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Miller JE, Higgins LD, Dong Y, Collins JE, Bean JF, Seitz AL, Katz JN, Jain NB. Association of Strength Measurement with Rotator Cuff Tear in Patients with Shoulder Pain: The Rotator Cuff Outcomes Workgroup Study. Am J Phys Med Rehabil 2016; 95:47-56. [PMID: 26098921 DOI: 10.1097/phm.0000000000000329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study examines the association between strength measurements and supraspinatus tear in patients with shoulder pain. This study characterized determinants of abduction strength among patients with tears. DESIGN A total of 208 patients with shoulder pain were recruited. Strength was tested using a handheld dynamometer. Supraspinatus tears were diagnosed by combination of clinical assessment and blinded magnetic resonance imaging review. Associations of supraspinatus tear with patient characteristics and strength measurements (abduction, internal rotation and external rotation) were assessed using multivariable logistic regression models. RESULTS Patients with supraspinatus tear had decreased abduction strength (P = 0.02) and decreased external rotation strength (P < 0.01). When adjusted for age, sex, tear laterality, and body mass index, decreased abduction strength (odds ratio, 1.18/kg; 95% confidence interval, 1.06-1.32) and decreased external rotation strength (odds ratio, 1.29/kg; 95% confidence interval, 1.14-1.48) were associated with supraspinatus tear. In patients with tear, age 60 yrs or older, female sex, and visual analog scale pain score were significantly associated with decreased abduction strength but tear size, fatty infiltration, and atrophy were not. CONCLUSIONS Decreased abduction and external rotation strength were associated with supraspinatus tear in patients with shoulder pain. In this cohort, the abduction strength of patients with tears was influenced by demographic factors but not tear characteristics.
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Affiliation(s)
- Jennifer Earle Miller
- From the Departments of Physical Medicine & Rehabilitation and Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee (NBJ); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, Massachusetts (JEM, JFB, NBJ); Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (LDH, YD, JEC, JNK, NBJ); Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (JEC); Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (ALS); and Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (JNK)
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Vidt ME, Santago AC, Tuohy CJ, Poehling GG, Freehill MT, Kraft RA, Marsh AP, Hegedus EJ, Miller ME, Saul KR. Assessments of Fatty Infiltration and Muscle Atrophy From a Single Magnetic Resonance Image Slice Are Not Predictive of 3-Dimensional Measurements. Arthroscopy 2016; 32:128-39. [PMID: 26391648 PMCID: PMC4706774 DOI: 10.1016/j.arthro.2015.06.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) determine whether standard clinical muscle fatty infiltration and atrophy assessment techniques using a single image slice for patients with a rotator cuff tear (RCT) are correlated with 3-dimensional measures in older individuals (60+ years) and (2) to determine whether age-associated changes to muscle morphology and strength are compounded by an RCT. METHODS Twenty older individuals were studied: 10 with an RCT of the supraspinatus (5 men and 5 women) and 10 matched controls. Clinical imaging assessments (Goutallier and Fuchs scores and cross-sectional area ratio) were performed for participants with RCTs. Three-dimensional measurements of rotator cuff muscle and fat tissues were obtained for all participants using magnetic resonance imaging (MRI). Isometric joint moment was measured at the shoulder. RESULTS There were no significant associations between single-image assessments and 3-dimensional measurements of fatty infiltration for the supraspinatus and infraspinatus muscles. Compared with controls, participants with RCTs had significantly increased percentages of fatty infiltration for each rotator cuff muscle (all P ≤ .023); reduced whole muscle volume for the supraspinatus, infraspinatus, and subscapularis muscles (all P ≤ .038); and reduced fat-free muscle volume for the supraspinatus, infraspinatus, and subscapularis muscles (all P ≤ .027). Only the teres minor (P = .017) fatty infiltration volume was significantly greater for participants with RCTs. Adduction, flexion, and external rotation strength (all P ≤ .021) were significantly reduced for participants with RCTs, and muscle volume was a significant predictor of strength for all comparisons. CONCLUSIONS Clinical scores using a single image slice do not represent 3-dimensional muscle measurements. Efficient methods are needed to more effectively capture 3-dimensional information for clinical applications. Participants with RCTs had increased fatty infiltration percentages that were likely driven by muscle atrophy rather than increased fat volume. The significant association of muscle volume with strength production suggests that treatments to preserve muscle volume should be pursued for older patients with RCTs. LEVEL OF EVIDENCE Level II, diagnostic study, with development of diagnostic criteria on the basis of consecutive patients with universally applied reference gold standard.
