and visual analog score (r = 0.75, P < 0.0002) in RCD patients. ANG and IL-10 levels were significantly lower in RCD patients versus controls. IL-1β and ANG levels were significantly correlated with degenerative tendon grade in RCD patients. No difference in IL-6 and bFGF levels was observed between RCD patients and controls. Patients with degenerative changes had markedly lower ANG levels compared with controls. Power Doppler ultrasound showed high blood vessel density in patients with tendon rupture. Conclusion: The pathogenesis of RCD is associated with an imbalance

  1. Roles of poloidal rotation in the q = 1 high-order harmonic tearing modes in a tokamak plasma

    SciTech Connect

    Wei Lai; Wang Zhengxiong

    2013-01-15

    Roles of poloidal rotation in stabilizing the m/n=1/1 kink-tearing mode and exciting its high-order harmonic tearing modes are numerically investigated by using a reduced magnetohydrodynamic model. It is found that the high-order harmonic tearing modes, such as m/n=2/2, m/n=3/3, or even much higher-m harmonics, can be destabilized so significantly by rotation shear as to be more unstable than or comparable to the m/n=1/1 mode. Moreover, the short wave-length Kelvin- Helmholtz (KH) instabilities can be excited in the large rotation shear regime. The scaling power laws of the linear growth rate for each harmonic mode in different rotation shear regimes are verified by the previous relevant theoretical results based on the non-constant-{psi} and constant-{psi} behavior categories in tearing modes. During the nonlinear evolution, the m/n=2/2 mode dominated phase first appears and then is followed by the m/n=1/1 mode dominated nonlinear phase instead. Afterward, some smaller sub-islands due to the high-order harmonics are produced in the large irregular m=1 crescent-shaped island, and then a coalescence process of turbulent island chains occurs before the decay phase.

  2. Towards the development of a novel experimental shoulder simulator with rotating scapula and individually controlled muscle forces simulating the rotator cuff.

    PubMed

    Baumgartner, Daniel; Tomas, Daniel; Gossweiler, Lukas; Siegl, Walter; Osterhoff, Georg; Heinlein, Bernd

    2014-03-01

    A preclinical analysis of novel implants used in shoulder surgery requires biomechanical testing conditions close to physiology. Existing shoulder experiments may only partially apply multiple cycles to simulate postoperative, repetitive loading tasks. The aim of the present study was therefore the development of an experimental shoulder simulator with rotating scapula able to perform multiple humeral movement cycles by simulating individual muscles attached to the rotator cuff. A free-hanging, metallic humerus pivoted in a polyethylene glenoid is activated by tension forces of linear electroactuators to simulate muscles of the deltoideus (DELT), supraspinatus (SSP), infraspinatus/teres minor and subscapularis. The abductors DELT and SSP apply forces with a ratio of 3:1 up to an abduction angle of 85°. The rotating scapular part driven by a rotative electro actuator provides one-third to the overall arm abduction. Resulting joint forces and moments are measured by a 6-axis load cell. A linear increase in the DELT and SSP motors is shown up to a maximum of 150 and 50 N for the DELT and SSP, respectively. The force vector in the glenoid resulted in 253 N at the maximum abduction. The present investigation shows the contribution of individual muscle forces attached to the moving humerus to perform active abduction in order to reproducibly test shoulder implants. PMID:24170552

  3. Does an in-season detraining period affect the shoulder rotator cuff strength and balance of young swimmers?

    PubMed

    Batalha, Nuno M; Raimundo, Armando M; Tomas-Carus, Pablo; Marques, Mário A C; Silva, António J

    2014-07-01

    Imbalance in shoulder rotator muscles is a well-documented problem in swimmers, and it is important to implement land-based strength training programs. Meanwhile, the effects of a detraining period on swimmers' shoulder rotator muscles are unknown. The purpose of this study was to analyze the effects of a strength training program and detraining on the strength and balance of shoulder rotator cuff muscles in young swimmers, despite the continuity of usual water training. An experimental group (n = 20) and a control group (n = 20) of young male swimmers with the same characteristics (age, body mass, height, training volume, and maturational state) were evaluated. In both groups, the peak torques of shoulder internal (IR) and external (ER) rotators were assessed during preseason, midseason (16 weeks), and postseason (32 weeks). The experimental group underwent a strength training regimen from baseline to 16 weeks and a detraining period from 16 to 32 weeks. Concentric action at 60°·s-1 and 180°·s-1 was measured using an isokinetic dynamometer. The ER/IR strength ratios were obtained. At 60°·s-1, there were significant increments in IR strength and the ER/IR ratio in both shoulders. This trend was the same throughout the competitive season. The tendency was the same at 180°·s-1 because training effects were noted primarily in IR and ER/IR ratios. Moreover, the absence of land-based strength training, from 16 to 32 weeks, revealed a reduction in the ER/IR ratio values in both shoulders. Our findings suggest that young swimmers' coaches should use dry-land strength training protocols, and that it is recommended that these should be conducted on a regular basis (during the whole season). PMID:24345974

  4. Infusion Methods for Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Byeon, Gyeong Jo; Yoon, Ji Uk; Kim, Eun Jung; Baek, Seung Hoon; Ri, Hyun Su

    2015-01-01

    Background Infusion methods during regional analgesia using perineural catheters may influence the quality of postoperative analgesia. This study was conducted to compare the effects of combined or bolus-only infusion of 0.2% ropivacaine on the postoperative analgesia in interscalene brachial plexus block (ISBPB) with perineural catheterization. Methods Patients scheduled for arthroscopic rotator cuff repair were divided into two groups, one that would receive a combined infusion (group C, n = 32), and one that would receive intermittent infusion (group I, n = 32). A perineural catheter was inserted into the interscalene brachial plexus (ISBP) using ultrasound (US) and nerve stimulation, and 10 ml of 0.2% ropivacaine was administered. After the operation, group C received a continuous infusion of 4 ml/h, and a 4 ml bolus with a lockout interval of 60 min. Group I received only a 4 ml bolus, and the lockout interval was 30 min. Postoperative pain by the numeric rating scale (NRS) and the forearm muscle tone by the manual muscle test (MMT) were checked and evaluated at the following timepoints: preoperative, and postoperative 1, 4, 12, 24, 36, and 48 h. Supplemental opioid requirements, total consumed dose of local anesthetic, and adverse effects were compared between the two groups. Results Sixty-four patients completed the study and the postoperative values such as operation time, time to discharge, and operation site were comparable. There were no differences in NRS scores and supplemental opioid requirements between the two groups. The MMT scores of group I at 4 and 12 h after surgery were significantly higher than those of group C (P < 0.05). The total consumed dose of local anesthetic was significantly lower in group I than in group C (P < 0.05). The adverse effects were not different between the groups. Conclusions The bolus-only administration of 0.2% ropivacaine provided a similar analgesic effect with a lower total volume of local anesthetic and decreased

  5. Knotless single-row rotator cuff repair: a comparative biomechanical study of 2 knotless suture anchors.

    PubMed

    Efird, Chad; Traub, Shaun; Baldini, Todd; Rioux-Forker, Dana; Spalazzi, Jeffrey P; Davisson, Twana; Hawkins, Monica; McCarty, Eric

    2013-08-01

    The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior, P=.385; posterior, P=.389). Maximum load to failure was significantly greater (P=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors. The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically. PMID:23937749

  6. No difference in long-term development of rotator cuff rupture and muscle volumes in impingement patients with or without decompression.

    PubMed

    Ketola, Saara; Lehtinen, Janne; Elo, Petra; Kortelainen, Seppo; Huhtala, Heini; Arnala, Ilkka

    2016-08-01

    Background and purpose - Arthroscopic acromioplasty is still commonly used in the treatment of shoulder impingement syndrome, even though its benefits are questioned; randomized controlled studies have not shown any benefits when compared to non-operative treatment. In this randomized study, we investigated whether operative treatment protects from later rotator cuff rupture and whether it has any effect on the development of rotator cuff muscle volume. Patients and methods - 140 stage-II impingement patients were randomized to a structured exercise group (n = 70) or to an operative group (n = 70). In the operative group, arthroscopic acromioplasty was performed, after which a similar structured exercise program was begun. MRI of the shoulder was done at baseline and at 5 years. Results - There were no statistically significant differences in either the amount of perforating ruptures of the supraspinatus tendon or in the changes in muscle volume at 5 years. The grading of muscle fatty degeneration showed worse results in the operative group, but this difference was not statistically significant. Interpretation - In this study, we found that arthroscopic acromioplasty does not have any long-term benefit based on radiological findings of muscle volumes. Also, the frequency of later rotator cuff rupture was similar irrespective of whether or not surgery was performed. Acromioplasty is not justified as a treatment for dynamic shoulder impingement syndrome. PMID:27348693

  7. Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study

    PubMed Central

    Suh, Mi Ri; Chang, Won Hyuk; Choi, Hyo Seon

    2014-01-01

    Objective To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. Methods A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). Results US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (ДVAS=-2.8) was significantly larger than caused by oral NSAID (ДVAS=-1.5) (p<0.05). Conclusion In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle. PMID:25379497

  8. A randomised controlled trial comparing continuous supraclavicular and interscalene brachial plexus blockade for open rotator cuff surgery.

    PubMed

    Koh, W U; Kim, H J; Park, H S; Choi, W J; Yang, H S; Ro, Y J

    2016-06-01

    Continuous interscalene block is an approved modality for postoperative pain control, but it may cause hemidiaphragmatic paresis. In this study we aimed to determine whether continuous supraclavicular block would provide postoperative analgesia comparable to that of continuous interscalene block and reduce the incidence of hemidiaphragmatic paresis. Patients scheduled for open rotator cuff repair were randomly allocated to receive continuous interscalene (n = 38) or supraclavicular block (n = 37). Both participants and assessing clinicians were blinded to the group allocation. The primary endpoint was the mean pain intensity 24 h after the surgery. Postoperative mean (SD) pain scores at 24 h were similar in the supraclavicular and interscalene groups (2.57 (1.71) vs 2.84 (1.75) respectively; p = 0.478). The incidence of complete or partial hemidiaphragmatic paresis was lower in the supraclavicular group at 1 h after admission to the postanaesthetic care unit and 24 h after the surgery [25 (68%) vs 38 (100%); p = 0.001 and 14 (38%) vs 27 (71%) respectively; p = 0.008]. Continuous supraclavicular block provided comparable analgesia compared with interscalene block with a reduced incidence of complete or partial hemidiaphragmatic paresis for 24 h following surgery. PMID:26954669

  9. Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study

    PubMed Central

    CASTAGNA, ALESSANDRO; DE GIORGI, SILVANA; GAROFALO, RAFFAELE; CONTI, MARCO; TAFURI, SILVIO; MORETTI, BIAGIO

    2015-01-01

    Purpose the aim of the present study was to verify the differences in the clinical outcomes of two arthroscopic techniques used to treat calcifying tendinitis of the shoulder: needling versus complete removal of the calcium deposit and tendon repair. Methods from September 2010 to September 2012, 40 patients with calcifying tendinitis of the rotator cuff were arthroscopically treated by the same surgeon using one of the two following techniques: needling (Group 1) and complete removal of the calcium deposit and tendon repair with suture anchors (Group 2). Both groups followed the same rehabilitation program. The two groups were compared at 6 and 12 months of follow-up for the presence of residual calcifications and for the following clinical outcomes: Constant score, American Shoulder and Elbow Surgeons Evaluation Form (ASES) shoulder score, University of California Los Angeles (UCLA) shoulder rating scale, Simple Shoulder Test (SST) and Visual Analogue Scale (VAS). Results all the clinical scores (Constant, ASES, UCLA, SST and VAS scores) improved significantly between baseline and postoperative follow-up, both at 6 and at 12 months. No differences at final follow-up were found between the two groups. Conclusions both the techniques were effective in solving the symptoms of calcifying tendinitis of the shoulder. Clinical scores improved in both groups. Residual calcifications were found in only a few cases and were always less than 10 mm. Level of evidence Level II, prospective comparative study. PMID:26904521

  10. Concentric versus eccentric isokinetic strengthening of the rotator cuff. Objective data versus functional test.

    PubMed

    Ellenbecker, T S; Davies, G J; Rowinski, M J

    1988-01-01

    Twenty-two male and female college varsity tennis players trained for 6 weeks, one group using eccentric isokinetic internal and external shoulder rotation, and the second group using concentric isokinetic internal and external shoulder rotation. Subjects pretested and posttested both concentrically and eccentrically, so that training overflow and specificity could be examined. Three maximally hit tennis serves made before and after training, which were analyzed by high speed cinematography to obtain ball velocity, served as a functional performance measurement. Statistical analysis of peak torque (newton meters) and peak torque to body weight ratio have revealed significant concentric strength gains (P less than 0.005) in the concentric as well as the eccentric training groups. Eccentric strength gains were demonstrated by the concentric training group at selected speeds (P less than 0.05 and P less than 0.005) but were not generated in the eccentric group at the P less than 0.05 significance level. Functional test analysis shows an increase in maximal serve velocity at a significance level of P less than 0.005 in the concentric training group, with no significant (P greater than 0.01) increases in the eccentric group. PMID:3344883

  11. High-resolution ultrasound of rotator cuff and biceps reflection pulley in non-elite junior tennis players: anatomical study

    PubMed Central

    2014-01-01

    Background Tennis is believed to be potentially harmful for the shoulder, therefore the purpose of this study is to evaluate the anatomy of the rotator cuff and the coraco-humeral ligament (CHL) in a-symptomatic non-elite junior tennis players with high-resolution ultrasound (US). Methods From August 2009 to September 2010 n = 90 a-symptomatic non-elite junior tennis players (mean age ± standard deviation: 15 ± 3) and a control group of age- and sex- matched subjects were included. Shoulder assessment with a customized standardized protocol was performed. Body mass index, dominant arm, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings were recorded. Results Abnormalities were found at ultrasound in 14/90 (15%) players. Two players had supraspinatus tendinosis, two had subacromial impingement and ten had subacromial bursitis. CHL thickness resulted comparable in the dominant and non-dominant arms (11.3 ± 4.4 mm vs. 13 ± 4.2, p > 0.05). Multivariate analysis demonstrated that no association was present among CHL thickness and the variables evaluated. In the control group, abnormalities were found at ultrasound in 6/60 (10%) subjects (sub-acromial bursitis). No statistically significant differences between players and control group were found (p = 0.71). Conclusion In a-symptomatic non-elite junior tennis players only minor shoulder abnormalities were found. PMID:25034864

  12. TENOTOMY WITH OR WITHOUT TENODESIS OF THE LONG HEAD OF THE BICEPS USING REPAIR OF THE ROTATOR CUFF

    PubMed Central

    Ikemoto, Roberto Yukio; Pileggi, Paulo Eduardo; Murachovsky, Joel; Nascimento, Luís Gustavo Prata; Serpone, Rogerio Bueno; Strose, Eric; Oliveira, Luiz Henrique Almeida

    2015-01-01

    Objective: To compare the functional results among patients undergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff injuries, with a minimum two-year follow-up. Method: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of motion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA) score and the elbow strength index. Results: The mean UCLA score of the sample went from 16.92 (range: 8 to 25) to 31.45 (range: 13 to 35) (p < 0.001). Comparison of the pre and postoperative UCLA scores in the two groups showed that the difference in the group with tenotomy and tenodesis was 15.95 and in the group with tenotomy alone, 14.62 (p = 0.023). However, there was no statistical significance in comparing the groups regarding pain in the bicipital groove, Popeye sign or elbow strength index. Conclusion: This study showed that the difference in UCLA scores was statistically significant. The group with tenotomy and tenodesis of the long head of the biceps presented better functional results. PMID:27047893

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

    PubMed Central

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

    2013-01-01

    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

  14. Infraspinatus delamination does not affect supraspinatus tear repair.

    PubMed

    Zilber, Sébastien; Carillon, Yannick; Lapner, Peter C; Walch, Gilles; Nové-Josserand, Laurent

    2007-05-01

    Supraspinatus full-thickness tears with associated infraspinatus delamination are a frequent lesion, although the results of repair have not been reported. We retrospectively identified 35 patients treated for this cuff lesion among 378 open repaired full-thickness cuff tears. The aim of the study was to assess the subjective, objective, and anatomic outcomes of a subset of patients with supraspinatus tears involving delamination of the whole infraspinatus tendon. Thirty of the 35 patients were reviewed with magnetic resonance imaging at a minimum followup of 2 years (mean, 3.5 years; range, 2-6.5 years). The mean nonweighted Constant-Murley score at followup was 80/100 points, with an average gain of 17 points. Magnetic resonance imaging revealed all supraspinatus tendons but two were continuous. We observed no tear of the infraspinatus tendon, although a persistent delamination was present in 11 cases. One half of the patients had minor weakness in external rotation. One third of the infraspinatus muscles had minor fatty infiltration. Conservation of the infraspinatus tendon after closing the delamination did not seem to compromise the outcome of the supraspinatus repair. Avoiding resection of the infraspinatus delamination and treatment with simple curettage and closure yields satisfactory midterm functional and anatomic results. PMID:17308479

  15. All-Endoscopic Single-Row Repair of Full-Thickness Gluteus Medius Tears

    PubMed Central

    Levy, David M.; Bogunovic, Ljiljana; Grzybowski, Jeffrey S.; Kuhns, Benjamin D.; Bush-Joseph, Charles A.; Nho, Shane J.

