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Haft M, Pearson ZC, Ahiarakwe U, Nelson SY, Srikumaran U. Evaluating The Effect of Arthroscopic Rotator Cuff Repair with Concomitant Subacromial Decompression on 2, 4, and 6 Year Reoperation Rates. J Am Acad Orthop Surg 2024; 32:697-704. [PMID: 38657174 DOI: 10.5435/jaaos-d-23-00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/10/2023] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The risks and benefits of including an arthroscopic subacromial decompression (ASD) during arthroscopic rotator cuff repair (RCR) are uncertain. Some studies suggest no difference in revision surgery rates, whereas others have found higher revision surgery rates associated with concomitant ASD. In this study, we compare mid-term revision surgery rates in patients undergoing arthroscopic RCR with or without concomitant ASD. METHODS A retrospective cohort analysis was conducted using a national all-payer claims database. Current Procedural Terminology and International Classification of Disease , 10th Revision , codes were used to identify patients who underwent primary arthroscopic RCR with or without ASD in the United States. The primary study outcome was revision surgery at 2, 4, and 6 years. Univariate analysis was conducted on demographic variables (age, sex) and comorbidities in the Elixhauser Comorbidity Index using chi-square and Student t -tests. Multivariate analysis was conducted using logistic regression. RESULTS A total of 11,188 patients were identified who underwent RCR and met the inclusion criteria. Of those, 8,994 (80%) underwent concomitant ASD. Concomitant ASD was associated with lower odds of all-cause revision surgery to the ipsilateral shoulder at 2 years (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51 to 0.73), 4 years (OR, 0.60; 95% CI, 0.51 to 0.70), and 6 years (OR, 0.59; 95% CI, 0.51 to 0.69). Concomitant ASD was also associated with lower odds of revision RCR at 2 years (OR, 0.68; 95% CI, 0.53 to 0.86), 4 years (OR, 0.63; 95% CI, 0.50 to 0.78), and 6 years (OR, 0.61; 95% CI, 0.49 to 0.76). DISCUSSION Arthroscopic RCR with concomitant ASD is associated with lower odds of all-cause revision surgery in the ipsilateral shoulder at 2, 4, and 6 years. The lower mid-term revision surgery rates suggest benefits to performing concomitant ASD with primary arthroscopic RCR. Continued research on the mid to long-term benefits of ASD is needed to determine which patient populations benefit most from this procedure. DATA AVAILABILITY The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Mark Haft
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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2
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Springer B, Dreisbach R, Schatz KD, Kubista B, Waldstein W. Online Videos Regarding Relevant Postoperative Patient Information and Postoperative Rehabilitation After Arthroscopic Rotator Cuff Repair Provide Poor Information Quality, Accuracy, and Reliability. Arthroscopy 2023; 39:2443-2453.e2. [PMID: 37355180 DOI: 10.1016/j.arthro.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair. METHODS By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos. RESULTS Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, β = 1.496 [P < .001]; GQS, β = 1.105 [P < .001]; DISCERN score, β = 11.234 [P < .001]; and RCS, β = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by non-medically trained individuals (P = .041). CONCLUSIONS The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair. CLINICAL RELEVANCE Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.
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Affiliation(s)
- Bernhard Springer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Robin Dreisbach
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Klaus-Dieter Schatz
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Bernd Kubista
- Department of Orthopaedics, Sanatorium Hera, Vienna, Austria
| | - Wenzel Waldstein
- Clinic for Orthopaedics Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany.