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Affiliation(s)
- Meghan E. Vidt
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Anthony C. Santago
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA,Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary G. Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael T. Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert A. Kraft
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Anthony P. Marsh
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Eric J. Hegedus
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Michael E. Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R. Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
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 sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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Rosskopf AB, Ehrmann C, Buck FM, Gerber C, Flück M, Pfirrmann CWA. Quantitative Shear-Wave US Elastography of the Supraspinatus Muscle: Reliability of the Method and Relation to Tendon Integrity and Muscle Quality. Radiology 2015; 278:465-74. [PMID: 26540450 DOI: 10.1148/radiol.2015150908] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the reliability of ultrasonographic (US) elastography of the supraspinatus (SSP) muscle, define normal shear-wave velocity (SWV) values, and correlate findings with tendon integrity and muscle quality. MATERIALS AND METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all patients. SSP SWV (in meters per second) was prospectively assessed twice in 22 asymptomatic volunteers (mean age ± standard deviation, 53.8 years ± 15.3; 11 women and 11 men) by two independent examiners by using shear-wave elastography. Forty-four patients (mean age, 51.9 years ± 15.0; 22 women and 22 men) were prospectively included. SWV findings were compared with tendon integrity, tendon retraction (Patte classification), fatty muscle infiltration (Goutallier stages 0-IV), and muscle volume atrophy (tangent sign) on magnetic resonance (MR) images. Descriptive statistics, Spearman correlation, analysis of variance, two-sample t test, and intraclass correlation coefficient (ICC) were used. RESULTS Test-retest reliability for mean total SWV (MTSWV) was good for examiner 1 (ICC = 0.70; 95% confidence interval [CI]: 0.30, 0.87; P = .003) and excellent for examiner 2 (ICC = 0.80; 95% CI: 0.53, 0.92; P < .001). Interexaminer reliability was excellent (ICC = 0.89; 95% CI: 0.64, 0.96; P < .001). MTSWV in volunteers (3.0 m/sec ± 0.5) was significantly higher than that in patients (2.5 m/sec ± 0.5; P = .001). For tendon integrity, no significant difference in MTSWV was found. For tendon retraction, MTSWV varies significantly between patients with different degrees of retraction (P = .047). No significant differences were found for Goutallier subgroups. MTSWV was significantly lower with a positive tangent sign (P = .015; n = 10). CONCLUSION Shear-wave elastography is reproducible for assessment of the SSP muscle. Mean normal SSP SWV is 3.0 m/sec ± 0.5. SWV decreases with increasing fat content (Goutallier stage 0-III) and increases in the final stage of fatty infiltration (Goutallier stage IV).
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Affiliation(s)
- Andrea B Rosskopf
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christine Ehrmann
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Florian M Buck
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christian Gerber
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Martin Flück
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christian W A Pfirrmann
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
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Santago AC, Vidt ME, Tuohy CJ, Poehling GG, Freehill MT, Jordan JH, Kraft RA, Saul KR. Quantitative Analysis of Three-Dimensional Distribution and Clustering of Intramuscular Fat in Muscles of the Rotator Cuff. Ann Biomed Eng 2015; 44:2158-67. [PMID: 26514349 DOI: 10.1007/s10439-015-1488-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/14/2015] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, 27157, USA.
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- Department of Mechanical and Aerospace Engineering, North Carolina State University, 911 Oval Drive, Engineering Building 3, Campus Box 7910, Raleigh, NC, 27695-7910, USA.
| | - Meghan E Vidt
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jennifer H Jordan
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Robert A Kraft
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, 27157, USA
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, 911 Oval Drive, Engineering Building 3, Campus Box 7910, Raleigh, NC, 27695-7910, USA
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Management of Posterior Tibial Tendon Rupture With Allograft Reconstruction, Osteotomy, and Peroneus Brevis to Longus Transfer. TECHNIQUES IN FOOT AND ANKLE SURGERY 2015. [DOI: 10.1097/btf.0000000000000084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bachasson D, Singh A, Shah S, Lane JG, Ward SR. The role of the peripheral and central nervous systems in rotator cuff disease. J Shoulder Elbow Surg 2015; 24:1322-35. [PMID: 26189809 PMCID: PMC4508670 DOI: 10.1016/j.jse.2015.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/19/2015] [Accepted: 04/04/2015] [Indexed: 02/01/2023]
Abstract
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 muscle changes that have a negative impact on 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 (1) exacerbate structural and functional muscle changes induced by tendon tear, (2) compromise the reversal of these changes during surgery and rehabilitation, (3) contribute to pain generation and persistence of pain, (4) impair shoulder function through reduced proprioception, kinematics, and muscle recruitment, and (5) help 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 on 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.