    2016-01-01

    Abductor tendon tears typically develop insidiously in middle-aged women and can lead to debilitating lateral hip pain and a Trendelenburg limp. The gluteus medius tendon is most commonly torn and may show fatty degeneration over time, similar to the rotator cuff muscles of the shoulder. Endoscopic repair offers a therapeutic alternative to traditional open techniques. This article describes the workup, examination, and endoscopic repair of a full-thickness gluteus medius tear presenting as lateral hip pain and weakness. The surgical repair for this case used a single-row suture anchor technique. In addition, the indications and technique for a double-row repair will be discussed. PMID:27073767

  16. A correlation study of the American Shoulder and Elbow Society Score and the Oxford Shoulder Score with the use of regression analysis to predict one score from the other in patients undergoing reverse shoulder joint arthroplasty for cuff tear arthropathy

    PubMed Central

    Poon, Peter C

    2014-01-01

    Background More than 30 different scoring systems are available for evaluating outcomes of shoulder surgery. Unfortunately, given the multitude of scoring systems, there is no objective method to compare results between studies when different scoring systems are utilized. Methods We compared the American Shoulder and Elbow Society score (ASES) and the Oxford Shoulder Score (OSS) in patients undergoing reverse shoulder arthroplasty for cuff tear arthropathy. Twenty-nine patients had the ASES and OSS recorded pre-operatively, and at 6 and 12 months follow-up. The paired scores were assessed for their degree of correlation and sensitivity to change over time. Linear regression analysis was used to formulate a regression equation to predict one score from the other. Results The ASES and OSS correlated well with a Pearson’s correlation coefficient of 0.91 (p < 0.0001, n = 87). Both scores were sensitive to change. Regression analysis yielded a formula to predict the ASES from the OSS and vice versa with good accuracy (r2 = 0.83, F1,85 = 422.6, p < 0.0001). Conclusions Where good correlation exists, regression formulae can be used to accurately predict one score from the other in a specific population that it has been validated for. This can be of benefit when objectively comparing outcomes between studies using these two scoring systems.

  17. Tear System

    MedlinePlus

    ... with tear production or tear drainage. Increased Tear Production and Dry Eyes The eye has two sets ... as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the ...

  18. Rotator cuff exercises

    MedlinePlus

    ... activities, including your shoulder joint and your shoulder blade Observe your spine and posture as you stand ... band Isometric shoulder exercises Wall push-ups Shoulder blade (scapular) retraction - no tubing Shoulder blade (scapular) retraction - ...

  19. Rotator cuff repair

    MedlinePlus

    ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier ... Techniques of the Shoulder, Elbow, and Knee in Sports Medicine . 2nd ed. Philadelphia, PA: 2013:chap 24. Read ...

  20. Rotator Cuff Exercises

    MedlinePlus

    ... you finish doing all 4 exercises, put an ice pack on your shoulder for 20 minutes. It's best to use a plastic bag with ice cubes in it or a bag of frozen peas, not gel packs. If you do all 4 exercises 3 to ...

  1. Rotator cuff exercises

    MedlinePlus

    Shoulder exercises ... A key part in your recovery is doing exercises to make the muscles and tendons in your ... for everyday tasks or sports activities Before doing exercises at home, ask your doctor or physical therapist ...

  2. Rotator Cuff Repair

    MedlinePlus

    ... healing to bone takes a minimum of six weeks, but if you keep somebody immobilized for that ... hit ground strokes fairly early, within 10-12 weeks. However, when it comes to the overhead activities, ...

  3. Detection of partial-thickness tears in ligaments and tendons by Stokes-polarimetry imaging

    NASA Astrophysics Data System (ADS)

    Kim, Jihoon; John, Raheel; Walsh, Joseph T.

    2008-02-01

    A Stokes polarimetry imaging (SPI) system utilizes an algorithm developed to construct degree of polarization (DoP) image maps from linearly polarized light illumination. Partial-thickness tears of turkey tendons were imaged by the SPI system in order to examine the feasibility of the system to detect partial-thickness rotator cuff tear or general tendon pathology. The rotating incident polarization angle (IPA) for the linearly polarized light provides a way to analyze different tissue types which may be sensitive to IPA variations. Degree of linear polarization (DoLP) images revealed collagen fiber structure, related to partial-thickness tears, better than standard intensity images. DoLP images also revealed structural changes in tears that are related to the tendon load. DoLP images with red-wavelength-filtered incident light may show tears and related organization of collagen fiber structure at a greater depth from the tendon surface. Degree of circular polarization (DoCP) images exhibited well the horizontal fiber orientation that is not parallel to the vertically aligned collagen fibers of the tendon. The SPI system's DOLP images reveal alterations in tendons and ligaments, which have a tissue matrix consisting largely of collagen, better than intensity images. All polarized images showed modulated intensity as the IPA was varied. The optimal detection of the partial-thickness tendon tears at a certain IPA was observed. The SPI system with varying IPA and spectral information can improve the detection of partial-thickness rotator cuff tears by higher visibility of fiber orientations and thereby improve diagnosis and treatment of tendon related injuries.

  4. [Stress fracture of the scapular spine associated with rotator cuff dysfunction: Report of 3 cases and review of the literature].

    PubMed

    García-Coiradas, J; Lópiz, Y; Marco, F

    2014-01-01

    Scapular spine stress fractures have been scarcely reported in the literature. Their pathomechanics, clinical course and treatment are not well established. We review 3 cases in 2 patients that were associated with cuff dysfunction. On follow-up, none of these fractures progressed to healing. Two of them needed osteosynthesis and bone grafting, and the third one became a painless non-union. The authors propose the combination of 3 factors as a reason for this lesion: a functionally impaired cuff, a greater activation of the muscles with origin and insertion in the spine-acromion and a fragile bone. As we believe that these fractures are unstable, and non-union would be expected, their surgical management is recommended. PMID:24821480

  5. Endoscopic Treatment of Gluteus Medius Tears: A Review.

    PubMed

    Lerebours, Frantz R; Cohn, Randy; Youm, Thomas

    2016-03-01

    Greater trochanteric pain syndrome (GTPS) is a term used to describe disorders of the peritrochanteric region. This constellation of conditions includes greater trochanteric bursitis, gluteus medius (GM) tears, and external coxa saltans or snapping hip syndrome. Tears of the abductor mechanism, more specifically gluteus medius tears, have recently gained a considerable amount of interest in the orthopaedic literature. Abductor tears were first described by Bunker and Kagan in the late 1990s. They used the rotator cuff as an analogous structure to describe the pathological process associated with gluteus medius tears. Tears of the gluteus medius tendon can often be difficult to recognize. The clinical presentation is often attributed to trochanteric bursal inflammation, without any further workup. Provocative hip physical examination findings are an important key to proper diagnosis of abductor injuries. Depending on the size of the tear, patients with abductor tendon pathology may present with a Trendelenburg gait and reduced resisted abduction strength accompanied by pain. Initial noninvasive management of greater trochanteric pain syndrome includes oral or topical anti-inflammatory medication and activity modification. Physical therapy or other treatment modalities can be considered, with a focus on core strengthening, truncal alignment, and iliotibial band stretching. Gluteus medius tears have historically been repaired in an open fashion; however, the advent of new endoscopic surgery techniques has allowed for a less invasive approach. Access to the peritrochanteric space affords the surgeon with access to pathology associated with the greater trochanter, iliotibial band, trochanteric bursa, sciatic nerve, short external-rota tors, iliopsoas tendon, and the gluteus medius and minimus tendon attachments. Over the last decade, we have seen rapid technological advances in hip arthroscopy, improved diagnostic imaging and interpretation, and an improved

  6. Relationship Between Onset Thresholds, Trigger Types, and Rotation Shear for the m/n=2/1 Neoclassical Tearing Mode in a High-β Spherical Torus

    SciTech Connect

    Gerhardt, S. P.; Brennan, D. P.; Buttery, R.; La Haye, R. J.; Sabbagh, S.; Strait, E.; Bell, M.; Bell, R.; Fredrickson, E.; Gates, D.; LeBlanc, B.; Menard, J.; Stutman, D.; Tritz, K.; Yuh, H.

    2009-02-24

    The onset conditions for the m/n=2/1 neoclassical tearing mode (NTM) are studied in terms of neoclassical drive, triggering instabilities, and toroidal rotation or rotation shear, in the spherical torus NSTX [M. Ono, et al., Nuclear Fusion 40, 557 (2000)]. There are three typical onset conditions for these modes, given in order of increasing neoclassical drive required for mode onset: triggering by energetic particle modes, triggering by edge localized modes, and cases where the modes appear to grow without a trigger. In all cases, the required drive increases with toroidal rotation shear, implying a stabilizing effect from the shear.

  7. The Effect of Purified Multi-potent Human Bone-marrow Derived Mesenchymal Stem Cells on Rotator Cuff Tendon Healing in an Athymic Rat

    PubMed Central

    Degen, Ryan; Carbone, Andrew; Carballo, Camilia; Zong, Jianchun; Chen, Tony; Ying, Lilly; Lebaschi, Amir; Deng, Xiang-Hua; Rodeo, Scott A.

    2016-01-01

    Objectives: Bone marrow concentrates are being used to augment soft tissue healing. However, only 0.01% of these cells meet the criteria of a mesenchymal stem cell (MSC), which likely accounts for the variability in reported results. Previous studies using an established rat rotator cuff repair model have demonstrated that bone marrow-derived MSCs had no effect on healing. In this study we evaluated the effect of purified human MSCs on rotator cuff healing in an athymic rat model. Our hypothesis is that purified human MSCs added to the repair site will improve biomechanical strength and fibrocartilage formation of the healing tendon. Methods: Fifty-two athymic rats underwent unilateral detachment and repair of the supraspinatus tendon with either fibrin glue (control) or fibrin glue with 106 hMSCs (experimental) applied at the repair site. Flow cytometry verified the stem cell phenotype of the cells as CD73+, CD90+, CD105+, CD 14-, CD34- and CD45-. Rats were sacrificed at 2 and 4 weeks, with 10 used for biomechanical testing and 3 for histologic analysis from each group. Results: Biomechanical testing revealed a significant increase in failure load (11.5±2.4 N vs. 8.5±2.4 N, p=0.002) and stiffness (7.1±1.2 N/mm vs. 5.7±2.1 N/mm, p>0.17).Biomechanical testing revealed a significant increase in failure load (11.5±2.4 N vs. 8.5±2.4 N, p=0.002) and stiffness (7.1±1.2 N/mm vs. 5.7±2.1 N/mm, p<0.001) in the experimental group compared with the control group at 2 weeks. Similarly, safranin-O staining identified increased fibrocartilage formation at the repair site at 2 weeks in the hMSC group (18.6±2.9% vs. 9.1±1.6%, p=0.026). These effects dissipated by 4 weeks, with no significant biomechanical or histologic differences between groups (p>0.17). Conclusion: These data demonstrate the potential for stem cells to augment tendon healing. This is the first study to use purified stem cells, rather than simple bone marrow concentrate. In the future, cell

  8. Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised, double-blind, placebo-controlled trial

    PubMed Central

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

    2007-01-01

    Background Chronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness. Methods/Design This randomised, double-blind, placebo-controlled trial will involve 200 participants with CRCP recruited from medical practices, outpatient departments and the community via print and radio media. Participants will be randomly allocated to a physiotherapy or placebo group using concealed allocation stratified by treating physiotherapist. Both groups will receive 10 sessions of individual standardised treatment over 10 weeks from one of 10 project physiotherapists. For the following 12 weeks, the physiotherapy group will continue a home exercise program and the placebo group will receive no treatment. The physiotherapy program will comprise shoulder joint and spinal mobilisation, soft tissue massage, postural taping, and home exercises for scapular control, posture and rotator cuff strengthening. The placebo group will receive inactive ultrasound and gentle application of an inert gel over the shoulder region. Blinded assessment will be conducted at baseline and at 10 weeks and 22 weeks after randomisation. The primary outcome measures are self reported questionnaires including the shoulder pain and disability index (SPADI), average pain on an 11-point numeric rating scale and participant perceived global rating of change. Secondary measures include Medical Outcomes Study 36-item short form (SF-36), Assessment of Quality of Life index, numeric rating scales for shoulder pain and stiffness, participant perceived rating of change for pain, strength and stiffness, and manual muscle testing for shoulder strength using a handheld dynamometer. To evaluate cost-effectiveness, participants will record the use of all health-related treatments in a log

  9. Biceps instability and Slap type II tear in overhead athletes.

    PubMed

    Osti, Leonardo; Soldati, Francesco; Cheli, Andrea; Pari, Carlotta; Massari, Leo; Maffulli, Nicola

    2012-10-01

    Type II lesions are common lesions encountered in overhead athletes with controversies arising in term of timing for treatment, surgical approach, rehabilitation and functional results. The aim of our study was to evaluate the outcomes of arthroscopic repair of type II SLAP tears in overhead athletes, focusing on the time elapsed from diagnosis and treatment, time needed to return to sport, rate of return to sport and to previous level of performance, providing an overview concerning evidence for the effectiveness of different surgical approaches to type II SLAP tears in overhead athletes. A internet search on peer reviewed Journal from 1990, first descriprion of this pathology, to 2012, have been conducted evaluating the outcomes for both isolated Slap II tear overhead athletes and those who presented associated lesions treated. The results have been analyzed according to the scale reported focusing on return to sport and level of activity. Apart from a single study, non prospective level I and II studies were detected. Return to play at the same level ranged form 22% to 94% with different range of technique utilized with the majority of the authors recommending the fixation of these lesions but biceps tenodesis can lead to higher satisfaction racte when directly compated to the anchor fixation. Associated pathologies such as partial or full tickness rotator cuff tear did not clearly affect the outcomes and complications rate. There is no consensus regarding timing and treatment for type II SLAP, especially in overhead athletes who need to regain a high level of performance. PMID:23738307

  10. Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis--a systematic review.

    PubMed

    Huisstede, Bionka M A; Gebremariam, Lukas; van der Sande, Renske; Hay, Elaine M; Koes, Bart W

    2011-10-01

    Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data and assessed the methodological quality. Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective (moderate evidence) than placebo in mid-term. For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or high-ESWT versus placebo, each other, or other treatments. This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis. PMID:21396877

  11. Repair versus shaving of partial-thickness articular-sided tears of the upper subscapularis tendon. A prospective randomized controlled trial

    PubMed Central

    RANDELLI, PIETRO; ARRIGONI, PAOLO; ALIPRANDI, ALBERTO; SDAO, SILVANA; RAGONE, VINCENZA; D’AMBROSI, RICCARDO; RANDELLI, FILIPPO; CABITZA, PAOLO; BANFI, GIUSEPPE

    2015-01-01

    Purpose the purpose of this study was to evaluate whether treating partial-thickness articular-sided tears of the upper subscapularis (SSC) tendon with a dedicated suture anchor would result in an internal rotation strength improvement compared with simple shaving of the SSC tendon and footprint. Methods twenty-six patients with a limited SSC tendon tear (equal or inferior to the most superior centimeter) in association with a posterosuperior cuff lesion were prospectively randomized to two treatments: repair with a dedicated suture anchor versus shaving of the tendon and footprint. The patients also underwent long head of the biceps (LHB) treatment and posterosuperior cuff tear repair. In each patient the following parameters were measured both preoperatively and at a minimum follow-up of 2.5 years: strength in internal rotation in the bear-hug testing position (using a digital tensiometer), DASH score and Constant scores. MRI assessment of tendon healing was performed at the final follow-up. Results twenty of the 26 patients (76%) were reviewed after a mean follow-up time of 42 months: 11 patients had undergone SSC tendon repair and nine simple shaving. At final follow-up no significant differences were found between the repaired and shaving group in strength in internal rotation (9.5 ± 3.8 kg versus 10.3±5.4 kg; p=0.7). The DASH score and Constant score also failed to show significant differences between the two groups. Furthermore, no significant difference in SSC tendon healing rate was observed on MRI evaluation. Conclusions partial-thickness articular-sided tear of the upper SSC tendon in association with a posterosuperior rotator cuff repair and LHB treatment, when limited to the superior centimeter of the SSC tendon, shows a comparable performance in terms of strength in internal rotation either after simple shaving or a tendon-to-bone repair. Level of evidence Level II, prospective comparative study. PMID:26889466

  12. Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair

    PubMed Central

    Islam, Anowarul; Bohl, Michael S.; Tsai, Andrew G; Younesi, Mousa; Gillespie, Robert; Akkus, Ozan

    2015-01-01

    Background Currently, there are no well-established suture protocols to attach fully load-bearing scaffolds which span tendon defects between bone and muscle for repair of critical sized tendon tears. Methods to attach load-bearing tissue repair scaffolds could enable functional repair of tendon injuries. Methods Sixteen rabbit shoulders were dissected (New Zealand white rabbits, 1 yr. old, female) to isolate the humeral-infraspinatus muscle complex. A unique suture technique was developed to allow for a 5 mm segmental defect in infraspinatus tendon to be replaced with a mechanically strong bioscaffold woven from pure collagen threads. The suturing pattern resulted in a fully load-bearing scaffold. The tensile stiffness and strength of scaffold repair was compared with intact infraspinatus and regular direct repair. Findings The failure load and displacement at failure of the scaffold repair group were 59.9 N (Standard Deviation, SD = 10.7) and 10.3 mm (SD = 2.9), respectively and matched those obtained by direct repair group which were 57.5 N (SD = 15.3) and 8.6 mm (SD = 1.5), (p > 0.05). Failure load, displacement at failure and stiffness of both of the repair groups were half of the intact infraspinatus shoulder group. Interpretation With the developed suture technique, scaffolds repair showed similar failure load, displacement at failure and stiffness to the direct repair. This novel suturing pattern and the mechanical robustness of the scaffold at time zero indicates that the proposed model is mechanically viable for future in vivo studies which has a higher potential to translate into clinical uses. PMID:26009492