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3
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Hinsley H, Ganderton C, Arden NK, Carr AJ. Relationship between shoulder abduction strength and rotator cuff tear in elderly women: a general population study. BMJ Open 2023; 13:e071908. [PMID: 37460264 DOI: 10.1136/bmjopen-2023-071908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To investigate the effect of age-related rotator cuff tears on shoulder strength in a general population cohort. DESIGN Cross sectional observational study. SETTING This study was set in an outpatient clinic setting in Chingford, North East London, and was a component of the 20 year visit of the Chingford 1000 women cohort. PARTICIPANTS Individuals were part of the Chingford 1000 women cohort, a 20-year-old longitudinal population study. This cohort has been extensively characterised as representative of the population of the UK. At the 20 year visit, 446 attended for shoulder assessment and were aged between 64 and 87. PRIMARY AND SECONDARY OUTCOME MEASURES Isometric shoulder abduction strength measured using a Nottingham Mecmesin Myometer and the presence of rotator cuff pathology, determined via ultrasound examination (GE voluson i portable ultrasound machine with a 10-16MHz linear probe). Shoulders were classified into normal, abnormal tendon/partial tear, full-thickness tears (>0 and ≤2.5 cm) and full-thickness tears (>2.5 cm). Symptoms were defined using the Oxford Shoulder Score, where an abnormal score was defined as symptomatic. RESULTS 446 women (891 shoulders) aged 71 (range 65-84) were included in the study. Age, the presence of pain and the non-dominant arm were demonstrated to reduce strength. Rotator cuff tears and pathology had no isolated effect on shoulder strength in those aged under 70. However, in the over 70s full-thickness tears>0 and ≤2.5 cm, and >2.5 cm had mean reductions of 6.3 and 12.7 N, respectively (p<0.001). CONCLUSION Rotator cuff tears of all sizes in those aged under 70 were not associated with a loss of shoulder strength. In those aged over 70, strength was reduced by 30% with small and 40% with large full thickness tears. Loss in strength was associated a loss of ability to perform activities of daily living but only for large tears.
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Affiliation(s)
- Hannah Hinsley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charlotte Ganderton
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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4
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Woodmass JM, Al Khatib L, McRae S, Lapner P, Mascarenhas R, Neogi D, MacDonald PB. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears: Long-Term Outcomes of a Multicenter, Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:2101-2107. [PMID: 36476738 DOI: 10.2106/jbjs.22.00135] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to reevaluate patients from a previous randomized controlled trial at a long-term follow-up to determine the long-term efficacy of subacromial decompression in patients with full-thickness rotator cuff tears. METHODS This is a secondary study based on a previous, multicenter, randomized controlled trial with patients allocated to arthroscopic rotator cuff repair with or without acromioplasty. The original study was conducted between 2003 and 2011, and the secondary study was conducted between 2015 and 2021. Patients were invited by a blinded assessor to return to complete the Western Ontario Rotator Cuff (WORC) index and a questionnaire about reoperation and to undergo a clinical assessment. If participants were unable to return, they were asked to complete the questionnaires by mail. A chart review on all participants in the original study was conducted. RESULTS Eighty-six patients were randomized in the original trial, with 31 of 45 from the group without acromioplasty and 25 of 41 from the acromioplasty group returning for long-term follow-up. The mean duration (and standard deviation) of follow-up was 11.2 ± 2.4 years for the group without acromioplasty and 11.5 ± 2.6 years for the acromioplasty group. There was no significant difference in WORC scores between the groups with and without acromioplasty at the time of the long-term follow-up (p = 0.30). Seven (16%) of the 45 patients in the group without acromioplasty underwent reoperation. One (2%) of the initial 41 patients allocated to acromioplasty underwent reoperation. All patients who underwent a reoperation had a Type-2 or 3 acromion. CONCLUSIONS Patients who underwent rotator cuff repair with or without acromioplasty experienced improvement of outcomes from their preoperative level at a long-term follow-up (mean, 11 years), and there were no differences in patient-reported outcomes, specifically WORC scores, between these groups. However, a significantly higher reoperation rate was observed in patients who had rotator cuff repair without acromioplasty, specifically in those with a Type-2 or 3 acromion. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarret M Woodmass
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | | - Sheila McRae
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Peter B MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
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5