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Affiliation(s)
- Damien Bachasson
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Anshuman Singh
- Department of Orthopaedics, Kaiser Permanente Southern California, San Diego, CA, USA
| | - Sameer Shah
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA,Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | | | - Samuel R. Ward
- Department of Radiology, University of California San Diego, La Jolla, CA, USA,Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA,Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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Marcon M, Ciritsis B, Laux C, Nanz D, Fischer MA, Andreisek G, Ulbrich EJ. Quantitative and qualitative MR-imaging assessment of vastus medialis muscle volume loss in asymptomatic patients after anterior cruciate ligament reconstruction. J Magn Reson Imaging 2014; 42:515-25. [PMID: 25446958 DOI: 10.1002/jmri.24777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/27/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To quantitatively and qualitatively assess vastus medialis muscle atrophy in asymptomatic patients with anterior cruciate ligament reconstruction, using the nonoperated leg as control. METHODS Prospective Institutional Review Board approved study with written informed patient consent. Thirty-three asymptomatic patients (men, 21; women,12) with ACL-reconstruction underwent MR imaging of both legs (axial T1-weighted spin-echo and 3D spoiled dual gradient-echo sequences). Muscle volume and average fat-signal fraction (FSF) of the vastus medialis muscles were measured. Additionally, Goutallier classification was used to classify fatty muscle degeneration. Significant side differences were evaluated using the Wilcoxon test and, between volumes and FSF, using student t-tests with P-value < 0.05 and < 0.025, respectively. RESULTS The muscle volume was significantly smaller in the operated (mean ± SD, 430.6 ± 119.6 cm(3) ; range, 197.3 to 641.7 cm(3) ) than in the nonoperated leg (479.5 ± 124.8 cm(3) ; 261.4 to 658.9 cm(3) ) (P < 0.001). Corresponding FSF was 6.3 ± 1.5% (3.9 to 9.2%) and 5.8 ± 0.9% (4.0 to 7.4%), respectively, with a nonsignificant (P > 0.025) difference. The relative muscle-volume and FSF differences were -10.1 ± 8.6% (7.1 to -30.1%) and 10.9 ± 29.4% (39.7 to 40.1%). The qualitative assessment revealed no significant differences (P > 0.1). CONCLUSION A significant muscle volume loss of the vastus medialis muscle does exist in asymptomatic patients with ACL-reconstruction, but without fatty degeneration.
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Affiliation(s)
- Magda Marcon
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland.,Department of Radiology, University Hospital Udine, P.le S. Maria della Misericordia Udine, Italy
| | - Bernhard Ciritsis
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Laux
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Nanz
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael A Fischer
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland.,Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Gustav Andreisek
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Erika J Ulbrich
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
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Clavert P, Thomazeau H. Peri-articular suprascapular neuropathy. Orthop Traumatol Surg Res 2014; 100:S409-11. [PMID: 25454727 DOI: 10.1016/j.otsr.2014.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 10/02/2014] [Indexed: 02/02/2023]
Abstract
Suprascapular nerve entrapment was first described in 1959 by Kopell and Thompson. Although rare, this condition is among the causes of poorly explained shoulder pain in patients with manifestations suggesting a rotator-cuff tear but normal tendons by imaging studies. Suprascapular nerve entrapment may cause 2% of all cases of chronic shoulder pain. Among the many reported causes of suprascapular nerve entrapment, the most common are para-labral cysts, usually in the spinoglenoid notch, and microtrauma in elite athletes. The potential relevance of concomitant rotator-cuff tears remains debated. Less common causes include tumours, scapular fractures, and direct trauma involving traction. Early diagnosis and treatment are crucial to avoid the development of irreversible muscle wasting. Endoscopic surgery to treat the various causes of suprascapular nerve compression has superseded open nerve release.
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Affiliation(s)
- P Clavert
- Service de chirurgie du membre supérieur, CCOM, CHU de Strasbourg, Strasbourg, France.