  13. The Subscapularis Interlocking Stitch for the Arthroscopic Treatment of Subscapularis Tendon Tears at the Shoulder

    PubMed Central

    Kircher, Jörn; Schwalba, Knut; Hedtmann, Achim

    2015-01-01

    Restoration of subscapularis function is essential for long-term maintenance of good clinical results for both traumatic and nontraumatic rotator cuff tears. The anatomic repair of partially and completely torn tendons from the footprint at the lesser tuberosity is the goal of surgical repair. The described technique, with a combination of an interlocking stitch and additional mattress sutures using a double-loaded suture anchor, provides reduction of the retracted tendon, sufficient pullout strength, and compression of the tendon to the footprint to facilitate healing. PMID:26900550

  14. 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

    PubMed Central

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

    2009-01-01

    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) Sham-Placebo Device (PLACEBO). All groups received the same postoperative dressing and the same device treatment instructions. Group I was given HWDS which they were to utilize for one hour twice a day for 90 days postoperatively. Group II was given the same instructions with a Placebo device (PLACEBO). Range of motion was assessed by using one-way ANOVA with a Duncan Multiple Range Test for differences between the groups preoperatively, 45 days postoperatively, and 90 days postoperatively by using an active/passive scale for five basic ranges of motions: Forward Elevation, External Rotation (arm at side), External Rotation (arm at 90 degrees abduction), Internal Rotation (arm at side), and Internal Rotation (arm at 90 degrees abduction). The study also evaluated postoperative changes in strength by using the Medical Research Council (MRC) grade assessed strength testing. Results Patients who received HWDS compared to PLACEBO demonstrated, on average, significantly improved range of motion. Results confirm a significant difference for external rotation at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), active at 90 days postoperatively (p = 0.007). Internal rotation also demonstrated significant improvement compared to PLACEBO at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), and active range at 90 days postoperatively (p = 0.006). There was no significant difference between the two groups for strength testing. Conclusion HWDS compared to PLACEBO induces a

  15. LIPOMA ARBORESCENS: RARE CASE OF ROTATOR CUFF TEAR ASSOCIATED WITH THE PRESENCE OF LIPOMA ARBORESCENS IN THE SUBACROMIAL-SUBDELTOID AND GLENOHUMERAL BURSA

    PubMed Central

    Benegas, Eduardo; Neto, Arnaldo Amado Ferreiro; Teodoro, Daniel Sabatini; da Silva, Marcos Vinícius Muriano; de Oliveira, Augusto Medaglia; Filippi, Renée Zon; de Santis Prada, Flávia

    2015-01-01

    Lipoma arborescens is a rare intra-articular disease that is usually monoarticular and is characterized by extensive proliferation of the synovial villi and hyperplasia of the subsynovial fat. The synovial tissue is progressively replaced by mature fat cells in the synovial membrane. The present study reports a case of a rare condition of lipoma arborescens that was simultaneously intra-articular (glenohumeral joint) and in the subacromial-subdeltoid bursa, in association with a torn supraspinatus tendon. The clinical, histological and radiographic presentations and treatment are discussed here. The description of this case includes radiographic and magnetic resonance evaluations and pathological examination. Although lipoma arborescens is a rare condition, it should be taken into consideration in cases presenting synovial hyperproliferation and synovial fat replacement. PMID:27047861

  16. STRENGTH EXERCISES COMBINED WITH DRY NEEDLING WITH ELECTRICAL STIMULATION IMPROVE PAIN AND FUNCTION IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY: A RETROSPECTIVE CASE SERIES

    PubMed Central

    2016-01-01

    ABSTRACT Background and Purpose Rotator cuff tendinopathy (RTCT) is regularly treated by the physical therapist. Multiple etiologies for RTCT exist, leading an individual to seek treatment from their provider of choice. Strengthening exercises (SE) have been reported to be effective in the treatment of RTCT, but there is limited evidence on the effectiveness of dry needing (DN) for this condition. The purpose of this retrospective case series was to investigate DN to various non-trigger point-based anatomical locations coupled with strengthening exercises (SE) as a treatment strategy to decrease pain and increase function in healthy patients with chronic RTC pathology. Case Descriptions Eight patients with RTCT were treated 1-2 times per week for up to eight weeks, and no more than sixteen total treatment sessions of SE and DN. Outcomes were tested at baseline and upon completion of therapy. A long-term outcome measure follow up averaging 8.75 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Quick Dash (QD). Outcomes Clinically meaningful improvements in disability and pain in the short term and upon long-term follow up were demonstrated for each patient. The mean VAS was broken down into best (VASB), current (VASC), and worst (VASW) rated pain levels and the mean was calculated for the eight patients. The mean VASB improved from 22.5 mm at the initial assessment to 2.36 mm upon completion of the intervention duration. The mean VASC improved from 28.36 mm to 5.0 mm, and the mean VASW improved from 68.88 mm to 13.25 mm. At the long-term follow up (average 8.75 months), The mean VASB, VASC, and VASW scores were 0.36 mm, 4.88 mm, and 17.88 mm respectively. The QDmean for the eight patients improved from 43.09 at baseline to 16.04 at the completion of treatment. At long-term follow-up, the QDmean was 6.59. Conclusion Clinically meaningful improvements in pain and disability were

  17. A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy

    PubMed Central

    Leroux, Timothy; Chahal, Jaskarndip; Wasserstein, David; Verma, Nikhil N.; Romeo, Anthony A.

    2015-01-01

    Context: A comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients. Objective: A systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies. Data Sources: MEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013). Study Selection: Levels 1 through 4 studies reporting clinical outcomes of concurrent RCR and LHB tenotomy or tenodesis with minimum 1-year follow-up. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Two independent reviewers identified eligible studies and applied the exclusion criteria. Clinical outcome data, including functional outcome score(s), biceps deformity and cramping, and patient satisfaction, were extracted. Clinical outcome data from included studies were pooled (weighted according to study size) and reported. A meta-analysis was performed only on outcomes extracted from comparative studies (α = 0.05). Results: Twelve studies (N = 565 patients; mean age, 61.3 years; 46.3% men) were included. Of these, 6 (N = 263) included RCR and LHB tenotomy and 9 (N = 302) included RCR and LHB tenodesis. A meta-analysis was performed on 3 comparative studies (levels 1 and 2), demonstrating that the postoperative Constant score at a mean follow-up of 25.5 months was significantly greater after tenodesis (92.8 [tenodesis] vs 90.6 [tenotomy], P < 0.01); however, this difference was less than the reported minimal clinically important difference of 10.4 points. Similarly, the rate of biceps deformity was significantly less after tenodesis (15.5% [tenotomy] vs 3.9% [tenodesis], P < 0.01); however, most patients were not bothered by it. There were no significant differences in the rate of biceps cramping or patient satisfaction. Conclusion: Although the

  18. Rotator cuff - self-care

    MedlinePlus

    Your doctor will likely refer you to a physical therapist to learn exercises for your shoulder . You may ... activity. Also, when examined by your doctor or physical therapist, you should have: Full strength in the muscles ...

  19. SLAP Tears

    MedlinePlus

    ... caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from: • A ... labrum tears as a result of repeated shoulder motion. This cross-section view of the shoulder socket ...

  20. The Hug-up Test: A New, Sensitive Diagnostic Test for Supraspinatus Tears

    PubMed Central

    Liu, Yu-Lei; Ao, Ying-Fang; Yan, Hui; Cui, Guo-Qing

    2016-01-01

    Background: The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods: Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results: The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898) and size (Fisher's exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions: The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and

  1. CLINICAL DIAGNOSIS OF SUBSCAPULARIS TENDON TEAR USING THE BEAR HUG SEMIOLOGICAL MANEUVER

    PubMed Central

    Schiefer, Márcio; Júnior, Yonder Archanjo Ching-San; Silva, Sérgio Maurício; Fontenelle, César; Dias Carvalho, Marcos Genúncio; de Faria, Fabio Garcia; Franco, José Sérgio

    2015-01-01

    Objective: To evaluate the Bear Hug maneuver for clinically diagnosing subscapularis tendon tears, and compare this with other maneuvers described previously (Lift-off, Napoleon and Belly Press). Methods: Forty-nine patients with rotator cuff injuries who had undergone arthroscopy to repair the injury and had previously been assessed using the semiological maneuvers mentioned above were evaluated. Results: The diagnostic values obtained for the Bear Hug test were as follows: sensitivity 75%, specificity 56%, positive predictive value 62%, negative predictive value 70% and accuracy 65%. Conclusion: The highest sensitivity and negative predictive value values were obtained with the Bear Hug test. The highest specificity value was seen with the Lift-off test. The Belly press test gave the greatest specificity, positive predictive and accuracy values. PMID:27047870

  2. Special report: Occlusive cuff controller

    NASA Technical Reports Server (NTRS)

    Baker, J. T.

    1975-01-01

    A mechanical occlusive cuff controller suitable for blood flow experiments in space shuttle flights is described. The device requires 115 volt ac power and a pressurized gas source. Two occluding cuff pressures (30 and 50 mmHg) are selectable by a switch on the front panel. A screw driver adjustment allows accurate cuff pressurization levels for under or oversized limbs. Two pressurization cycles (20 second and 2 minutes) can be selected by a front panel switch. Adjustment of the timing cycles is also available through the front panel. A pushbutton hand switch allows remote start of the cuff inflation cycle. A stop/reset switch permits early termination of the cycle and disabling of the controller to prevent inadvertent reactivation. Pressure in the cuff is monitored by a differential aneroid barometer. In addition, an electrocardiogram trigger circuit permits the initiation of the pressurization cycle by an externally supplied ECG cycle.

  3. Rolling cuff flexible bellows

    DOEpatents

    Lambert, Donald R.

    1985-01-01

    A flexible connector apparatus used to join two stiff non-deformable members, such as piping. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

  4. Rolling cuff flexible bellows

    SciTech Connect

    Lambert, D. R.

    1985-09-10

    A flexible connector apparatus used to join two stiff non-deformable members, such as piping. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

  5. 21 CFR 868.5760 - Cuff spreader.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  6. 21 CFR 868.5760 - Cuff spreader.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  7. 21 CFR 868.5760 - Cuff spreader.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  8. 21 CFR 868.5760 - Cuff spreader.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  9. 21 CFR 868.5760 - Cuff spreader.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  10. Observing the Coupling of the Toroidal Plasma Rotation Due to m/n = 2/1 and m/n = 3/2 Neoclassical Tearing Modes by Uncorrected n = 2 Error Field in DIII-D

    NASA Astrophysics Data System (ADS)

    Okabayashi, M.; Tobias, B. J.; Strait, E. J.; La Haye, R. J.; Paz-Soldan, C.; Shiraki, D.; Hanson, J. M.

    2014-10-01

    Injection of electromagnetic torque by tearing mode rotation control feedback can sustain rotation of the 2/1 NTM, avoiding mode locking for several seconds after the mode appearance. This feedback process optimizes the phasing of rotating applied n = 1 field relative to the mode, hence preventing the locking and simultaneously compensating the n = 1 error field (EF). In high beta discharges, the large amplitude sustained 2/1 NTM reduces the local toroidal rotation to near zero at the q = 3/2 surface and =1, implying the angular momentum is coupled between the two rational surfaces. The mode at the q = 3/2 surface is identified as a m/n = 3/2. The mode is presumably affected by n = 2 EF as well as remaining uncorrected n = 1 EF. A possible process of sustained NTM with velocity shear due to the Er buildup by large size magnetic islands will also be discussed. Work supported by the US Department of Energy under DE-AC02-09CH11466, DE-FC02-04ER54698, DE-AC05-00OR22725, and DE-FG02-04ER54761.

  11. Meniscus tears - aftercare

    MedlinePlus

    Knee cartilage tear - aftercare ... forms a buffer between the bones in your knee to protect the joint. The meniscus: Acts like a shock-absorber Helps lubricate your knee joint Can tear and limit your ability to ...

  12. Rotator Cuff and Shoulder Conditioning Program

    MedlinePlus

    ... your doctor’s supervision. Talk to your doctor or physical therapist about which exercises will best help you meet ... weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued ...

  13. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders

    PubMed Central

    Schwartzberg, Randy; Reuss, Bryan L.; Burkhart, Bradd G.; Butterfield, Matt; Wu, James Y.; McLean, Kevin W.

    2016-01-01

    Background: The incidence of superior labral surgery has increased in the past decade in the United States, and a contributing factor could be an increased rate of superior labral tears diagnosed with magnetic resonance imaging (MRI). Prior MRI studies of the asymptomatic shoulder have focused on rotator cuff pathology or pathology in a narrow and specific group of athletes. Labral abnormalities have not previously been thoroughly evaluated in asymptomatic middle-aged individuals. Purpose: To evaluate the prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people (age range, 45-60 years). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 asymptomatic adults (age range, 45-60 years) with no history of surgery or injury to either shoulder were included in the study. Physical examinations of all shoulders were performed. Noncontrast MRI (1.5 T) was performed in 1 randomly determined shoulder of each subject. Two fellowship-trained musculoskeletal radiologists who were blinded to the purpose of the study and ages of the subjects evaluated each MRI. Results: Radiologists interpreted the MRIs as consistent with superior labral tears in 55% and 72% of the cohort. Comparison of the radiological evaluations of the superior labra were moderate (κ = 0.410, P = .033). There were no differences in readings for superior labral tear regarding age (P = .87), sex (P = .41), whether the dominant shoulder underwent MRI (P = .99), whether the subject worked a physical job (P = .08), or whether the subject participated in overhead sports for a period of 1 year (P = .62). Conclusion: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. Clinical Relevance: To avoid

  14. Avoidance of Tearing Mode Locking and Disruption with Electro-Magnetic Torque Introduced by Feedback-based Mode Rotation Control in DIII-D and RFX-mod

    SciTech Connect

    Okabayashi, M.; Zanca, P.; Strait, E. J.

    2014-09-01

    Disruptions caused by tearing modes (TMs) are considered to be one of the most critical roadblocks to achieving reliable, steady-state operation of tokamak fusion reactors. Here we have demonstrated a very promising scheme to avoid such disruptions by utilizing the electro-magnetic (EM) torque produced with 3D coils that are available in many tokamaks. In this scheme, the EM torque to the modes is created by a toroidal phase shift between the externally-applied field and the excited TM fields, compensating for the mode momentum loss due to the interaction with the resistive wall and uncorrected error fields. Fine control of torque balance is provided by a feedback scheme. We have explored this approach in two vastly different devices and plasma conditions: DIII-D and RFX-mod operated in tokamak mode. In DIII-D, the plasma target was high βN plasmas in a non-circular divertor tokamak. In RFX-mod, the plasma was ohmically-heated plasma with ultralow safety factor in a circular limiter discharge of active feedback coils outside the thick resistive shell. The DIII-D and RFX-mod experiments showed remarkable consistency with theoretical predictions of torque balance. The application to ignition-oriented devices such as International Thermonuclear Experimental Reactor (ITER) would expand the horizon of its operational regime. The internal 3D coil set currently under consideration for edge localized mode suppression in ITER would be well suited to this purpose.

  15. Measurement of Contact Behavior Including Slippage of Cuff When Using Wearable Physical Assistant Robot.

    PubMed

    Akiyama, Yasuhiro; Okamoto, Shogo; Yamada, Yoji; Ishiguro, Kenji

    2016-07-01

    Continuous use of wearable robots can cause skin injuries beneath the cuffs of robots. To prevent such injuries, understanding the contact behavior of the cuff is important. Thus far, this contact behavior has not been studied because of the difficulty involved in measuring the slippage under the cuff. In this study, for the first time, the relative displacement, slippage, and interaction force and moment at the thigh cuff of a robot during sit-to-stand motion were measured using an instrumented cuff, which was developed for this purpose. The results indicated that the slippage and relative displacement under the cuff was uneven because of the rotation of the cuff, which suggests that the risk of skin injuries is different at different positions. Especially, the skin closer to the hip showed larger dynamism, with a maximum slippage of approximately 10 mm and a displacement of 20 mm during motion. Another important phenomenon was the individual difference among subjects. During motion, the interaction force, moment, and slippage of some subjects suddenly increased. Such behavior results in stress concentration, which increases the risk of skin injuries. These analyses are intended to understand how skin injuries are caused and to design measures to prevent such injuries. PMID:26276994

  16. Tear biomarkers for keratoconus.

    PubMed

    Nishtala, Krishnatej; Pahuja, Natasha; Shetty, Rohit; Nuijts, Rudy M M A; Ghosh, Arkasubhra

    2016-01-01

    Keratoconus is a progressive corneal thinning, ectatic condition, which affects vision. Recent advances in corneal topography measurements has helped advance proper diagnosis of this condition and increased research and clinical interests in the disease etiopathogenesis. Considerable progress has been achieved in understanding the progression of the disease and tear fluid has played a major role in the progress. This review discusses the importance of tear fluid as a source of biomarker for keratoconus and how advances in technology have helped map the complexity of tears and thereby molecular readouts of the disease. Expanding knowledge of the tear proteome, lipidome and metabolome opened up new avenues to study keratoconus and to identify probable prognostic or diagnostic biomarkers for the disease. A multidimensional approach of analyzing tear fluid of patients layering on proteomics, lipidomics and metabolomics is necessary in effectively decoding keratoconus and thereby identifying targets for its treatment. PMID:27493978

  17. Antimicrobial Compounds in Tears

    PubMed Central

    McDermott, Alison M.

    2013-01-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. PMID:23880529

  18. Effect of return to overuse activity following an isolated supraspinatus tendon tear on adjacent intact tendons and glenoid cartilage in a rat model.