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Barandiaran AF, Houck DA, Schumacher AN, Seidl AJ, Frank RM, Vidal AF, Wolcott ML, McCarty EC, Bravman JT. Shoulder Surgery as an Effective Treatment for Shoulder-Related Sleep Disturbance: A Systematic Review. Arthroscopy 2022; 38:989-1000.e1. [PMID: 34478767 DOI: 10.1016/j.arthro.2021.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature in an effort to investigate sleep quality and disturbances and the association with clinical outcomes of patients undergoing shoulder surgery. METHODS A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to PRISMA guidelines. All English-language literature reporting clinical outcomes and sleep quality and disturbance after shoulder surgery was reviewed by 2 independent reviewers. Outcomes assessed included patient-reported outcomes (PROs) and sleep quality. Specific PROs included the Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) for pain, Simple Shoulder Test (SST), University of California Los Angeles (UCLA) Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Score (ASES). Study methodology was assessed using the Modified Coleman Methodology Score. Descriptive statistics are presented. RESULTS Sixteen studies (11 level IV, 2 level III, 3 level II) with a total of 2748 shoulders were included (age, 12-91 years; follow-up, 0.25-132 months). In total, 2198 shoulders underwent arthroscopic rotator cuff repair (RCR), 131 shoulders underwent arthroscopic capsular release, 372 shoulders underwent total shoulder arthroplasty (TSA), 18 shoulders underwent comprehensive arthroscopic management, and 29 shoulders underwent sternoclavicular joint procedures. All shoulder surgeries improved self-reported sleep and PROs from before to after surgery. In RCR patients, PSQI scores were significantly associated with VAS scores, SST scores (r = 0.453, r = -0.490, P < .05, respectively), but not significantly associated with UCLA Shoulder rating scale or the ASES scores (r = 0.04, r = 0.001, P > .05, respectively). In TSA patients, PSQI scores were significantly associated with ASES scores (r = -0.08, P < .05). All 4 RCR studies and 1 TSA study using PSQI found significant improvements in mean PSQI scores within 6 to 24 months (P < .05). CONCLUSIONS Surgical intervention for rotator cuff tear and glenohumeral osteoarthritis significantly improves self-reported sleep in patients with shoulder pain. However, there remains a dearth of available studies assessing the effects of surgical intervention for adhesive capsulitis, sternoclavicular joint instability, and sternoclavicular osteoarthritis on sleep. Future studies should use sleep-specific PROs and quantitative measures of sleep to further elucidate the relationship between sleep and the effect of shoulder surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Michelle L Wolcott
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
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6
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Kim T, Cheong IY. Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation. Ann Rehabil Med 2022; 45:422-430. [PMID: 35000367 PMCID: PMC8743845 DOI: 10.5535/arm.21133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization. METHODS Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed. RESULTS Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization. CONCLUSION Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.
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Affiliation(s)
- Tayeun Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - In Yae Cheong
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
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7
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Zwolak P, Meyer P, Molnar L, Kröber M. The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors. Arch Orthop Trauma Surg 2022; 142:25-31. [PMID: 32844306 DOI: 10.1007/s00402-020-03584-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
To date two main techniques are used in arthroscopic full-thickness rotator cuff tears, the conventional knot-tying suture bridge technique and the knotless technique. We evaluated whether there is a difference in clinical outcome using both techniques. Our patients underwent arthroscopic treatment of full-thickness rotator cuff tears, and we retrospectively evaluated clinical function, strength and surgery time. Eighty-three shoulders operated between September 2012 and December 2013 were included in the study. We had nineteen patients in the knotless group, and sixty-four in the knot-tying group. In addition, we performed preoperatively radiological (magnetic resonance imaging-MRI) conformation of full-thickness rotator cuff tear in our patients. For clinical evaluation, we used Quick Disabilities of the Arm, Shoulder and Hand score (q-DASH) and the Shoulder Pain and Disability (SPADI) score, and we measured the strength of a range of motion postoperatively using a conventional dynamometer. The patients were evaluated preoperatively, and at 6, 9, and 12 months postoperatively. The follow-up period was 12 months. The scores in both treatment groups improved at twelve months follow-up, but there was no statistical difference between both groups at twelve months after surgery; q-DASH score between groups (p = 0.092) and SPADI score (p = 0.700). Similarly, there was no statistical difference between the groups in regard to strength, surgery time, and range of motion at the twelve months follow-up. Our data confirm that both techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome.Level of evidence IV.