| | - H Thomazeau
- Service de chirurgie orthopédique et réparatrice, CHU de Rennes, Rennes, France
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Cross-sectional area measurements versus volumetric assessment of the quadriceps femoris muscle in patients with anterior cruciate ligament reconstructions. Eur Radiol 2014; 25:290-8. [PMID: 25358592 DOI: 10.1007/s00330-014-3424-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/15/2014] [Accepted: 08/29/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our aim was to validate the use of cross-sectional area (CSA) measurements at multiple quadriceps muscle levels for estimating the total muscle volume (TMV), and to define the best correlating measurement level. METHODS Prospective institutional review board (IRB)-approved study with written informed patient consent. Thighs of thirty-four consecutive patients with ACL-reconstructions (men, 22; women, 12) were imaged at 1.5-T using three-dimensional (3D) spoiled dual gradient-echo sequences. CSA was measured at three levels: 15, 20, and 25 cm above the knee joint line. TMV was determined using dedicated volumetry software with semiautomatic segmentation. Pearson's correlation and regression analysis (including standard error of the estimate, SEE) was used to compare CSA and TMV. RESULTS The mean ± standard deviation (SD) for the CSA was 60.6 ± 12.8 cm(2) (range, 35.6-93.4 cm(2)), 71.1 ± 15.1 cm(2) (range, 42.5-108.9 cm(2)) and 74.2 ± 17.1 cm(2) (range, 40.9-115.9 cm(2)) for CSA-15, CSA-20 and CSA-25, respectively. The mean ± SD quadriceps' TMV was 1949 ± 533.7 cm(3) (range, 964.0-3283.0 cm(3)). Pearson correlation coefficient was r = 0.835 (p < 0.01), r = 0.906 (p < 0.01), and r = 0.956 (p < 0.01) for CSA-15, CSA-20 and CSA-25, respectively. Corresponding SEE, expressed as percentage of the TMV, were 15.2%, 11.6% and 8.1%, respectively. CONCLUSION The best correlation coefficient between quadriceps CSA and TMV was found for CSA-25, but its clinical application to estimate the TMV is limited by a relatively large SEE. KEY POINTS • Cross-sectional area was used to estimate QFM size in patients with ACL-reconstruction • A high correlation coefficient exists between quadriceps CSA and volume • Best correlation was seen 25 cm above the knee joint line • A relatively large standard error of the estimate limits CSA application.
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Magnetic resonance anatomy of the superior part of the rotator cuff in normal shoulders, assessment and practical implication. Surg Radiol Anat 2014; 36:993-1000. [PMID: 24985026 DOI: 10.1007/s00276-014-1331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/12/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The superior part of the rotator cuff consists of the anterior (SSa) and posterior (SSp) parts of the supraspinatus tendon, the infraspinatus (IS) tendon plus the articular capsule. An overlap of the distal SSp tendon by the anterior part of the IS one has been anatomically demonstrated; the insertion area of the IS is more anterior than currently believed. The aim of our study was to assess this complex architecture through standard MRI scans. METHODS Twenty-five healthy volunteers underwent a shoulder MRI. Three planes T2 fat saturation sequences were read in consensus by two radiologists. The SSa, the SSp, the IS tendons and the articular capsule were assessed for visibility. The patterns of demarcation of each structure from adjacent ones were assessed. The width and the thickness of each tendinous band were measured on sagittal images. RESULTS The SSa, the SSp and the IS tendons were distinguishable in all patients. The anterior part of the IS tendon overlapped the SSp tendon to reach a quite anterior insertion into the greater tuberosity of the humerus. The SSa, the SSp and the IS tendons were 6.5-3.4, 15.1-2.8 and 26.8-2.2 mm wide and thick, respectively. CONCLUSION MR images of the normal superior rotator cuff are consistent with latest anatomical descriptions. The distal superposition of the IS over the SSp tendon should be considered regarding the linear increased signal areas and the commonly named "partial thickness ruptures" of the superior rotator cuff as well as the fatty infiltration of the IS muscle.
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Yamakado K. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair. Open Access J Sports Med 2014; 5:129-36. [PMID: 24982592 PMCID: PMC4074897 DOI: 10.2147/oajsm.s63345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Rotator-cuff surgery is well recognized to be a painful procedure. Objectives The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR). Materials and methods This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB). The visual analog scale (at 6 hours and on the first, second, and third postoperative days) and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated. Results The respective visual analog scale scores (mm) obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73) before surgery, 9.1 and 19.4 (P=0.12) at 6 hours after surgery, 24.4 and 44.6 (P=0.019) on the first postoperative day, 19.4 and 40.4 (P=0.0060) on the second postoperative day, and 18.5 and 27.8 (P=0.21) on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020), respectively. Conclusion ca-SSNB was highly effective in controlling postoperative pain after ARCR.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics, Fukui General Hospital, Fukui, Japan
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Leclere LE, Shi LL, Lin A, Yannopoulos P, Higgins LD, Warner JJP. Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy. Arthroscopy 2014; 30:639-44. [PMID: 24630957 DOI: 10.1016/j.arthro.2014.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 02/02/2023]
Abstract
Suprascapular neuropathy is generally considered to be a diagnosis of exclusion, although it has been described in association with several activities and conditions. To our knowledge, this is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. We present 4 cases of patients who presented with complete fatty infiltration of the supraspinatus (1 patient), infraspinatus (2 patients), and both (1 patient) resulting from suprascapular neuropathy. Each of these patients underwent arthroscopic suprascapular nerve decompression and subsequently had immediate improvement in pain and subjective shoulder value.
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Affiliation(s)
- Lance E Leclere
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago, Chicago, Illinois, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Paul Yannopoulos
- Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Laurence D Higgins
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Jon J P Warner
- Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
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