    PubMed

    Reuther, Katherine E; Thomas, Stephen J; Sarver, Joseph J; Tucker, Jennica J; Lee, Chang-Soo; Gray, Chancellor F; Glaser, David L; Soslowsky, Louis J

    2013-05-01

    Rotator cuff tears are common conditions that can alter shoulder mechanics and may lead to damage of intact joint tissues. These injuries are of particular concern in populations who perform tasks requiring repetitive overhead activity (e.g., athletes and laborers) and who are likely to return to aggressive pre-injury activity levels despite limited understanding of the potentially damaging effects on the remaining tissues. Therefore, we investigated the effect of returning to overuse activity following a supraspinatus tear on shoulder function and the mechanical properties of the remaining intact tendons and glenoid cartilage. Forty rats underwent 4 weeks of overuse activity to create a tendinopathic condition followed by detachment of the supraspinatus tendon and were then randomized into two groups: continued overuse or cage activity. Ambulatory measurements were performed throughout the 8 weeks prior to euthaniasia, and properties of the adjacent tendons and cartilage were evaluated. Results demonstrated that shoulder function was not compromised in the return to overuse group. However, alterations of the glenoid cartilage and biceps tendon properties occurred. Our results help define the contributory roles of common mechanical injury mechanisms and provide a framework by which physicians could better prescribe long-term treatment strategies for patients. PMID:23280495

  19. Effect of Return to Overuse Activity Following an Isolated Supraspinatus Tendon Tear on Adjacent Intact Tendons and Glenoid Cartilage in a Rat Model

    PubMed Central

    Reuther, Katherine E.; Thomas, Stephen J.; Sarver, Joseph J.; Tucker, Jennica J.; Lee, Chang-Soo; Gray, Chancellor F.; Glaser, David L.; Soslowsky, Louis J.

    2013-01-01

    Rotator cuff tears are common conditions that can alter shoulder mechanics and may lead to damage of intact joint tissues. These injuries are of particular concern in populations who perform tasks requiring repetitive overhead activity (e.g., athletes and laborers) and who are likely to return to aggressive pre-injury activity levels despite limited understanding of the potentially damaging effects on the remaining tissues. Therefore, we investigated the effect of returning to overuse activity following a supraspinatus tear on shoulder function and the mechanical properties of the remaining intact tendons and glenoid cartilage. Forty rats underwent 4 weeks of overuse activity to create a tendinopathic condition followed by detachment of the supraspinatus tendon and were then randomized into two groups: continued overuse or cage activity. Ambulatory measurements were performed throughout the 8 weeks prior to euthaniasia, and properties of the adjacent tendons and cartilage were evaluated. Results demonstrated that shoulder function was not compromised in the return to overuse group. However, alterations of the glenoid cartilage and biceps tendon properties occurred. Our results help define the contributory roles of common mechanical injury mechanisms and provide a framework by which physicians could better prescribe long-term treatment strategies for patients. PMID:23280495

  20. Cuff width alters the amplitude envelope of wrist cuff pressure pulse waveforms.

    PubMed

    Jilek, Jiri; Stork, Milan

    2010-07-01

    The accuracy of noninvasive blood pressure (BP) measurement with any method is affected by cuff width. Measurement with a too narrow cuff overestimates BP and measurement with a too wide cuff underestimates BP. Automatic wrist cuff BP monitors use permanently attached narrow cuffs with bladders about 6 cm wide. Such narrow cuffs should result in under-cuffing for wrist circumferences larger than 15 cm. The objective of this qualitative study was to show that a narrow wrist cuff results in increased BP values when a cuff pulse amplitude ratio algorithm is used. According to the algorithm used in this study, systolic pressure (SBP) corresponds to the point of 50% of maximal amplitude; for diastolic pressure (DBP) the ratio is 70%. Data were acquired from 12 volunteers in the sitting position. The mean wrist circumference was 18 cm. The acquired cuff pulse data were used to compute SBP, mean pressure (MAP) and DBP. The mean values for a 6 cm cuff were SBP = 144 mmHg, MAP = 104 mmHg and DBP = 88 mmHg. The values for a 10 cm cuff were SBP = 128 mmHg, MAP = 93 mmHg and DBP = 78 mmHg. The reference BP values were SBP = 132 mmHg, MAP = 96 mmHg and DBP = 80 mmHg. All narrow (6 cm) cuff BP values were higher than wide (10 cm) cuff or reference BP values. The results indicate that wider wrist cuffs may be desirable for more accurate and reliable BP measurement with wrist monitors. PMID:20505218

  1. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve...

  2. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve...

  3. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve...

  4. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve...

  5. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve...

  6. Logic-controlled occlusive cuff system

    NASA Technical Reports Server (NTRS)

    Baker, J. T.; Hoffler, G. W. (Inventor); Hursta, W. N.

    1981-01-01

    An occlusive cuff system comprises a pressure cuff and a source of regulated compressed gas feeding the cuff through an electrically operated fill valve. An electrically operated vent valve vents the cuff to the ambient pressure. The fill valve is normally closed and the vent valve is normally open. In response to an external start signal, a logic network opens the fill valve and closes the vent valve, thereby starting the pressurization cycle and a timer. A pressure transducer continuously monitors the pressure in the cuff. When the transducer's output equals a selected reference voltage, a comparator causes the logic network to close the fill valve. The timer, after a selected time delay, opens the vent valve to the ambient pressure, thereby ending the pressurization cycle.

  7. The nonlinear tearing mode

    NASA Technical Reports Server (NTRS)

    Van Hoven, G.; Steinolfson, R. S.

    1984-01-01

    A series of nonlinear computations of tearing-mode development have been performed which achieve higher values of the magnetic Reynolds number and larger wavelengths than previously considered. A prime candidate for the realization of dynamic reconnection is the resistive magnetic tearing mode, a spontaneous instability of a stressed magnetic field. Typical simulations are described for a magnetic Lundquist number S of 10 to the 4th and wavelength parameters alpha from 0.05 to 0.5. In all cases, the nonlinear mode initially evolves at the linear growth rate, followed by a period of reduced growth. Another common feature is the formation of secondary flow vortices, near the tearing surface, which are opposite in direction to the initial linear vortices.

  8. Rolling-cuff flexible bellows

    DOEpatents

    Lambert, D.R.

    1982-09-27

    A flexible connector apparatus used to join two stiff non-deformable members, such as piping, is described. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

  9. Nibbling Tears of Wine

    NASA Astrophysics Data System (ADS)

    Aristoff, Jeff; Bush, John

    2006-11-01

    The meniscus of an alcohol-rich solution is known to climb upwards due to an evaporation-induced Marangoni stress, thus initiating the tears of wine phenomenon. Rather than merging directly, the tears may bob up and down when they make contact with the underlying reservoir, appearing to nibble at its edge. We present a qualitative description of this flow and propose a simple theoretical model for this behavior. We thus rationalize the observed dependence of the nibbling frequency on the system parameters.

  10. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a surgical opening of the trachea to facilitate ventilation to the lungs. The cuff may be a separate...

  11. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a surgical opening of the trachea to facilitate ventilation to the lungs. The cuff may be a separate...

  12. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a surgical opening of the trachea to facilitate ventilation to the lungs. The cuff may be a separate...

  13. Tear dynamics and dry eye.

    PubMed

    Tsubota, K

    1998-10-01

    Tears undergo four processes: production by the lacrimal gland, distribution by blinking, evaporation from the ocular surface and drainage through the nasolacrimal duct. Abnormalities in any of these steps can cause dry eye. There are two kinds of tear production, basic and reflex, which can be distinguished from each other by the Schirmer test with nasal stimulation. Reflex tearing is important because it supplies such essential components as EGF and vitamin A, whose deficiency may cause squamous metaplasia. There is no reflex tearing in Sjogren's syndrome because of destruction of the lacrimal gland. In cases of diminished or absent reflex tearing, topical autologous serum is the treatment of choice. Even when there is adequate tear production, insufficient distribution, such as occurs with the decreased blinking associated with the use of video display terminals (VDT), may cause dry eye. Any process or activity that suppresses blinking interferes with tear distribution. Tear evaporation increases under certain conditions and in some diseases. When the exposed ocular surface area is increased, such as in VDT work, tear evaporation increases. Meibomian gland dysfunction (MGD) also causes increased tear evaporation by altering the quality of the oily layer in tears. Tear evaporation can be suppressed by using a warm compresser or a humidifier, narrowing the palpebral fissure, or wearing protective eyeglasses. The tear clearance rate is measured by fluorescein dye dilution in the conjunctiva. When the tear clearance is low, inflammatory cytokines or preservatives accumulate in the conjunctival sac, resulting in ocular surface diseases. Frequent use of artificial tears without preservative is the key treatment. A differential diagnosis of the abnormalities of tear dynamics can give us a proper understanding of the pathogenesis of dry eye. With this knowledge, we can formulate an efficient therapeutic approach. PMID:9777650

  14. Tearing Modes in Tokamaks

    NASA Astrophysics Data System (ADS)

    White, R. B.

    2008-05-01

    This lecture gives a basic introduction to magnetic £elds, magnetic surface destruction, toroidal equilibrium and tearing modes in a tokamak, including the linear and nonlinear development of these modes and their modi£cation by current drive and bootstrap current, and sawtooth oscillations and disruptions.

  15. Tears of Wine

    ERIC Educational Resources Information Center

    Gugliotti, Marcos

    2004-01-01

    The unique occurrence of the upward motion of a thin film of wine, and its formation into drops inside the wall of a wine glass is explained. Evaporation of alcohol generates a surface tension gradient, moving the film of wine upwards on the internal sides of a wine glass, where it collects and forms into drops or tears.

  16. Rotationally actuated prosthetic helping hand

    NASA Technical Reports Server (NTRS)

    Norton, William E. (Inventor); Belcher, Jewell G., Jr. (Inventor); Carden, James R. (Inventor); West, Thomas W. (Inventor)

    1991-01-01

    A prosthetic device has been developed for below-the-elbow amputees. The device consists of a cuff, a stem, a housing, two hook-like fingers, an elastic band for holding the fingers together, and a brace. The fingers are pivotally mounted on a housing that is secured to the amputee's upper arm with the brace. The stem, which also contains a cam, is rotationally mounted within the housing and is secured to the cuff, which fits over the amputee's stump. By rotating the cammed stem between the fingers with the lower arm, the amputee can open and close the fingers.

  17. Meniscus tears in children.

    PubMed

    Bellisari, Greg; Samora, Walter; Klingele, Kevin

    2011-03-01

    Increased athletic participation by the skeletally immature athlete and a heightened suspicion by physicians have contributed to an increase in the incidence of meniscal injuries in children and adolescents. In young patient, meniscal injury could have long-term consequences, so an understanding of recognition and treatment is essential. We review the anatomy and development of the menisci, review classification and diagnosis of meniscal tears, discuss management options and outcomes of treatment, and focus on discoid lateral meniscus and meniscal cysts. PMID:21293238

  18. Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure

    PubMed Central

    Annoni, Raquel; de Almeida, Antonio Evanir

    2015-01-01

    Objective To test the agreement between two handcrafted devices and a cuff-specific manometer. Methods The agreement between two handcrafted devices adapted to measure tracheal tube cuff pressure and a cuff-specific manometer was tested on 79 subjects. The cuff pressure was measured with a commercial manometer and with two handcrafted devices (HD) assembled with aneroid sphygmomanometers (HD1 and HD2). The data were compared using Wilcoxon and Spearman tests, the intraclass correlation coefficient (ICC) and limit-of-agreement analysis. Results Cuff pressures assessed with handcrafted devices were significantly different from commercial device measurements (pressures were higher when measured with HD1 and lower with HD2). The ICCs between the commercial device and HD1 and HD2 were excellent (ICC = 0.8 p < 0.001) and good (ICC = 0.66, p < 0.001), respectively. However, the Bland- Altman plots showed wide limits of agreement between HD1 and HD2 and the commercial device. Conclusion The handcrafted manometers do not provide accurate cuff pressure measurements when compared to a cuff-specific device and should not be used to replace the commercial cuff manometers in mechanically ventilated patients. PMID:26376160

  19. Knotless Arthroscopic Repair of Subscapularis Tendon Tears Using Looped Suture.

    PubMed

    Gilmer, Brian B; Crall, Timothy S; Guttmann, Dan

    2015-06-01

    Subscapularis tendon tears present a technical challenge because both diagnosis and arthroscopic treatment can be difficult. One difficulty is the limited visualization and working space of the anterior shoulder. Although most tears of the subscapularis are partial- or full-thickness tears of the upper third of the tendon, occasionally, larger or more retracted tears are encountered. Various techniques have been developed to treat a wide variety of tear patterns. We present a simple technique using a looped suture that remains easy to use in the limited working space of the anterior shoulder; can be easily modified to accommodate a broad spectrum of subscapularis pathology, from partial to full and retracted tears; and uses familiar viewing and working portals. This technique creates a single-row, knotless repair. Traction on the superior suture improves visualization and ease of passing more inferior sutures. Risks include unintentional over-tensioning of the repair and medialization of the femoral footprint, which can be avoided with appropriate exposure and arm positioning during repair. Postoperative care includes restriction of external rotation for 3 to 6 weeks and strengthening at 3 months. PMID:26258042

  20. Knotless Arthroscopic Repair of Subscapularis Tendon Tears Using Looped Suture

    PubMed Central

    Gilmer, Brian B.; Crall, Timothy S.; Guttmann, Dan

    2015-01-01

    Subscapularis tendon tears present a technical challenge because both diagnosis and arthroscopic treatment can be difficult. One difficulty is the limited visualization and working space of the anterior shoulder. Although most tears of the subscapularis are partial- or full-thickness tears of the upper third of the tendon, occasionally, larger or more retracted tears are encountered. Various techniques have been developed to treat a wide variety of tear patterns. We present a simple technique using a looped suture that remains easy to use in the limited working space of the anterior shoulder; can be easily modified to accommodate a broad spectrum of subscapularis pathology, from partial to full and retracted tears; and uses familiar viewing and working portals. This technique creates a single-row, knotless repair. Traction on the superior suture improves visualization and ease of passing more inferior sutures. Risks include unintentional over-tensioning of the repair and medialization of the femoral footprint, which can be avoided with appropriate exposure and arm positioning during repair. Postoperative care includes restriction of external rotation for 3 to 6 weeks and strengthening at 3 months. PMID:26258042

  1. Giant retinal tears.

    PubMed

    Shunmugam, Manoharan; Ang, Ghee Soon; Lois, Noemi

    2014-01-01

    A giant retinal tear (GRT) is a full-thickness neurosensory retinal break that extends circumferentially around the retina for three or more clock hours in the presence of a posteriorly detached vitreous. Its incidence in large population-based studies has been estimated as 1.5% of rhegmatogenous retinal detachments, with a significant male preponderance, and bilaterality in 12.8%. Most GRTs are idiopathic, with trauma, hereditary vitreoretinopathies and high myopia each being causative in decreasing frequency. The vast majority of GRTs are currently managed with a pars plana vitrectomy; the use of adjunctive circumferential scleral buckling is debated, but no studies have shown a clear anatomical or visual advantage with its use. Similarly, silicone oil tamponade does not influence long-term outcomes when compared with gas. Primary and final retinal reattachment rates are achieved in 88% and 95% of patients, respectively. Even when the retina remains attached, however, visual recovery may be limited. Furthermore, fellow eyes of patients with a GRT are at higher risk of developing retinal tears and retinal detachment. Prophylactic treatment under these circumstances may be considered but there is no firm evidence of its efficacy at the present time. PMID:24138895

  2. Tear Film Lipids

    PubMed Central

    Butovich, Igor A.

    2013-01-01

    Human meibomian gland secretions (MGS, or meibum) are formed from a complex mixture of lipids of different classes such as wax esters, cholesteryl esters, (O-acyl)-ω-hydroxy fatty acids (OAHFA) and their esters, acylglycerols, diacylated diols, free fatty acids, cholesterol, and a smaller amount of other polar and nonpolar lipids, whose chemical nature and the very presence in MGS have been a matter of intense debates. The purpose of this review is to discuss recent results that were obtained using different experimental techniques, estimate limitations of their usability, and discuss their biochemical, biophysical, and physiological implications. To create a lipid map of MGS and tears, the results obtained in the author’s laboratory were integrated with available information on chemical composition of MGS and tears. The most informative approaches that are available today to researchers, such as HPLC-MS, GC-MS, and proton NMR, are discussed in details. A map of the meibomian lipidome (as it is seen in reverse phase liquid chromatography/mass spectrometry experiments) is presented. Directions of future efforts in the area are outlined. PMID:23769846

  3. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  4. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  5. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  6. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  7. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into...

  8. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  9. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an airtight...

  10. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an airtight...

  11. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an airtight...

  12. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an airtight...

  13. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an airtight...

  14. Tear-ducts in wine

    NASA Astrophysics Data System (ADS)

    Bush, John W. M.

    1999-11-01

    We examine the radial spoke pattern evident in the meniscus region in glasses of strong alcoholic beverages exhibiting the `tears-in-wine' phenomenon. We demonstrate that the pattern results from ridge-like elevations of the free surface which are supported by evaporatively-driven Marangoni convection in the meniscus region. Vortices associated with the convective motions are aligned in the radial direction by the surface tension gradient responsible for the generation of tears. The radial flow is focussed into the ridges, which thus serve as the principal conduits of fluid for the tears; consequently, we refer to the ridges as `tear-ducts'. The phenomenon is examined experimentally, and a numerical model of evaporatively-driven Marangoni convection is developed which reproduces the salient features of the tear-duct phenomenon.

  15. Tear Lipocalin: Structure and Function

    PubMed Central

    Dartt, Darlene A.