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Affiliation(s)
- Pawel Zwolak
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland. .,Department of Orthopaedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Philipp Meyer
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland
| | - Laszlo Molnar
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland
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8
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Kraus NR, Garvey KD, Higgins LD, Matzkin E. Ibuprofen Use Did Not Affect Outcome Metrics After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e491-e497. [PMID: 34027460 PMCID: PMC8129460 DOI: 10.1016/j.asmr.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/15/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids. Methods Patients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the outcomes registry from 2012 to 2016 were screened for inclusion in this study. Inclusion criteria were primary arthroscopic rotator cuff repair, at least 2 years from the date of surgery and over the age of 18. Exclusion criteria were revision and open rotator cuff repair. All patients followed the standard postoperative rehabilitation protocol for rotator cuff repair. Patients were divided into 2 cohorts. Group I included patients who received ibuprofen/nonsteroidal anti-inflammatory agents (NSAID) after surgery (n = 281), and Group II consisted of patients who did not receive ibuprofen/NSAID after surgery (n = 182). Patient-reported outcome measures for Visual Analogue Scale, American Shoulder Elbow Surgeons score, Single Assessment Numeric Evaluation score, Simple Shoulder Test and The Veterans Rand 12-Item Health Survey were collected preoperatively and at 3 and 6 months, 1 year, and 2 years after surgery. Statistical analysis was performed to compare patient-reported outcome measures between Group I and II. Results This study consisted of 463 patients who underwent arthroscopic rotator cuff repair, and patients were divided into 2 cohorts. There were 281 patients who did not receive ibuprofen/NSAID after operation in Group I and 182 patients who did receive ibuprofen in Group II. There were no statistically significant differences between the 2 groups in age at treatment, mean body mass index, gender, ethnicity, diabetes, and number of rotator cuff tendons involved; however, there was a statistically significant difference in receiving worker’s compensation (P = .005), and this was subsequently adjusted for in our analysis. There were no significant differences in patient-reported outcomes for all metrics between the group prescribed ibuprofen and the group that was not prescribed ibuprofen at 1 and 2 years after surgery or in change from baseline. Conclusion Patients receiving ibuprofen did as well as patients who did not receive ibuprofen after arthroscopic rotator cuff repair on patient-reported outcome measures assessing shoulder pain, function, and overall health. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Nicholas R Kraus
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kirsten D Garvey
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laurence D Higgins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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9
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Tudini FT. Isokinetic testing of the shoulder rotator muscles of older individuals with shoulder pathology: An integrative review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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11
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Mori D, Kizaki K, Funakoshi N, Yamashita F, Mizuno Y, Shirai T, Kobayashi M. Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients. Orthop J Sports Med 2019; 7:2325967119838249. [PMID: 31041329 PMCID: PMC6477774 DOI: 10.1177/2325967119838249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The presence of delamination and a larger rotator cuff tear (RCT) size have
been associated with poorer outcomes in rotator cuff repair. Therefore, we
developed a new surgical procedure, arthroscopic lamina-specific double-row
fixation (ALSDR), for the repair of large delaminated RCTs. Purpose: To investigate the clinical outcomes, magnetic resonance imaging findings,
and satisfaction with several variables after ALSDR for large delaminated
RCTs. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 active patients (mean age, 59.1 years) undergoing ALSDR were
assessed by a numeric rating scale (NRS; 0-10) for pain, surgery, work, and
exercise as well as American Shoulder and Elbow Surgeons (ASES), Constant,
and Simple Shoulder Test (SST) scores at a mean of 65.9 months
postoperatively. Rotator cuff integrity was determined by magnetic resonance
imaging. The Spearman correlation coefficient (ρ) was used to determine the
correlation between clinical and NRS scores. Results: Five patients (16.7%) had a retear. Each of the postoperative functional and
NRS scores except the NRS work score was significantly better in the healed
shoulders than in the shoulders with a retear (P <
.001). The NRS pain score showed a significant negative correlation with
ASES, Constant, and SST scores (ρ = −0.775, −0.668, and −0.742,
respectively; P < .001 for all). The NRS surgery score
had a positive correlation with Constant and SST scores (ρ = 0.393
[P = .032] and ρ = 0.456 [P = .011],
respectively). The NRS work score had a positive correlation with ASES,
Constant, and SST scores (ρ = 0.382 [P = .037], ρ = 0.386
[P = .035], and ρ = 0.414 [P = .023],
respectively). The NRS exercise score had a positive correlation with ASES,
Constant, and SST scores (ρ = 0.567 [P = .001], ρ = 0.511
[P = .004], and ρ = 0.639 [P <
.001], respectively). Conclusion: Our results showed that there was a significant correlation between clinical
and NRS scores. The results indicate that ALSDR can provide a high degree of
functionality and can be a useful alternative treatment for active patients
with large delaminated RCTs.
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Affiliation(s)
- Daisuke Mori
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
- Daisuke Mori, MD, Department of Orthopaedic Surgery, Kyoto
Shimogamo Hospital, 17 Shimogamo Higashimorigamaecho, Sakyo-ku, Kyoto, 606-0866,
Japan ()
| | - Kazuha Kizaki
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
| | - Noboru Funakoshi
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
| | - Fumiharu Yamashita
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
| | - Yasuyuki Mizuno
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
| | - Takaaki Shirai
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
| | - Masahiko Kobayashi
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto,
Japan
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12
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Rincón‐Hurtado ÁM, Rocha‐Buelvas A, López‐Cardona A, Martínez JW. Calidad de vida relacionada con la salud de pacientes con lesiones de manguito rotador, Eje Cafetero, Colombia, 2013. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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13
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Rincón-Hurtado ÁM, Rocha-Buelvas A, López-Cardona A, Martínez JW. Health-related quality of life of patients with rotator cuff injuries, Cofee Triangle, Colombia, 2013. Rev Bras Ortop 2018; 53:364-372. [PMID: 29892590 PMCID: PMC5993925 DOI: 10.1016/j.rboe.2018.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the quality of life related to health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013. Methods Cross-sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Socio-demographic, biological, clinical and self-perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, Chi-square and logistic regression for analysis. Results 72% (173) reported poor quality of life related to health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor quality of life related to health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor quality of life related to health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status. Conclusion The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.
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Affiliation(s)
| | | | | | - José William Martínez
- Departamento de Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira (UTP), Pereira, Colombia
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Baumer TG, Dischler J, Mende V, Zauel R, van Holsbeeck M, Siegal DS, Divine G, Moutzouros V, Bey MJ. Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes. J Shoulder Elbow Surg 2017; 26:1064-1072. [PMID: 28131679 PMCID: PMC5438772 DOI: 10.1016/j.jse.2016.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of asymptomatic rotator cuff tears has been reported to range from 15% to 39%, but the influence of asymptomatic rotator cuff pathology on shoulder function is not well understood. This study assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. METHODS A clinical ultrasound examination was performed in 46 asymptomatic volunteers (age: 60.3 ± 7.5 years) with normal shoulder function to document the condition of their rotator cuff. The ultrasound imaging identified the participants as healthy (n = 14) or pathologic (n = 32). Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex (Biodex Medical Systems, Inc., Shirley, NY, USA), and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores. RESULTS Compared with healthy volunteers, those with rotator cuff pathology had significantly less abduction (P = .050) and elevation (P = .041) strength, their humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). No significant differences were detected in the Western Ontario Rotator Cuff Index, visual analog scale, range of motion, or acromiohumeral distance. CONCLUSIONS The differences observed between the healthy volunteers and those with asymptomatic rotator cuff pathology lend insight into the changes in joint mechanics, shoulder strength, and conventional clinical outcomes associated with the early stages of rotator cuff pathology. Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology.