    2014-01-01

    Lipocalins are a family of diverse low molecular weight proteins that act extracellularly. They use multiple recognition properties that include: 1) ligand binding to small hydrophobic molecules, 2) macromolecular complexation with other soluble macromolecules, and 3) binding to specific cell surface receptors to deliver cargo. Tear lipocalin (TLC) is a major protein in tears and has a large ligand binding cavity that allows the lipocalin to bind an extensive and diverse set of lipophilic molecules. TLC can also bind to macromolecules including the tear proteins lactoferin and lysozyme. The receptor to which TLC binds is termed tear lipocalin interacting membrane receptor (LIMR). LIMR appears to work by endocytosis. TLC has a variety of suggested functions in tears including regulation of tear viscosity, binding and release of lipids, endonuclease inactivation of viral DNA, binding of microbial siderophores (iron chelators used to deliver essential iron to bacteria), use as a biomarker for dry eye, and possession of anti-inflammatory activity. Additional research is warranted to determine the actual functions of TLC in tears and the presence of its receptor on the ocular surface. PMID:21791187

  16. Electronic enhancement of tear secretion

    NASA Astrophysics Data System (ADS)

    Brinton, Mark; Lim Chung, Jae; Kossler, Andrea; Kook, Koung Hoon; Loudin, Jim; Franke, Manfred; Palanker, Daniel

    2016-02-01

    Objective. To study electrical stimulation of the lacrimal gland and afferent nerves for enhanced tear secretion, as a potential treatment for dry eye disease. We investigate the response pathways and electrical parameters to safely maximize tear secretion. Approach. We evaluated the tear response to electrical stimulation of the lacrimal gland and afferent nerves in isofluorane-anesthetized rabbits. In acute studies, electrical stimulation was performed using bipolar platinum foil electrodes, implanted beneath the inferior lacrimal gland, and a monopolar electrode placed near the afferent ethmoid nerve. Wireless microstimulators with bipolar electrodes were implanted beneath the lacrimal gland for chronic studies. To identify the response pathways, we applied various pharmacological inhibitors. To optimize the stimulus, we measured tear secretion rate (Schirmer test) as a function of pulse amplitude (1.5-12 mA), duration (0.1-1 ms) and repetition rate (10-100 Hz). Main results. Stimulation of the lacrimal gland increased tear secretion by engaging efferent parasympathetic nerves. Tearing increased with stimulation amplitude, pulse duration and repetition rate, up to 70 Hz. Stimulation with 3 mA, 500 μs pulses at 70 Hz provided a 4.5 mm (125%) increase in Schirmer score. Modulating duty cycle further increased tearing up to 57%, compared to continuous stimulation in chronically implanted animals (36%). Ethmoid (afferent) nerve stimulation increased tearing similar to gland stimulation (3.6 mm) via a reflex pathway. In animals with chronically implanted stimulators, a nearly 6 mm increase (57%) was achieved with 12-fold less charge density per pulse (0.06-0.3 μC mm-2 with 170-680 μs pulses) than the damage threshold (3.5 μC mm-2 with 1 ms pulses). Significance. Electrical stimulation of the lacrimal gland or afferent nerves may be used as a treatment for dry eye disease. Clinical trials should validate this approach in patients with aqueous tear deficiency, and

  17. 49 CFR 178.1070 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.1070 Section 178.1070... Containers § 178.1070 Tear test. (a) General. The tear test must be conducted for the qualification of all of Flexible Bulk Containers design types. (b) Special preparation for the tear test. Flexible Bulk...

  18. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.818 Section 178.818 Transportation... Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not less...

  19. The minimal leak test technique for endotracheal cuff maintenance.

    PubMed

    DA, Harvie; Jn, Darvall; M, Dodd; A, De La Cruz; M, Tacey; Rl, D'Costa; D, Ward

    2016-09-01

    Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under- and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20-30 cmH2O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a three-month period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH2O; 11 of 45 patients (24%) had cuff pressures <20 cmH2O; 14 of 45 patients (31%) had cuff pressures ≥30 cmH2O. Univariate analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume (P=0.008 and P <0.001 respectively), though this association was lost on multivariate analysis. No association was demonstrated between any measured variables and cuff pressures. Inter-operator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over- and under-inflation, and alternative techniques, such as cuff manometry, should be employed. PMID:27608343

  20. Control device for prosthetic urinary sphincter cuff

    NASA Technical Reports Server (NTRS)

    Reinicke, Robert H. (Inventor)

    1983-01-01

    A device for controlling flow of fluid to and from a resilient inflatable cuff implanted about the urethra to control flow of urine therethrough. The device comprises a flexible bulb reservoir and a control unit that includes a manually operated valve that opens automatically when the bulb is squeezed to force fluid into the cuff for closing the urethra. The control unit also includes a movable valve seat member having a relatively large area exposed to pressure of fluid in a chamber that is connected to the cuff and which moves to a position in which the valve member is unseated by an abutment when fluid pressure in the chamber exceeds a predetermined value to thereby relieve excess fluid pressure in the cuff. The arrangement is such that the valve element is held closed against the seat member by the full differential in fluid pressures acting on both sides of the valve element until the seat member is moved away from the valve element to thus insure positive closing of the valve element until the seat member is moved out of engagement with the valve element by excess pressure differential.

  1. Intra-articular Patterns of Bucket Handle Meniscal Tears and Its Relation to Reducibility

    PubMed Central

    Lim, Hong Chul; Bae, Ji-Hoon; Kim, Taik-Sun; Yang, Jae-Hyuk; Park, Sung-Chul

    2012-01-01

    Background The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. Methods From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. Results Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. Conclusions Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility. PMID:22662298

  2. Tear lipocalin is the major endonuclease in tears

    PubMed Central

    Yusifov, Taleh N.; Abduragimov, Adil R.; Narsinh, Kiran; Gasymov, Oktay K.

    2008-01-01

    Purpose Human endonucleases are integral to apoptosis in which unwanted or potentially harmful cells are eliminated. The rapid turnover of ocular surface epithelium and microbial colonization of the eyelids are continual sources of DNA in tears. Here, we determine the principal sources of endonuclease activity in tears. Methods Endonucleases in human tears were identified after Sephadex G100 gel filtration. DNA hydrolyzing activity was measured by the conversion pUC19 plasmid DNA to its circular form in agarose gels. Fractions with endonuclease activity were further isolated using a combination ConA-Sepharose DNA, oligo (dT) cellulose, and anion exchange chromatographies. The molecular weights of the DNA hydrolyzing proteins were estimated in zymograms and by calibration of size exclusion chromatography. DNase activities were characterized for activity at a variety of pH and ion concentrations as well as in the presence of inhibitors including NiCl2, ZnCl2, G-actin, and aurintricarboxylic acid (ATA). To determine the mode of hydrolysis, the cleaved ends of the DNA digested by tear DNases were analyzed by 3′ and 5′ end labeling using either terminal deoxynucleotidyl transferase or polynucleotide kinase with or without pretreatment with alkaline phosphatase. Results Tear lipocalin (TL) accounts for over 75% of the DNA catalytic activity in tears while a second endonuclease, ~34 kDa, is responsible for less than 24% of the activity. Both are Mg2+ dependent enzyme endonucleases that are enhanced by Ca2+, active at physiologic pH, inhibited by aurintricarboxylic acid, and catalyze hydrolysis of DNA to produce 3′-OH/5′P ends. However, the two enzymes can be distinguished by the inhibitory effect of NiCl2 and the sizes of the cleaved DNA fragments. Conclusions Two magnesium dependent extracellular endonucleases were identified in tears that are different from other major human extracellular nucleases. TL is the principal endonuclease in human tear fluid. Tear

  3. The Trapped Medial Meniscus Tear

    PubMed Central

    Herschmiller, Thomas A.; Anderson, John A.; Garrett, William E.; Taylor, Dean C.

    2015-01-01

    Background: Numerous clinical examination maneuvers have been developed to identify meniscus tears of the knee. While meniscus injuries vary significantly in type and severity, no maneuvers have been developed that help to distinguish particular tear characteristics. Purpose: This nonconsecutive case series highlights a distinctive clinical finding that correlates with inferiorly displaced flap tears of the medial meniscus that become trapped in the medial gutter of the knee, as identified through magnetic resonance imaging (MRI) and arthroscopy. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Eight patients with trapped medial meniscus tears were identified from a single surgeon’s academic orthopaedic sports medicine practice between January 2009 and January 2012. Each patient underwent clinical evaluation, MRI, and arthroscopic treatment for meniscus injury. Clinical notes, MRI images, radiology reports, and operative findings were reviewed and compared in a descriptive fashion. Results: Each patient displayed a positive clinical examination finding of medial knee pain inferior to the joint line with flexion and the application of valgus stress in the setting of a torn medial meniscus and intact medial collateral ligament (MCL). Preoperative MRI revealed a distinctive flap tear of the medial meniscus flipped inferiorly to lay trapped between the tibia and deep fibers of the MCL. On arthroscopy, flap tears were found displaced inferiorly and trapped in the medial gutter in 6 of the 8 patients. Displaced meniscal fragments in the remaining 2 patients were found within the medial compartment. Conclusion: Inferiorly displaced flap tears of the meniscus that have been displaced to the medial gutter can be localized through a careful examination technique. Clinical Relevance: Early identification of this injury pattern may help reduce the likelihood that the trapped fragment will be missed during arthroscopy. PMID:26675499

  4. Recurrent Fusobacterium pyogenic myositis of the rotator cuff A case report of recurrent Fusobacterium pyogenic myositis of the rotator cuff

    PubMed Central

    McElnay, Philip J.; McCann, Philip A.; Williams, Martin O.; Wakeley, Charles J.; Amirfeyz, Rouin

    2014-01-01

    Pyogenic myositis is uncommon. It normally affects the large muscle groups in the lower limb or trunk and the most common causative organism is Staphylococcus aureus. We present a case of an immunocompetent man who, unusually, had a recurring form of the disease in subscapularis and teres minor. The causative organism was also highly unusual (Fusobacterium). PMID:24926162

  5. Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment.

    PubMed

    Abe, Yukio; Moriya, Atsushi; Tominaga, Yasuhiro; Yoshida, Koji

    2016-03-01

    Background Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence Diagnostic/level IV. PMID:26855835

  6. Influence of Energetic Ions on Tearing Modes

    SciTech Connect

    Cai Huishan; Wang Shaojie; Xu Yinfeng; Cao Jintao; Li Ding

    2011-02-18

    In contrast with the stability effects of trapped energetic ions on tearing modes, the effects of circulating energetic ions (CEI) on tearing modes depend on the toroidal circulating direction, and are closely related to the momentum of energetic ions. CEI provide an additional source or sink of momentum to affect tearing modes. For co-CEI, tearing modes can be stabilized if the momentum of energetic ions is large enough. On the other hand, the growth of tearing modes can be enhanced by counter-CEI. Further, a possibility to suppress the island growth of neoclassical tearing modes by co-CEI is pointed out.

  7. Sphygmomanometer cuffs: a potential source of infection!

    PubMed

    Zargaran, David; Hardwick, Sarah; Adel, Reeja; Hill, George; Stubbins, Daniel; Salmasi, Abdul Majeed

    2015-02-01

    We evaluated the potential pathogenic hazard of sphygmomanometer blood pressure cuffs (BPCs) in a hospital setting. Prospectively, the presence of bacterial organisms on 120 BPCs in 14 medical wards and outpatient clinics in a district general hospital in London was assessed. Swabs taken from the inner aspect of the cuffs were cultured using standard microbiological techniques. Bacterial organisms were found in 85% (102) of the 120 BPCs assessed. The highest rates of contamination were found in the outpatients department (90%). There were differences in the most common bacterial species isolated between the samples obtained from the outpatient clinics and the wards, with coagulase-negative Staphylococcus and diphtheroids being the most prevalent species in the wards and outpatient clinics, respectively. These findings highlight the necessity to eliminate this potential risk of infection. PMID:24569512

  8. Cerebrovascular effects of the thigh cuff maneuver.

    PubMed

    Panerai, R B; Saeed, N P; Robinson, T G

    2015-04-01

    Arterial hypotension can be induced by sudden release of inflated thigh cuffs (THC), but its effects on the cerebral circulation have not been fully described. In nine healthy subjects [aged 59 (9) yr], bilateral cerebral blood flow velocity (CBFV) was recorded in the middle cerebral artery (MCA), noninvasive arterial blood pressure (BP) in the finger, and end-tidal CO2 (ETCO2) with nasal capnography. Three THC maneuvers were performed in each subject with cuff inflation 20 mmHg above systolic BP for 3 min before release. Beat-to-beat values were extracted for mean CBFV, BP, ETCO2 , critical closing pressure (CrCP), resistance-area product (RAP), and heart rate (HR). Time-varying estimates of the autoregulation index [ARI(t)] were also obtained using an autoregressive-moving average model. Coherent averages synchronized by the instant of cuff release showed significant drops in mean BP, CBFV, and RAP with rapid return of CBFV to baseline. HR, ETCO2 , and ARI(t) were transiently increased, but CrCP remained relatively constant. Mean values of ARI(t) for the 30 s following cuff release were not significantly different from the classical ARI [right MCA 5.9 (1.1) vs. 5.1 (1.6); left MCA 5.5 (1.4) vs. 4.9 (1.7)]. HR was strongly correlated with the ARI(t) peak after THC release (in 17/22 and 21/24 recordings), and ETCO2 was correlated with the subsequent drop in ARI(t) (19/22 and 20/24 recordings). These results suggest a complex cerebral autoregulatory response to the THC maneuver, dominated by myogenic mechanisms and influenced by concurrent changes in ETCO2 and possible involvement of the autonomic nervous system and baroreflex. PMID:25659488

  9. On cuff imbalance and tripolar ENG amplifier configurations.

    PubMed

    Triantis, Iasonas F; Demosthenous, Andreas; Donaldson, Nick

    2005-02-01

    Electroneurogram (ENG) recording techniques benefit from the use of tripolar cuffs because they assist in reducing interference from sources outside the cuff. However, in practice the performance of ENG amplifier configurations, such as the quasi-tripole and the true-tripole, has been widely reported to be degraded due to the departure of the tripolar cuff from ideal behavior. This paper establishes the presence of cuff imbalance and investigates its relationship to cuff asymmetry, cuff end-effects and interference source proximity. The paper also presents a comparison of the aforementioned amplifier configurations with a new alternative, termed the adaptive-tripole, developed to automatically compensate for cuff imbalance. The output signal-to-interference ratio of the three amplifier configurations were compared in vivo for two interference signals (stimulus artifact and M-wave) superimposed on compound action potentials. The experiments showed (for the first time) that the two interference signals result in different cuff imbalance values. Nevertheless, even with two distinct cuff imbalances present, the adaptive-tripole performed better than the other two systems in 61.9% of the trials. PMID:15709669

  10. Wear and Tear - Mechanical

    NASA Technical Reports Server (NTRS)

    Swanson, Theodore

    2008-01-01

    The focus of this chapter is on the long term wear and tear, or aging, of the mechanical subsystem of a spacecraft. The mechanical subsystem is herein considered to be the primary support structure (as in a skeleton or exoskeleton) upon which all other spacecraft systems rest, and the associated mechanisms. Mechanisms are devices which have some component that moves at least once, in response to some type of passive or active control system. For the structure, aging may proceed as a gradual degradation of mechanical properties and/or function, possibly leading to complete structural failure over an extended period of time. However, over the 50 years of the Space Age such failures appear to be unusual. In contrast, failures for mechanisms are much more frequent and may have a very serious effect on mission performance. Just as on Earth, all moving devices are subject to normal (and possibly accelerated) degradation from mechanical wear due to loss or breakdown of lubricant, misalignment, temperature cycling effects, improper design/selection of materials, fatigue, and a variety of other effects. In space, such environmental factors as severe temperature swings (possibly 100's of degrees C while going in and out of direct solar exposure), hard vacuum, micrometeoroids, wear from operation in a dusty or contaminated environment, and materials degradation from radiation can be much worse. In addition, there are some ground handling issues such as humidity, long term storage, and ground transport which may be of concern. This chapter addresses the elements of the mechanical subsystem subject to wear, and identifies possible causes. The potential impact of such degradation is addressed, albeit with the recognition that the impact of such wear often depends on when it occurs and on what specific components. Most structural elements of the mechanical system typically are conservatively designed (often to a safety factor of greater than approximately 1.25 on yield for

  11. Acute Medial Plantar Fascia Tear.

    PubMed

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409. PMID:27245491

  12. Tear exchange and contact lenses: A review

    PubMed Central

    Muntz, Alex; Subbaraman, Lakshman N.; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. PMID:25575892

  13. [Erythropoietin levels in human tear fluid].

    PubMed

    Zakharov, Iu M; Rykun, V S; Bagautdinov, D E; Romanenko, E A

    2010-11-01

    Erythropoietin level was evaluated in blood plasma and tear fluid of humans with normal functions of eye and normal blood characteristics. We examined 21 patients. Principle ability of erythropoietin level detection in patient's tear fluid ascertained. PMID:21427970

  14. Increased risks of endotracheal tube cuff colonization after prolonged intubation.

    PubMed

    Tsai, Wen-Hui; Hsu, Hui-Chi; Shih, Chung-Hung

    2014-06-30

    Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100% vs. 69.2%; P < 0.001) in the ETT cuff samples, but not in the extra-cuff samples (92.6% vs. 84.8%; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5% vs. 30.8%; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3% to 28.9% for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation. PMID:24826783

  15. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not less than... method. Once the IBC is placed on the ground, a 100-mm (4-inch) knife score, completely penetrating...

  16. Investigation of spherical tearing mode

    NASA Technical Reports Server (NTRS)

    Greene, John M.; Miller, R. L.

    1995-01-01

    The purpose of this research was to better understand tearing and reconnection in genuinely three-dimensional configurations. We have identified an equilibrium model that should contain the required features. Three papers have been written and a fourth is in preparation. They are listed in the bibliography.

  17. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section 868.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy...

  18. Oblique electron-cyclotron-emission radial and phase detector of rotating magnetic islands applied to alignment and modulation of electron-cyclotron-current-drive for neoclassical tearing mode stabilization

    SciTech Connect

    Volpe, F.; Austin, M. E.; Campbell, G.; Deterly, T.