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Affiliation(s)
- Timothy G Baumer
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA.
| | - Jack Dischler
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Veronica Mende
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Daniel S Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
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The effect of rotator cuff repair on early overhead shoulder function: a study in 1600 consecutive rotator cuff repairs. J Shoulder Elbow Surg 2017; 26:20-29. [PMID: 27521135 DOI: 10.1016/j.jse.2016.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/14/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are often surgically repaired, generally with good results. However, repairs not infrequently retear, and how important repair integrity is with respect to early functional outcomes after rotator cuff repair is unclear. Thus, the purpose of this study was to determine the effect of a retear on overhead activities in a large cohort of patients after rotator cuff repair. METHODS This was a retrospective cohort study of prospectively collected data from 1600 consecutive rotator cuff repairs. Outcomes were based on patient responses to the L'Insalata Shoulder Questionnaire and findings on examination preoperatively and at 6 months of follow-up. Repair integrity was determined by ultrasound imaging at the 6-month follow-up visit. RESULTS The 1600 patients (885 men, 715 women) were a mean age of 58 years. Postoperative ultrasound imaging found 13% (211 of 1600) of repairs had retorn. Significant improvements were seen irrespective of rotator cuff integrity in pain levels with overhead activity (P < .0001) and range of motion in forward flexion (P < .001) and abduction (P < .01). Patients with intact repairs had 9.5 N greater supraspinatus strength (P < .0001) and 6.9 N greater external rotation strength (P < .01) than those with a retear. CONCLUSION To our knowledge, this is the largest study to evaluate the effect of rotator cuff repair integrity on shoulder function. Patients who had an arthroscopic rotator cuff repair reported significant improvements in overhead pain levels irrespective of the repair integrity at 6 months. Repair integrity influenced supraspinatus and external rotation power, where patients with intact repairs were stronger than those with a retear.
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Gumina S, Candela V, Passaretti D, Venditto T, Mariani L, Giannicola G. Sleep quality and disturbances in patients with different-sized rotator cuff tear. Musculoskelet Surg 2016; 100:33-38. [PMID: 27900705 DOI: 10.1007/s12306-016-0405-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The literature is unanimous in saying that shoulder pain, due to rotator cuff tear (RCT), may be mostly at night; to our knowledge, this statement is not supported by scientific evidence. Our aim was to investigate sleep quality and disturbances in patient with RCT and in a control group. MATERIALS AND METHODS A case-control design study was used. We enrolled 324 consecutive patients (Group A) (156M-168F, mean age ± SD: 64.94 ± 6.97; range 47-74) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group (Group B) included 184 subjects (80M-104F, mean age ± SD = 63.34 ± 6.26; range 44-75) with no RCT. All participants were submitted to two standardized self-reported questionnaires evaluating sleep quality and disturbances: the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Data were submitted to statistics. RESULTS We found no significant differences between the two groups according to both PSQI (Group A: 5.22 ± 2.59; Group B: 5.21 ± 2.39) and ESS (Group A: 2.59 ± 2.54; Group B: 5.76 ± 2.63), p > 0.05. Patients with small tears had average PSQI and ESS higher than patients with large and massive lesions (p < 0.005). Pearson's test showed that tear severity was negatively correlated with both sleep latency (r 2 = -0.35, β = 0.069, p < 0.005) and sleep disturbances (r 2 = -0.65, β = 0.053, p < 0.001). CONCLUSIONS RCT is only one of the responsible causes for sleep disturbance in middle-aged and elderly subjects. Patients with small tears have a poorer sleep quality with respect to those with a more severe tear; particularly, they not only take more time to fall asleep, but also have a more disturbed sleep compared to patients with large and massive tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Gumina
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - V Candela
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - D Passaretti
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - T Venditto
- Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, Rome, Italy
| | - L Mariani
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - G Giannicola
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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Vrouva S, Batistaki C, Koutsioumpa E, Kostopoulos D, Stamoulis E, Kostopanagiotou G. The Greek version of Shoulder Pain and Disability Index (SPADI): translation, cultural adaptation, and validation in patients with rotator cuff tear. J Orthop Traumatol 2016; 17:315-326. [PMID: 27623841 PMCID: PMC5071243 DOI: 10.1007/s10195-016-0425-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to translate and culturally adapt a Greek version of the Shoulder Pain and Disability Index (SPADI) questionnaire and to validate its usage in Greek patients. MATERIALS AND METHODS A forward and backward translation was performed, and the final version of the Greek questionnaire was administered to 134 outpatients (mean age 47.4 ± 14.5) with rotator cuff tear under conservative treatment. The questionnaire was re-administered 2-5 days later to assess test-retest reliability. Patients completed the Greek SPADI, the Greek version of the Quick DASH (Disability of the Arm, Shoulder and Hand Questionnaire) and the EuroQoL EQ-5D. 102 of the 134 questionnaires were considered valid. RESULTS The internal consistencies of the SPADI total and its subscales measured with Cronbach's alpha coefficient were high (0.932 for SPADI-Total, 0.899 for SPADI-Disability, 0.905 for SPADI-Pain). Intraclass correlation coefficients showed excellent test-retest reliability (0.899 for Disability, 0.902 for Pain, and 0.929 for total SPADI). A significantly high positive correlation was found between the SPADI total score and its subscales, and Quick DASH for Pain and Disability. Significant correlations were also found between SPADI scales and EQ-5D variables. There was a moderate positive correlation with the variables "self-reliance" (r = 0.66), "common activities" (r = 0.58), and "pain/discomfort" (r = 0.49), and a weaker correlation with the "mobility" variable (r = 0.20). Factor analysis (PAF method) revealed a bidimensional formation of the SPADI. Eight items (five pain/three disability) weighted the first factor by >0.5, and five disability items weighted the second factor. CONCLUSIONS The Greek SPADI represents a valid and reliable tool for measuring pain and disability in patients with painful shoulder disorders. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- S Vrouva
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece
- Department of Physical Therapy, 401 Army General Hospital of Athens, Athens, Greece
| | - C Batistaki
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece.
| | - E Koutsioumpa
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - D Kostopoulos
- 1st Department of Orthopedics, 401 Army General Hospital of Athens, Athens, Greece
| | - E Stamoulis
- Department of Radiology, 401 Army General Hospital of Athens, Athens, Greece
| | - G Kostopanagiotou
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece
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Henseler JF, Raz Y, Nagels J, van Zwet EW, Raz V, Nelissen RGHH. Multivariate analyses of rotator cuff pathologies in shoulder disability. PLoS One 2015; 10:e0118158. [PMID: 25710703 PMCID: PMC4339721 DOI: 10.1371/journal.pone.0118158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/05/2015] [Indexed: 12/28/2022] Open
Abstract
Background Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC) muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability. Methods Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA). We investigated patients with superior (supraspinatus, n = 39) and posterosuperior (supraspinatus and infraspinatus, n = 30) RC tears, and patients with an intact RC (n = 52) as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively. Results Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (p<0.001) and discriminated between superior and posterosuperior tears. In contrast neither tear size nor fatty infiltration of the supraspinatus or infraspinatus contributed to superior humeral translation. Conclusion Our study reveals that infraspinatus atrophy has the strongest contribution to RC tear pathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability.
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Affiliation(s)
- Jan F. Henseler
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
- * E-mail:
| | - Yotam Raz
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Vered Raz
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
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Xu C, Yang X, Zhao J. Arthroscopic treatment for synovial chondromatosis of the subacromial bursa associated with partial rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 2015; 23:600-2. [PMID: 25217318 DOI: 10.1007/s00167-014-3308-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/03/2014] [Indexed: 11/25/2022]
Abstract
UNLABELLED Synovial chondromatosis is characterized by benign synovial proliferation that leads to chondral or osteochondral foci formation. In this case report, a right-handed female suffered from progressively worsening pain and limited mobility of forward elevation, abduction and external rotation in her right shoulder. A shoulder arthroscopy was conducted, during which, thickened bursal synovium and several loose bodies were observed, associated with bursal side tear of rotator cuff. A thorough synovectomy, subacromial debridement and acromioplasty were conducted. The pathological findings were consistent with synovial chondromatosis. After systematic rehabilitation, the patient had relief of shoulder pain and full range of motions in 14-months follow-up. LEVEL OF EVIDENCE Case report, Level IV.
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Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
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20
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Minns Lowe CJ, Moser J, Barker K. Living with a symptomatic rotator cuff tear 'bad days, bad nights': a qualitative study. BMC Musculoskelet Disord 2014; 15:228. [PMID: 25008095 PMCID: PMC4105791 DOI: 10.1186/1471-2474-15-228] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/12/2014] [Indexed: 11/18/2022] Open
Abstract
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 ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.