    2012-10-15

    A two channel oblique electron cyclotron emission (ECE) radiometer was installed on the DIII-D tokamak and interfaced to four gyrotrons. Oblique ECE was used to toroidally and radially localize rotating magnetic islands and so assist their electron cyclotron current drive (ECCD) stabilization. In particular, after manipulations operated by the interfacing analogue circuit, the oblique ECE signals directly modulated the current drive in synch with the island rotation and in phase with the island O-point, for a more efficient stabilization. Apart from the different toroidal location, the diagnostic view is identical to the ECCD launch direction, which greatly simplified the real-time use of the signals. In fact, a simple toroidal extrapolation was sufficient to lock the modulation to the O-point phase. This was accomplished by a specially designed phase shifter of nearly flat response over the 1-7 kHz range. Moreover, correlation analysis of two channels slightly above and below the ECCD frequency allowed checking the radial alignment to the island, based on the fact that for satisfactory alignment the two signals are out of phase.

  19. Oblique electron-cyclotron-emission radial and phase detector of rotating magnetic islands applied to alignment and modulation of electron-cyclotron-current-drive for neoclassical tearing mode stabilization.

    PubMed

    Volpe, F; Austin, M E; Campbell, G; Deterly, T

    2012-10-01

    A two channel oblique electron cyclotron emission (ECE) radiometer was installed on the DIII-D tokamak and interfaced to four gyrotrons. Oblique ECE was used to toroidally and radially localize rotating magnetic islands and so assist their electron cyclotron current drive (ECCD) stabilization. In particular, after manipulations operated by the interfacing analogue circuit, the oblique ECE signals directly modulated the current drive in synch with the island rotation and in phase with the island O-point, for a more efficient stabilization. Apart from the different toroidal location, the diagnostic view is identical to the ECCD launch direction, which greatly simplified the real-time use of the signals. In fact, a simple toroidal extrapolation was sufficient to lock the modulation to the O-point phase. This was accomplished by a specially designed phase shifter of nearly flat response over the 1-7 kHz range. Moreover, correlation analysis of two channels slightly above and below the ECCD frequency allowed checking the radial alignment to the island, based on the fact that for satisfactory alignment the two signals are out of phase. PMID:23126766

  20. RESULTS FROM ARTHROSCOPIC REPAIR OF ISOLATED TEARS OF THE SUBSCAPULARIS TENDON

    PubMed Central

    Godinho, Glaydson Gomes; de Oliveira França, Flávio; Freita, José Márcio Alves; Santos, Flávio Márcio Lago; dos Santos, Ricardo Barreto Monteiro; Taglietti, Thiago Martins; Guevara, Carlos Leonidas Escobar

    2015-01-01

    Objective: To evaluate the functional and clinical outcomes and identify prognostic factors in patients undergoing arthroscopic repair of isolated tears of the subscapularis tendon. Methods: Between January 2003 and May 2009, we identified 18 shoulders with isolated tears or deinsertions that were complete or affected at least one third of the subscapularis tendon and underwent arthroscopic repair. Results: Three shoulders (17%) showed lesions in the upper third of the subscapularis; nine shoulders (50%) showed lesions in the upper two thirds; and six shoulders (33%) presented complete tears. In comparing the range of lateral rotation of the injured shoulder between before surgery and the time of the reevaluation, there was no statistical difference (p = 0.091). The LHBT was damaged in 11 shoulders (61%). According to the Constant score validation, we had excellent and good results in 83% of the cases and 17% were reasonable. The reevaluations on three patients showed re-tearing on MRI. Acromioplasty was performed on ten patients and this procedure did not represent statistical differences in the final results (p = 0.57). Conclusions: There was no statistically significant difference in relation to preoperative lateral rotation between the injured shoulder and the contralateral side. There was no significant loss of lateral rotation after surgery. The LHBT may be normal in deinsertions of the subscapularis tendon. Acromioplasty did not influence the results. The re-tearing rate for arthroscopic repair of the subscapularis tendon was 16.6%. PMID:27042642

  1. Unsafe health and safety: sphygmomanometer cuffs are not interchangeable.

    PubMed

    Shaw, K C; McEniery, C M; Wilkinson, I B; Brown, M J

    2013-07-01

    Unknown to its hypertension specialists, a major teaching hospital changed the cuffs on its sphygmomanometers from manufacturer-validated to a uniform washable alternative, in line with 'Health and Safety' concerns surrounding potential cross-contamination between patients. When clinic doctors suspected serious under-reading with the new cuffs, a systematic comparison was undertaken in 54 patients (mean±s.d. age, 61±17 years), using two UM-101 sphygmomanometers, one using the original, manufacturer-supplied cuff and the other with the washable replacement. The study confirmed an average under-reading of 8±10/5±5 mm Hg using the washable cuff, and a third of patients with poorly controlled hypertension were considered normotensive, after using this cuff. The UM-101 sphygmomanometers have now been re-fitted with the original cuffs. Sphygmomanometer cuffs are not interchangeable between devices and a modicum of common sense should be shown to prevent changes made in the name of Health and Safety from having the opposite effect to that intended. PMID:23172028

  2. Vitamin D in Tear Fluid

    PubMed Central

    Lu, Xiaowen; Elizondo, Rodolfo A.; Nielsen, Rikke; Christensen, Erik I.; Yang, Jun; Hammock, Bruce D.; Watsky, Mitchell A.

    2015-01-01

    Purpose To determine the source(s) of vitamin D in tear fluid and examine the expression of the endocytic proteins and putative vitamin D transporters megalin and cubilin in lacrimal and Harderian glands. Methods Wild-type, heterozygous, and vitamin D receptor (VDR) knockout C57BL/6 mice were used, with a subset of knockout mice fed a replenishment diet for some studies. Mouse lacrimal and Harderian glands from each group were used to measure megalin and cubilin by RT-PCR, Western blot, and immunohistochemistry. New Zealand white rabbits were used to collect lacrimal and accessory gland fluid for vitamin D mass spectroscopy measurements. Results Ten-week-old knockout mice were significantly (P < 0.05) smaller than wild-type mice. Real-time PCR and Western blot showed decreased expression of megalin and cubilin in select VDR knockout mouse groups. Immunohistochemistry showed apical duct cell megalin staining and weaker megalin staining in VDR knockout mice compared with controls. Vitamin D2 was more prevalent in rabbit lacrimal and accessory gland fluid than vitamin D3, and greater amounts of Vitamin D2 were found in in tear fluid obtained directly from lacrimal and accessory glands as compared with plasma concentrations. Conclusions This is the first study to demonstrate the presence of megalin and cubilin in lacrimal and accessory glands responsible for producing tear fluid. The results strengthen the hypothesis that megalin and cubilin are likely involved in the secretory pathway of vitamin D into tear fluid by the duct cells. PMID:26348637

  3. Tear analysis in contact lens wearers.

    PubMed Central

    Farris, R L

    1985-01-01

    Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses. PMID:3914131

  4. Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation

    SciTech Connect

    Ma, Daniel J.; Michaletz-Lorenz, Martha; Goddu, S. Murty; Grigsby, Perry W.

    2012-03-15

    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.

  5. Vaginal Cuff Dehiscence in Robotic-Assisted Total Hysterectomy

    PubMed Central

    Kashani, Shabnam; Gallo, Taryn; Sargent, Anita; ElSahwi, Karim; Silasi, Dan-Arin

    2012-01-01

    Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Methods: This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy. Results: There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk. Conclusion: In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic-assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature. PMID:23484559

  6. Tracheomegaly Secondary to Tracheotomy Tube Cuff in Amyotrophic Lateral Sclerosis

    PubMed Central

    Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

    2015-01-01

    Abstract Tracheomegaly has not been reported in amyotrophic lateral sclerosis (ALS). Herein, the authors report a case of tracheomegaly secondary to tracheotomy tube cuff in a patient with ALS. To our knowledge, this is the first report of an ALS patient with tracheomegaly and of tracheomegaly being associated with tracheotomy tube cuff and home tracheotomy mechanical ventilator. The clinician should consider the possibility of tracheomegaly in the differential diagnosis, if a patient with ALS develops repeat air leakage around the tracheotomy tube or rupture of tracheotomy tube cuff. PMID:26496301

  7. Tear and decohesion of bovine pericardial tissue.

    PubMed

    Tobaruela, Almudena; Elices, Manuel; Bourges, Jean Yves; Rojo, Francisco Javier; Atienza, José Miguel; Guinea, Gustavo

    2016-10-01

    The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications. PMID:27337412

  8. Hot tearing evaluation for aluminium alloys

    NASA Astrophysics Data System (ADS)

    Brůna, Marek

    2016-06-01

    Hot tearing during solidification of aluminium alloys castings can be a serious problem. This phenomenon is well known but still insufficiently investigated. Hot tearing occurs in form of irregular cracks in metal castings that develop during solidification and cooling. The cause of hot tearing is generally attributed to the development of thermally induced tensile stresses and strains in a casting as the molten metal contracts during solidification and solid state shrinkage. Submited paper consists of two parts. The first part introduces the reader to the phenomenon of hot tearing. The second part describes newly developed method for assessing hot tearing susceptibility of aluminium alloys, and also gives the results on hot tearing for various aluminium alloys.

  9. Meniscal Root Tears: Identification and Repair.

    PubMed

    Doherty, David B; Lowe, Walter R

    2016-01-01

    Intact menisci are capable of converting the axial load of tibiofemoral contact into hoop stress that protects the knee joint. Total meniscectomy leads to rapid degeneration of the knee. Strong clinical and biomechanical data show meniscal root tears and avulsions are the functional equivalent of total meniscectomy. Lateral root tears commonly occur with knee ligament sprains and tears. Medial root tears are generally more chronic, and can be caused by preexisting knee arthritis. Meniscal root repair is indicated when there is identification of a meniscal root tear in a knee with minimal to no arthritis. Chronic root tears in the setting of osteoarthritis are treated conservatively. Meniscal root tears can acutely occur with cruciate ligament tears, can exaggerate symptoms of instability, and will have negative ramifications on outcomes of anterior cruciate ligament reconstruction if not addressed concomitantly. In this review, we describe the importance of the menisci for knee joint longevity through anatomy and biomechanics, the diagnostic workup, and ultimately a transosseous technique for repair of meniscal root tears and avulsions. PMID:27004274

  10. Artificial tears potpourri: a literature review.

    PubMed

    Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

    2014-01-01

    Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient's clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

  11. Artificial tears potpourri: a literature review

    PubMed Central

    Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

    2014-01-01

    Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

  12. Resistive wall tearing mode generated finite net electromagnetic torque in a static plasma

    SciTech Connect

    Hao, G. Z. Wang, A. K.; Xu, M.; Qu, H. P.; Peng, X. D.; Wang, Z. H.; Xu, J. Q.; Qiu, X. M.; Liu, Y. Q.

    2014-01-15

    The MARS-F code [Y. Q. Liu et al., Phys. Plasmas 7, 3681 (2000)] is applied to numerically investigate the effect of the plasma pressure on the tearing mode stability as well as the tearing mode-induced electromagnetic torque, in the presence of a resistive wall. The tearing mode with a complex eigenvalue, resulted from the favorable averaged curvature effect [A. H. Glasser et al., Phys. Fluids 18, 875 (1975)], leads to a re-distribution of the electromagnetic torque with multiple peaking in the immediate vicinity of the resistive layer. The multiple peaking is often caused by the sound wave resonances. In the presence of a resistive wall surrounding the plasma, a rotating tearing mode can generate a finite net electromagnetic torque acting on the static plasma column. Meanwhile, an equal but opposite torque is generated in the resistive wall, thus conserving the total momentum of the whole plasma-wall system. The direction of the net torque on the plasma is always opposite to the real frequency of the mode, agreeing with the analytic result by Pustovitov [Nucl. Fusion 47, 1583 (2007)]. When the wall time is close to the oscillating time of the tearing mode, the finite net torque reaches its maximum. Without wall or with an ideal wall, no net torque on the static plasma is generated by the tearing mode. However, re-distribution of the torque density in the resistive layer still occurs.

  13. Resistive wall tearing mode generated finite net electromagnetic torque in a static plasma

    NASA Astrophysics Data System (ADS)

    Hao, G. Z.; Liu, Y. Q.; Wang, A. K.; Xu, M.; Qu, H. P.; Peng, X. D.; Wang, Z. H.; Xu, J. Q.; Qiu, X. M.

    2014-01-01

    The MARS-F code [Y. Q. Liu et al., Phys. Plasmas 7, 3681 (2000)] is applied to numerically investigate the effect of the plasma pressure on the tearing mode stability as well as the tearing mode-induced electromagnetic torque, in the presence of a resistive wall. The tearing mode with a complex eigenvalue, resulted from the favorable averaged curvature effect [A. H. Glasser et al., Phys. Fluids 18, 875 (1975)], leads to a re-distribution of the electromagnetic torque with multiple peaking in the immediate vicinity of the resistive layer. The multiple peaking is often caused by the sound wave resonances. In the presence of a resistive wall surrounding the plasma, a rotating tearing mode can generate a finite net electromagnetic torque acting on the static plasma column. Meanwhile, an equal but opposite torque is generated in the resistive wall, thus conserving the total momentum of the whole plasma-wall system. The direction of the net torque on the plasma is always opposite to the real frequency of the mode, agreeing with the analytic result by Pustovitov [Nucl. Fusion 47, 1583 (2007)]. When the wall time is close to the oscillating time of the tearing mode, the finite net torque reaches its maximum. Without wall or with an ideal wall, no net torque on the static plasma is generated by the tearing mode. However, re-distribution of the torque density in the resistive layer still occurs.

  14. Stability of coupled tearing and twisting modes in tokamaks

    SciTech Connect

    Fitzpatrick, R.

    1994-03-01

    A dispersion relation is derived for resistive modes of arbitrary parity in a tokamak plasma. At low mode amplitude, tearing and twisting modes which have nonideal MHD behavior at only one rational surface at a time in the plasma are decoupled via sheared rotation and diamagnetic flows. At higher amplitude, more unstable {open_quote}compound{close_quote} modes develop which have nonideal behavior simultaneously at many surfaces. Such modes possess tearing parity layers at some of the nonideal surfaces, and twisting parity layers at others, but mixed parity layers are generally disallowed. At low mode number, {open_quote}compound{close_quote} modes are likely to have tearing parity layers at all of the nonideal surfaces in a very low-{beta} plasma, but twisting parity layers become more probable as the plasma {beta} is increased. At high mode number, unstable twisting modes which exceed a critical amplitude drive conventional magnetic island chains on alternate rational surfaces, to form an interlocking structure in which the O-points and X-points of neighboring chains line up.

  15. [Tear lactoferrin in keratoconjunctivitis sicca].

    PubMed

    Hu, F R; Wang, T H; Lin, L L; Ko, L S

    1989-04-01

    Keratoconjunctivitis sicca is a commonly encountered disease with decreased lacrimal gland activity. There are several tests to determine the lacrimal gland function, but all have limitations in accuracy, sensitivity or technical difficulty. At present, there is no reliable objective test to render a firm diagnosis of dry eye. Lactoferrin is one of the major proteins secreted by the lacrimal gland. Its concentration was found to correlate well to lacrimal gland activity. In this study we tried to evaluate the diagnostic value of lactoferrin measurement in comparison with other tests for keratoconjunctivitis sicca. Tests including the measurement of tear lactoferrin, Schirmer's-1 test, Schirmer's basal test, tear film break-up time, and rose bengal stain of the cornea were done on 60 healthy eyes and 56 eyes with keratoconjunctivitis sicca. The lactoferrin level was measured by a commercially available "Lactoplate" (Eagle Vision, U.S.A.). It is a plate containing gel loaded with rabbit anti-human-lactoferrin antiserum. Tear-moistened filter paper discs containing lactoferrin were placed on the gel. The lactoferrin concentration could be determined by measuring the concentric ring of precipitate after 72 hours incubation at room temperature. The average concentration of lactoferrin was 1.9 +/- 0.51 mg/ml in the normal group and 1.4 +/- 0.93 mg/ml in the keratoconjunctivitis sicca group. They were significantly different from each other (t-test: p less than 0.05). The results of the other 4 tests also showed a significant difference between the normal and keratoconjunctivitis sicca group, but the lactoferrin measurement had the highest specificity among these 5 tests. Because of the technical simplicity of measurement and its high specificity, lactoferrin measurement could be a valuable tool for the early and accurate diagnosis of keratoconjunctivitis sicca. PMID:2794946

  16. Congenital Aberrant Tearing: A Re-Look

    PubMed Central

    Miller, Marilyn T.; Strömland, Kerstin; Ventura, Liana

    2008-01-01

    Purpose Congenital aberrant tearing is characterized by tearing when eating (“crocodile tears”), lack of emotional tearing, or both. Most reported cases are associated with Duane syndrome. In our previous studies we observed aberrant tearing in individuals with thalidomide embryopathy and Möbius sequence. This report summarizes the literature on the subject and adds 3 new studies that give information on this unusual condition. Methods Twenty-eight individuals with Möbius sequence were interviewed about tearing symptoms at a support group meeting in Italy. In Sweden 30 adults primarily from the original thalidomide series were reexamined. In this latter study, a Schirmer test was done at baseline and repeated 5 minutes after eating. Twenty families in Brazil who have children with Möbius sequence were questioned about tearing symptoms and exposure to misoprostol during pregnancy. Results In the 28 Italian individuals, either “crocodile tears” or lack of emotional tearing was noted in 7 cases. In the thalidomide study, 10 of 30 patients had tearing when eating and 7 had no emotional tearing. Low Schirmer scores or increased tearing after eating was noted in a few asymptomatic individuals. Among the 20 Brazilian children with Möbius sequence, 10 had some tearing abnormality. Conclusion Congenital anomalous lacrimation is rare but usually associated with Duane syndrome or abduction deficits, as in Möbius sequence and, less frequently, facial nerve palsy. Studies implicate an early insult in development at 4 to 6 weeks. At that time the facial nerve, sixth nerve, and lacrimal nucleus are in close proximity in the embryo. PMID:19277226

  17. Subscapularis Tendon Repair Using Suture Bridge Technique

    PubMed Central

    Park, Yong Bok; Park, Young Eun; Koh, Kyoung Hwan; Lim, Tae Kang; Shon, Min Soo; Yoo, Jae Chul

    2015-01-01

    The subscapularis tendon plays an essential role in shoulder function. Although subscapularis tendon tears are less common than other rotator cuff tears, tears of the subscapularis tendon have increasingly been recognized with the advent of magnetic resonance imaging and arthroscopy. A suture bridge technique for the treatment of posterosuperior rotator cuff tears has provided the opportunity to improve the pressurized contact area and mean footprint pressure. However, suture bridge fixation of subscapularis tendon tears appears to be technically challenging. We describe an arthroscopic surgical technique for suture bridge repair of subscapularis tendon tears that obtains ideal cuff integrity and footprint restoration. Surgery using such a suture bridge technique is indicated for large tears, such as tears involving the entire first facet or more, tears with a disrupted lateral sling, and combined medium to large supraspinatus/infraspinatus tears. PMID:26052489

  18. IETI - Isogeometric Tearing and Interconnecting.

    PubMed

    Kleiss, Stefan K; Pechstein, Clemens; Jüttler, Bert; Tomar, Satyendra

    2012-11-01

    Finite Element Tearing and Interconnecting (FETI) methods are a powerful approach to designing solvers for large-scale problems in computational mechanics. The numerical simulation problem is subdivided into a number of independent sub-problems, which are then coupled in appropriate ways. NURBS- (Non-Uniform Rational B-spline) based isogeometric analysis (IGA) applied to complex geometries requires to represent the computational domain as a collection of several NURBS geometries. Since there is a natural decomposition of the computational domain into several subdomains, NURBS-based IGA is particularly well suited for using FETI methods. This paper proposes the new IsogEometric Tearing and Interconnecting (IETI) method, which combines the advanced solver design of FETI with the exact geometry representation of IGA. We describe the IETI framework for two classes of simple model problems (Poisson and linearized elasticity) and discuss the coupling of the subdomains along interfaces (both for matching interfaces and for interfaces with T-joints, i.e. hanging nodes). Special attention is paid to the construction of a suitable preconditioner for the iterative linear solver used for the interface problem. We report several computational experiments to demonstrate the performance of the proposed IETI method. PMID:24511167

  19. Suturing a tear of the anterior capsulorhexis

    PubMed Central

    Kleinmann, G; Chew, J; Apple, D J; Assia, E I; Mamalis, N

    2006-01-01

    Aim To describe a new technique of suturing a tear in the anterior capsulorhexis. Methods Continuous curvilinear capsulorhexis (CCC) with lens removal was done in five fresh cadaver eyes. The diameter of the CCC was measured with a calliper. Using the same calliper a tear of the CCC was created while opening the calliper's arms. The distance between the calliper's arms needed to tear the CCC was documented. Using 9‐0 Ethilon 9011, CS 160‐6 sutures in two eyes, 9‐0 Prolene, D‐8229, CTC‐6L sutures in two eyes, and 10‐0 Prolene, 9090, CTC‐6 suture in one eye, the tears were sutured. A tear in the CCC was created again in the same way as the first tear. The distance between the calliper's arms needed to tear the CCC was documented again. Results Suturing of the tear restored some of the strength/elasticity of the CCC. Better results were found while using the 9‐0 Prolene, D‐8229, CTC‐6L sutures than with the two others sutures. Conclusions Suturing of a broken CCC can restore at least some of the strength/elasticity of the CCC. This can be important before intraocular lens (IOL) implantation for the safety of the implantation or after the implantation to ensure proper fixation of the IOL. PMID:16547318

  20. Interferometric characterization of tear film dynamics

    NASA Astrophysics Data System (ADS)

    Primeau, Brian Christopher

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

  1. The Effects of Hemodialysis on Tear Osmolarity.

    PubMed

    Taskapili, Muhittin; Serefoglu Cabuk, Kubra; Aydin, Rukiye; Atalay, Kursat; Kirgiz, Ahmet; Sit, Dede; Kayabasi, Hasan

    2015-01-01

    Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 ± 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 ± 17.77 versus 301.88 ± 15.22 mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = -0.366,  p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305  p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = -0.426,  p = 0.004; r = -0.365,  p = 0.016; and r = -0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration. PMID:26640702

  2. Control of neoclassical tearing modes

    NASA Astrophysics Data System (ADS)

    Maraschek, M.

    2012-07-01

    Neoclassically driven tearing modes (NTMs) are a major problem for tokamaks operating in a conventional ELMy H-mode scenario. Depending on the mode numbers these pressure-driven perturbations cause a mild reduction in the maximum achievable βN = βt/(Ip/aBt) before the onset of the NTM, or can even lead to disruptions at a low edge safety factor, q95. A control of these types of modes in high βN plasmas is therefore of vital interest for magnetically confined fusion plasmas. The control consists of two major approaches, namely the control of the excitation of these modes and the removal, or at least mitigation, of these modes, once an excitation could not be avoided. For both routes examples will be given and the applicability of these approaches to ITER will be discussed.

  3. Linear and nonlinear effect of sheared plasma flow on resistive tearing modes

    SciTech Connect

    Hu, Qiming Hu, Xiwei; Yu, Q.

    2014-12-15

    The effect of sheared plasma flow on the m/n = 2/1 tearing mode is studied numerically (m and n are the poloidal and toroidal mode numbers). It is found that in the linear phase the plasma flow with a weak or moderate shear plays a stabilizing effect on tearing mode. However, the mode is driven to be more unstable by sufficiently strong sheared flow when approaching the shear Alfvén resonance (AR). In the nonlinear phase, a moderate (strong) sheared flow leads to a smaller (larger) saturated island width. The stabilization of tearing modes by moderate shear plasma flow is enhanced for a larger plasma viscosity and a lower Alfvén velocity. It is also found that in the nonlinear phase AR accelerates the plasma rotation around the 2/1 rational surface but decelerates it at the AR location, and the radial location satisfying AR spreads inwards towards the magnetic axis.

  4. Nonlinear tearing mode interactions and mode locking in reversed field pinches

    SciTech Connect

    Hegna, C.C.

    1996-06-01

    The nonlinear interaction of a set of tearing instabilities and plasma flow is studied in a cylindrical plasma. An analytic theory of mode locking is developed which includes the effects of the localized electromagnetic torques, plasma inertia and cross-field viscosity. The calculation is specialized for the case of mode locking on the Madison Symmetric Torus (MST) reversed field pinch. In MST plasmas, a set of m = 1 tearing instabilities become phase locked and form a toroidally localized, rotating magnetic disturbance. An evolution equation for the phase velocity of this magnetic disturbance is derived which accounts for two types of electromagnetic torques. The external torques describe the interaction of the tearing modes with static magnetic perturbations located outside the plasma region. The interior torques describe the nonlinear interaction of three tearing modes which satisfy a wave number resonance condition. For conditions typical of MST, the internal torques dominate the external torques, which suggest the nonlinear interaction of tearing instabilities play a prominent role in the momentum degradation and mode locking.

  5. Effects of Wing-Cuff on NACA 23015 Aerodynamic Performances

    NASA Astrophysics Data System (ADS)

    Meftah, S. M. A.; Belhenniche, M.; Madani Fouatih, O.; Imine, B.

    2014-03-01

    The main subject of this work is the numerical study control of flow separation on a NACA 23015 airfoil by using wing cuff. This last is a leading edge modification done to the wing. The modification consists of a slight extension of the chord on the outboard section of the wings. Different numerical cases are considered for the baseline and modified airfoil NACA 23015 according at different angle of incidence. The turbulence is modeled by two equations k-epsilon model. The results of this numerical investigation showed several benefits of the wing cuff compared with a conventional airfoil and an agreement is observed between the experimental data and the present study. The most intriguing result of this research is the capability for wing cuff to perform short take-offs and landings.

  6. On the tear resistance of skin

    DOE PAGESBeta

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; Schaible, Eric; Stewart, Polite; Ritchie, Robert O.; Meyers, Marc A.

    2015-03-27

    Tear resistance is vitally important for the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. Here we explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. Finally, we express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensilemore » direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip.« less

  7. On the tear resistance of skin.

    PubMed

    Yang, Wen; Sherman, Vincent R; Gludovatz, Bernd; Schaible, Eric; Stewart, Polite; Ritchie, Robert O; Meyers, Marc A

    2015-01-01

    Tear resistance is of vital importance in the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. We explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. We express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensile direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip. PMID:25812485

  8. On the tear resistance of skin

    SciTech Connect

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; Schaible, Eric; Stewart, Polite; Ritchie, Robert O.; Meyers, Marc A.

    2015-03-27

    Tear resistance is vitally important for the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. Here we explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. Finally, we express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensile direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip.

  9. On the tear resistance of skin

    NASA Astrophysics Data System (ADS)

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; Schaible, Eric; Stewart, Polite; Ritchie, Robert O.; Meyers, Marc A.

    2015-03-01

    Tear resistance is of vital importance in the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. We explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. We express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensile direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip.

  10. On the tear resistance of skin

    PubMed Central

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; Schaible, Eric; Stewart, Polite; Ritchie, Robert O.; Meyers, Marc A.

    2015-01-01

    Tear resistance is of vital importance in the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. We explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. We express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensile direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip. PMID:25812485

  11. Vertical Tears of the Lateral Meniscus

    PubMed Central

    Goyal, Kanu S.; Pan, Tiffany J.; Tran, Diane; Dumpe, Samuel C.; Zhang, Xudong; Harner, Christopher D.

    2014-01-01

    Background: Lateral meniscal tears are often seen with acute anterior cruciate ligament (ACL) injury and may be left in situ, repaired, or treated with meniscectomy. Clinical studies have shown good outcomes with vertical tears left in situ and poor outcomes following meniscectomy. However, clinically relevant studies are needed to establish a biomechanical foundation for treatment of these tears, particularly regarding the effects of meniscectomy. Purpose: To compare tibiofemoral joint mechanics following vertical lateral meniscal tears and meniscectomies. We hypothesized that a peripheral vertical tear of the lateral meniscus would alter joint mechanics, increasing contact pressure and area, and that more drastic effects would be seen following meniscectomy, at higher knee flexion angles, and with increased loads. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees (average age, 55 ± 12 years) were tested with 5 lateral meniscus states: intact, short vertical tear, extended vertical tear, posterior horn partial meniscectomy (rim intact), and posterior horn subtotal meniscectomy (rim excised). The specimens were loaded axially at knee flexion angles of 0°, 30°, and 60°, and musculotendinous forces were applied, simulating a 2-legged squat. Intra-articular contact pressures were measured using pressure-sensitive Fuji film. Kinematic data were acquired through digitization of fiducial markers. Results: Vertical tears did not cause a significant change in contact pressure or area. Partial meniscectomy increased maximum contact pressures in the lateral compartment at 30° and 60° from 5.3 MPa to 7.2 MPa and 7.6 MPa, respectively (P = .02, P = .007). Subtotal meniscectomy (8.4 MPa) significantly increased contact pressure compared with partial meniscectomy (7.6 MPa) at 60° (P = .04). Both meniscectomy states significantly increased contact pressures with increasing flexion from 0° to 60° (P < .001, P < .001). Conclusion

  12. Neoclassical tearing modes in a tokamak

    SciTech Connect

    Hahm, T.S.

    1988-08-01

    Linear tearing instability is studied in the banana collisionality regime in tokamak geometry. Neoclassical effects produce significant modifications of Ohm's law and the vorticity equation so that the growth rate of tearing modes driven by ..delta..' is dramatically reduced compared to the usual resistive MHD value. Consequences of this result, regarding the presence of pressure-gradient-driven neoclassical resistive interchange instabilities and the evolution of magnetic islands in the Rutherford regime, are discussed. 10 refs.

  13. Neoclassical tearing modes in a tokamak

    SciTech Connect

    Hahm, T.S.

    1988-12-01

    Linear tearing instability is studied in the banana collisionality regime in tokamak geometry. Neoclassical effects produce significant modifications of Ohm's law and the vorticity equation, so that the growth rate of tearing modes driven by ..delta..' is dramatically reduced compared to the usual resistive magnetohydrodynamic values. Consequences of this result, regarding the presence of pressure-gradient-driven neoclassical resistive interchange instabilities and the evolution of magnetic islands in the Rutherford regime, are discussed.

  14. Correlation between type of discoid lateral menisci and tear pattern.

    PubMed

    Bin, Seong-Il; Kim, Ji-Chul; Kim, Jong-Min; Park, Soo-Sung; Han, Young-Kil

    2002-07-01

    This study analyzed the relationship between type of discoid lateral menisci and tear pattern. There were 108 consecutive cases (103 patients) with discoid lateral meniscus tear treated by arthroscopy. Regarding type of discoid meniscus (Watanabe's classification), 38 cases were "complete" and 70 cases "incomplete." There was no Wrisberg type. Tear patterns were classified into simple horizontal, complicated horizontal, longitudinal, radial, degenerative, and complex tear. The relationship between tear pattern and type of discoid menisci was statistically highly significant. Simple horizontal tear was found only in the complete type of case, and radial, degenerative, and complex tears were found only in the incomplete type of case. In the longitudinal tear, however, we found no correlation between tear pattern and type of discoid meniscus. In addition, the extent of meniscal resection was dependent on the tear pattern. Subtotal or total meniscectomy was performed significantly more frequently in longitudinal and complex tears. In radial and degenerative tears only partial meniscectomy was carried out. Complicated horizontal tears showed no difference in extent of resection. Among the 13 cases of simple horizontal tears partial meniscectomy was performed in 12 cases. These findings about relationship between the type of discoid menisci and tear pattern could be useful in planning operation and deciding extent of resection. PMID:12172714

  15. Tear film measurement by optical reflectometry technique.

    PubMed

    Lu, Hui; Wang, Michael R; Wang, Jianhua; Shen, Meixiao

    2014-02-01

    Evaluation of tear film is performed by an optical reflectometer system with alignment guided by a galvanometer scanner. The reflectometer system utilizes optical fibers to deliver illumination light to the tear film and collect the film reflectance as a function of wavelength. Film thickness is determined by best fitting the reflectance-wavelength curve. The spectral reflectance acquisition time is 15 ms, fast enough for detecting film thickness changes. Fast beam alignment of 1 s is achieved by the galvanometer scanner. The reflectometer was first used to evaluate artificial tear film on a model eye with and without a contact lens. The film thickness and thinning rate have been successfully quantified with the minimum measured thickness of about 0.3 μm. Tear films in human eyes, with and without a contact lens, have also been evaluated. A high-contrast spectral reflectance signal from the precontact lens tear film is clearly observed, and the thinning dynamics have been easily recorded from 3.69 to 1.31 μm with lipid layer thickness variation in the range of 41 to 67 nm. The accuracy of the measurement is better than ±0.58% of the film thickness at an estimated tear film refractive index error of ±0.001. The fiber-based reflectometer system is compact and easy to handle. PMID:24500519

  16. Islands in the stream: The effect of plasma flow on tearing stability

    SciTech Connect

    La Haye, R. J.; Buttery, R. J.; Brennan, D. P.; Gerhardt, S. P.

    2010-05-15

    Reducing plasma flow clearly decreases the stability of tearing modes in multiple regimes (sawtooth, hybrid) in both high- and low-aspect-ratio tokamaks (DIII-D [J. L. Luxon, Nucl. Fusion 42, 614 (2002)], Joint European Torus [M. Keilhacker and the JET Team, Plasma Phys. Controlled Fusion 41, 301 (1999)], National Spherical Torus Experiment [M. Ono, S. M. Kaye, Y.-K. M. Peng, Nucl. Fusion 40, 557 (2000)], each with distinct means of lessening rotation). Further, reducing flow makes pre-existing 'saturated' islands larger at the same beta (beta). Thus lower plasma flow impairs high-beta operation owing both to the destabilization and to the impact of tearing-mode islands. Experimental results suggest that flow shear (not flow) at the tearing rational surface is classically stabilizing, making the effective tearing stability index DELTA{sup '} of the total current density profile more negative (more stable). In this picture, with profiles and all else the same, the minimum metastable beta at which neoclassical tearing modes (NTMs) can destabilize is proportional to -DELTA{sup '} and hence lower flow and flow shear lead to possible destabilization (depending on seeding) at lower beta. Similarly, if destabilized, the saturated NTM island width is proportional to -beta/DELTA{sup '} and thus increases as flow and flow shear are reduced. A working model gives a significant level of stabilizing shear if the plasma toroidal angular flow shear -dOMEGA{sub p}hi/dr at a given rational surface is of order of the inverse of the product of the local values of the parallel magnetic shear length L{sub s} and the Alfven time tau{sub A}. Experimental data are fitted for the effect of this normalization of flow shear in a simple empirical model for both onset and saturation of tearing modes. Most theoretical literature is on the consequence of flow shear on tearing stability at zero beta; tokamaks at high beta have large magnetic Prandtl number (an issue for the sign of the flow

  17. Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

    PubMed

    Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara

    2013-01-01

    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

  18. Real-time control of tearing modes using a line-of-sight electron cyclotron emission diagnostic

    NASA Astrophysics Data System (ADS)

    Hennen, B. A.; Westerhof, E.; Nuij, P. W. J. M.; Oosterbeek, J. W.; de Baar, M. R.; Bongers, W. A.; Bürger, A.; Thoen, D. J.; Steinbuch, M.; TEXTOR Team

    2010-10-01

    The stability and performance of tokamak plasmas are limited by instabilities such as neoclassical tearing modes. This paper reports on an experimental proof of principle of a feedback control approach for real-time, autonomous suppression and stabilization of tearing modes in a tokamak. The system combines an electron cyclotron emission diagnostic for sensing of the tearing modes in the same sight line with a steerable electron cyclotron resonance heating and current drive (ECRH/ECCD) antenna. A methodology for fast detection of q = m/n = 2/1 tearing modes and retrieval of their location, rotation frequency and phase is presented. Set-points to establish alignment of the ECRH/ECCD deposition location with the centre of the tearing mode are generated in real time and forwarded in closed loop to the steerable launcher and as a modulation pulse train to the gyrotron. Experimental results demonstrate the capability of the control system to track externally perturbed tearing modes in real time.

  19. Dose-Response Evaluation of Braslet-M Occlusion Cuffs

    NASA Technical Reports Server (NTRS)

    Ebert, Douglas; Garcia, Kathleen; Sargsyan, Ashot E.; Ham, David; Hamilton, Douglas; Dulchavsky, Scott A.

    2010-01-01

    Introduction: Braslet-M is a set of special elasticized thigh cuffs used by the Russian space agency to reduce the effects of the head-ward fluid shift during early adaptation to microgravity by sequestering fluid in the lower extremities. Currently, no imaging modalities are used in the calibration of the device, and the pressure required to produce a predictable physiological response is unknown. This investigation intends to relate the pressure exerted by the cuffs to the extent of fluid redistribution and commensurate physiological effects. Materials and Methods: Ten healthy subjects with standardized fluid intake participated in the study. Data collection included femoral and internal jugular vein imaging in two orthogonal planes, pulsed Doppler of cervical and femoral vessels and middle cerebral artery, optic nerve imaging, and echocardiography. Braslet-M cuff pressure was monitored at the skin interface using pre-calibrated pressure sensors. Using 6 and 30 head-down tilt in two separate sessions, the effect of Braslet-M was assessed while incrementally tightening the cuffs. Cuffs were then simultaneously released to document the resulting hemodynamic change. Results: Preliminary analysis shows correlation between physical pressure exerted by the Braslet-M device and several parameters such as jugular and femoral vein cross-sections, resistivity of the lower extremity vascular bed, and others. A number of parameters reflect blood redistribution and will be used to determine the therapeutic range of the device and to prevent unsafe application. Conclusion: Braslet-M exerts a physical effect that can be measured and correlated with many changes in central and peripheral hemodynamics. Analysis of the full data set will be required to make definitive recommendations regarding the range of safe therapeutic application. Objective data and subjective responses suggest that a safer and equally effective use of Braslet can be achieved when compared with the current

  20. Energetic Ion Interactions with Tearing Mode Stability

    NASA Astrophysics Data System (ADS)

    Halfmoon, Michael; Brennan, Dylan

    2015-11-01

    This study focuses on the interactions between energetic ions and pressure-driven, slow growing tearing modes in high beta tokamaks. Previous studies have shown that energetic ions interact with and affect the tearing mode stability, in a mechanism similar to those of ideal MHD instabilities and resistive wall modes. The 2/1 tearing mode is found to be damped or stabilized in the presence of energetic ions, with the most significant effects on the slow-growing resistive mode. To gain an understanding of the underlying physics of these effects, we have investigated a combination of reduced analytics and numerical simulations. In the reduced model, a high aspect ratio, step function equilibrium is investigated, where the dynamics of high-energy ions interacting with the tearing mode is implemented through integration over the pressure step. In the simulations, a series of experimentally relevant D-shaped equilibria with fixed monotonic safety factor and varying peaked pressure profiles is analyzed using the δf hybrid kinetic-mhd code in NIMROD. Results show a damping effect from the ions that is consistent between the reduced model and the simulations. The stabilizing effect is mainly due to trapped particle resonance, causing the tearing mode to have a finite frequency. US DOE Grant DE- SC0004125.

  1. Tear calcium levels and contact lens wear.

    PubMed Central

    Winder, A F; Ruben, M; Sheraidah, G A

    1977-01-01

    Hydrophilic contact lens spoliation can be associated with the deposition of calcium salts. The relationship between the concentration of calcium in tear fluid and contact lens use has been studied in healthy volunteers and in patients using various forms of hard and soft contact lenses, tear samples being collected with Schirmer strips and with lenses in situ. Methods are suggested for correcting data on calcium per strip to concentration when this cannot be directly determined. Further data were obtained by direct extraction of freshly removed soft contact lenses. The collected results indicate some variation in tear calcium concentrations, but values are unrelated to use of contact lens and type of lens fitted, and to the rates of tear flow with our procedures for collection. Local calcium concentrations are unlikely therefore to be a significant primary factor in soft contact lens spoliation, but the enlargement of the tear pool associated with the use of a soft contact lens does greatly increase the amount of calcium present, and this may be a factor in secondary deposition. PMID:911735

  2. Tear calcium levels and contact lens wear.

    PubMed

    Winder, A F; Ruben, M; Sheraidah, G A

    1977-08-01

    Hydrophilic contact lens spoliation can be associated with the deposition of calcium salts. The relationship between the concentration of calcium in tear fluid and contact lens use has been studied in healthy volunteers and in patients using various forms of hard and soft contact lenses, tear samples being collected with Schirmer strips and with lenses in situ. Methods are suggested for correcting data on calcium per strip to concentration when this cannot be directly determined. Further data were obtained by direct extraction of freshly removed soft contact lenses. The collected results indicate some variation in tear calcium concentrations, but values are unrelated to use of contact lens and type of lens fitted, and to the rates of tear flow with our procedures for collection. Local calcium concentrations are unlikely therefore to be a significant primary factor in soft contact lens spoliation, but the enlargement of the tear pool associated with the use of a soft contact lens does greatly increase the amount of calcium present, and this may be a factor in secondary deposition. PMID:911735

  3. Role of lactoferrin in the tear film.

    PubMed

    Flanagan, J L; Willcox, M D P

    2009-01-01

    The surface of the eye provides an inert barrier against infection. Through its unique combination of antimicrobial action and anti-inflammatory activities lactoferrin (Lf) in the tear film plays an important role in the maintenance of ocular health. In order to maintain clarity the eye must provide immunological defense without immunopathology. Along with physical barriers, soluble plasma factors and other proteins such as lysozyme, Lf produced by the acinar cells of the lacrimal gland serves a number of roles in defense for this purpose. Lf in tears provides antimicrobial efficacy by binding free iron thus reducing the availability of iron necessary for microbial growth and survival as well as pathogenesis. Lf has been shown to inhibit biofilm formation and thus may play a role in protecting contact lens surfaces from colonization. Virus particles' entry into epithelial cells is inhibited by Lf while an excess of Lf in tear film is thought to limit the opportunistic Lf-mediated bridging of adenovirus and host cell that occurs in other tissues. Lf dampens the classical complement activation pathway by binding to markers of inflammation and immune activation while pathogen-associated molecular patterns such as lipopolysaccharide (LPS) are targeted by Lf for removal through tears and hydrodynamic flushing. This review focuses on the role of Lf in human tear film and its contribution to ocular health during contact lens wear. PMID:18718499

  4. Patellotibial contusions in anterior cruciate ligament tears.

    PubMed

    Wissman, Robert D; England, Eric; Mehta, Kaushal; Nepute, Joshua; Von Fischer, Nathaniel; Apgar, Josh; Javadi, Ariyan

    2014-02-01

    Bone contusions are an important ancillary finding of many knee injuries. Not only are they a source of pain, they may suggest a mechanism of injury or a specific derangement of the knee joint. We have encountered a small number of patients being evaluated for anterior cruciate ligament (ACL) tears with unexplained patellar and tibial edema at magnetic resonance (MR) imaging. We present three individuals with contusions of the inferior patella with a corresponding contusion of the anteromedial tibial plateau. Internal derangements in these patients were similar to other individuals with acute ACL tears, however osseous contusions were more widespread. In conclusion, patellotibial contusions are rare and may indicate an injury with forces greater than usually encountered in most ACL tears. A careful search for uncommon associated injuries is prudent in these high-energy knee injuries. PMID:24037484

  5. Nonlinear evolution of magnetopause tearing modes

    NASA Technical Reports Server (NTRS)

    Coroniti, F. V.; Quest, K. B.

    1984-01-01

    Since the magnetosheath plasma is highly turbulent, reconnection at the dayside magnetopause is likely to be temporally unsteady. The tearing mode can be viewed as a model for the unsteady development of a reconnecting magnetic topology. Magnetopause tearing occurs in the guide-field limit and has a wave packet spatial structure in the east-west direction. This paper solves for the nonlinear evolution of a single wavelength guide-field tearing mode including the effects of finite transit time on the Landau resonant electrons. Short wavelength modes evolve algebraically in time with perturbation amplitudes proportional to t-squared. Long wavelength modes are fully nonlinear, and the amplitude grows linearly in time.

  6. Utilizing resonant magnetic perturbations to enhance neoclassical tearing mode stabilization by rf current

    NASA Astrophysics Data System (ADS)

    Wang, Xiaoguang; Zhang, Xiaodong; Yu, Qingquan; Wu, Bin; Zhu, Sizheng; Wang, Jinfang; Zhang, Yang; Wang, Xiaojing

    2015-09-01

    A new method to stabilize the rotating neoclassical tearing mode (NTM) by using both the rf current drive and the static resonant magnetic perturbation (RMP) is investigated. When a non-uniform mode rotation is induced by the RMP, the stabilization of NTM by the rf current is found to be enhanced if the RMP phase has a half period difference from that of the rf wave deposition along the helical angle. The required rf current for mode stabilization is reduced by about one third if an appropriate RMP amplitude is applied.

  7. Analysis of tear glucose concentration with electrospray ionization mass spectrometry.

    PubMed

    Taormina, Christopher R; Baca, Justin T; Asher, Sanford A; Grabowski, Joseph J; Finegold, David N

    2007-02-01

    We have developed a mass spectrometry-based method that allows one to accurately determine the glucose concentration of tear fluid. We used a 1 microL micro-capillary to collect tear fluid from the tear meniscus with minimal irritation of the eye. We analyzed the 1 muL volume of collected tear fluid with liquid-chromatography electrospray ionization mass spectrometry with the use of D-glucose-6,6-d2 as an internal standard. Repeated measurements and a recovery experiment on pooled, onion-induced tears showed that the analysis of the glucose in tears was precise (4% relative standard deviation) and provided 100% recovery. We found the tear glucose concentration of one fasting nondiabetic subject to be 13 to 51 microM while the onion-induced tear glucose concentration of a different nondiabetic subject to be 211 to 256 microM. PMID:17084090

  8. Analysis of Tear Glucose Concentration with Electrospray Ionization Mass Spectrometry

    PubMed Central

    Taormina, Christopher R.; Baca, Justin T.; Finegold, David N.; Asher, Sanford A.; Grabowski, Joseph J.

    2007-01-01

    We have developed a mass spectrometry-based method which allows one to accurately determine the glucose concentration of tear fluid. We used a 1 μL micro-capillary to collect tear fluid from the tear meniscus with minimal irritation of the eye. We analyzed the 1 μL volume of collected tear fluid with liquid-chromatography electrospray ionization mass spectrometry with the use of D-glucose-6,6-d2 as an internal standard. Repeated measurements and a recovery experiment on pooled, onion-induced tears showed that the analysis of the glucose in tears was precise (4% relative standard deviation) and provided 100% recovery. We found the tear glucose concentration of one fasting non-diabetic subject to be 13 to 51 μM while the onion-induced tear glucose concentration of a different non-diabetic subject to be 211 to 256 μM. PMID:17084090

  9. Langmuir films study on lipid-containing artificial tears.

    PubMed

    Torrent-Burgués, J

    2016-04-01

    Lipid-containing artificial tears are a type of artificial tears that use lipid components in order to restore the lipid layer of the tear film. One of these components is lecithin which can be applied in spray solutions containing lecithin liposomes. In this work the behavior of three of these commercial tears based on lecithin, Innoxa, Opticalm and Optrex, are studied using the Langmuir technique. The obtained isotherms are presented, discussed and compared. This technique seems useful in order to see the film behavior of the lipid components of these tears and determine some important parameters such as fluidity and extension at the air-water interface, and allows us to discern differences between these commercial tears. Innoxa and Optrex tears are more similar to each other than to Opticalm tears. Opticalm presents more fluidity, probably due to the presence of more insaturations in the fatty acid chains of the phospholipids of the lecithin used in fabrication. PMID:26764100

  10. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

    PubMed

    Mahmoodpoor, Ata; Peyrovi-far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad Eslam Jamal

    2013-01-01

    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

  11. Magnetotail dynamics excited by the streaming tearing mode

    NASA Technical Reports Server (NTRS)

    Sato, T.; Walker, R. J.

    1982-01-01

    Magnetotail reconnection in the presence of plasma streaming parallel to the neutral sheet is modeled. The tearing mode is excited much more violently in the case with parallel plasma flow in the plasma sheet than in the case with no flow. The flow patterns for the nonlinear resistive tearing mode and the streaming tearing mode are much more complex than those for the linear tearing mode. Flow vortices are observed in both cases.

  12. On the stabilization of neoclassical tearing modes by electron cyclotron waves

    NASA Astrophysics Data System (ADS)

    Ramponi, G.; Lazzaro, E.; Nowak, S.

    1999-09-01

    The control of neoclassical tearing modes in tokamaks by means of electron cyclotron current drive and heating is investigated. The nonlinear evolution of the amplitude in absence and in presence of the stabilizing terms of an auxiliary current inside the island and of the associate heating is solved self-consistently with the evolution of the rotation frequency for International Thermonuclear Experimental Reactor (ITER) reference magnetic equilibrium [ITER-JCT and Home Teams, Plasma Phys. Controlled Fusion 37, A19 (1995)]. It is shown that, unless the wall braking torque is neutralized by external means, neoclassical tearing modes in ITER will be locked in a very short time. On the other hand, for rotating islands, the beneficial effect of modulating the current source in phase with the island rotation is pointed out, after an analysis of the time scales of the relevant phenomena (time response of the driven current, island rotation frequency, power pulse duration, and inductive response of the plasma). Consideration is given to different effects that may reduce the efficiency of the control of the flux reconnection rate and to the benefits of wall stabilization associated to the island rotation frequency. A quantitative assessment of the EC (electron cyclotron) power required to keep the island width at a reasonable level is given, both in absence and in presence of wall stabilization.

  13. 49 CFR 173.340 - Tear gas devices.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Tear gas devices. 173.340 Section 173.340... SHIPMENTS AND PACKAGINGS Gases; Preparation and Packaging § 173.340 Tear gas devices. (a) Packagings for tear gas devices must be approved prior to initial transportation by the Associate Administrator....

  14. Integrated Approach for Prediction of Hot Tearing

    NASA Astrophysics Data System (ADS)

    Suyitno; Kool, W. H.; Katgerman, L.

    2009-10-01

    Shrinkage, imposed strain rate, and (lack of) feeding are considered the main factors that determine cavity formation or the formation of hot tears. A hot-tearing model is proposed that will combine a macroscopic description of the casting process and a microscopic model. The micromodel predicts whether porosity will form or a hot tear will develop. Results for an Al-4.5 pct Cu alloy are presented as a function of the constant strain rate and cooling rate. Also, incorporation of the model in a finite element method (FEM) simulation of the direct-chill (DC) casting process is reported. The model shows features well known from literature such as increasing hot-tearing sensitivity with increasing deformation rate, cooling rate, and grain size. Similar trends are found for the porosity formation as well. The model also predicts a beneficial effect of applying a ramping procedure during the start-up phase, which is an improvement in comparison with earlier findings obtained with alternative models. In principle, the model does not contain adjustable parameters, but several parameters are not well known. A full quantitative validation not only requires detailed casting trials but also independent determination of some thermophysical parameters of the semisolid mush.

  15. Tear-Duct Obstruction and Surgery

    MedlinePlus

    ... could block a duct, but reconstructive surgery right after the accident or injury may prevent this. Signs of Blocked Tear Ducts ... kids. It may take up to a week after surgery before symptoms improve. Your doctor will give you antibiotic ointment or drops along with ... Injuries Pinkeye (Conjunctivitis) Retinopathy of Prematurity Preparing Your Child ...

  16. 49 CFR 178.1070 - Tear test.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR PACKAGINGS Testing of Flexible Bulk... Flexible Bulk Containers design types. (b) Special preparation for the tear test. Flexible Bulk Container...) Test method. (1) A Flexible Bulk Container design type must be placed on the ground and a 300 mm...

  17. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not...) Test method. Once the IBC is placed on the ground, a 100-mm (4-inch) knife score, completely penetrating the wall of a wide face, is made at a 45° angle to the principal axis of the IBC, halfway...

  18. Tearing mode analysis in tokamaks, revisited

    SciTech Connect

    Nishimura, Y.; Callen, J.D.; Hegna, C.C.

    1997-12-01

    A new {Delta}{prime} shooting code has been developed to investigate tokamak plasma tearing mode stability in a cylinder and large aspect ratio ({epsilon} {le} 0.25) toroidal geometries, neglecting toroidal mode coupling. A different computational algorithm is used (shooting out from the singular surface instead of into it) to resolve the strong singularities at the mode rational surface, particularly in the presence of finite pressure term. Numerical results compare favorably with Furth et al. results. The effects of finite pressure, which are shown to decrease {Delta}{prime}, are discussed. It is shown that the distortion of the flux surfaces by the Shafranov shift, which modifies the geometry metric element stabilizes the tearing mode significantly, even in a low {beta} regime before the toroidal magnetic curvature effects come into play. Double tearing modes in toroidal geometries are examined as well. Furthermore, m {ge} 2 tearing mode stability criteria are compared with three dimensional initial value MHD simulation by the FAR code.

  19. A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients

    PubMed Central

    Khalil, Noha M.; El-Gendy, Heba A.

    2016-01-01

    Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. A