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Liem D, Buschmann VE, Schmidt C, Gosheger G, Vogler T, Schulte TL, Balke M. The prevalence of rotator cuff tears: is the contralateral shoulder at risk? Am J Sports Med 2014; 42:826-30. [PMID: 24500916 DOI: 10.1177/0363546513519324] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rotator cuff tears are a common cause of pain and disability of the shoulder. Information on the prevalence and identification of potential risk factors could help in early detection of rotator cuff tears and improve treatment outcome. HYPOTHESIS Patients treated for a symptomatic rotator cuff tear on one side have a higher prevalence of rotator cuff tears and decreased shoulder function on the contralateral side compared with an age- and sex-matched group of healthy individuals. STUDY DESIGN Case control study; Level of evidence, 3. METHODS One group consisted of 55 patients who had been arthroscopically treated on one shoulder for rotator cuff tear (tear group). In this group, the nonoperated contralateral shoulder was examined. For comparison, the matching shoulder in a control group consisting of 55 subjectively healthy individuals matched by age (±1 year) and sex to the tear group was included. Diagnosis of a rotator cuff tear was made by ultrasound. Outcomes were measured using the Constant score. RESULTS The prevalence of supraspinatus tears was significantly higher (P < .0001) in the tear group (67.3%) compared with the control group (11.0%). The Constant score for the activities of daily living subscale, however, was significantly lower (18.4) in the tear group compared with the control group (19.9; P = .012). No other subcategory score nor the overall score showed a significant difference. There was a significantly higher tear prevalence in the tear group of patients aged between 50 and 59 years (P < .001) and 60 and 69 years (P = .004). No tear was diagnosed in the control group in individuals younger than 60 years. CONCLUSION Patients treated for partial and full-thickness rotator cuff tears have a significantly higher risk of having a tear on the contralateral side and have noticeable deficits in their shoulder function regarding activities of daily living even if the tear is otherwise asymptomatic.
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Affiliation(s)
- Dennis Liem
- Dennis Liem, Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Str 33, 48149 Muenster, Germany.
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The accuracy of sonoelastography in fatty degeneration of the supraspinatus: a comparison of magnetic resonance imaging and conventional ultrasonography. J Ultrasound 2014; 17:279-85. [PMID: 25368685 DOI: 10.1007/s40477-014-0064-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/07/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Sonolastography (SE) technique is one of the new functional ultrasonic imaging techniques, which was developed in the past few years and can obtain the distributions of elasticity in tissues. Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the ability of SE to assess the fatty degeneration of suprasupinatus (SSP) and to compare it to the MRI and the conventional ultrasonography (US) findings. MATERIALS AND METHODS The institutional review board approved the study, and a retrospective analysis between January 2013 and September 2013 was performed on 101 shoulders of 98 consecutive patients using MRI, US, and SE for the evaluation of shoulder lesion. Oblique sagittal images of SSP were obtained using SE. The SE images were evaluated by reviewers using an experimentally proven color grading system. RESULTS When comparing SE to standard MRI findings, the mean sensitivity of SE was 95.6 %, the specificity 87.5 %, and the accuracy 91.1 %. The interobserver reliability of the SE findings was "almost perfect agreement" with a weighted kappa coefficient of 0.81. On comparing MRI with the SE findings, the grades of MRI and SE have a positive correlation (r = 0.855, P = <0.001). Furthermore, the grades of US and SE also have a positive correlation (r = 0.793, P = <0.001). CONCLUSION SE is valuable in the quantitative assessment of the severity of the fatty atrophy of the supraspinatus and has an excellent accuracy, an excellent correlation with MRI and the conventional US, and an excellent interobserver reliability.
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Karas V, Hussey K, Romeo AR, Verma N, Cole BJ, Mather RC. Comparison of subjective and objective outcomes after rotator cuff repair. Arthroscopy 2013; 29:1755-61. [PMID: 24071390 DOI: 10.1016/j.arthro.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether subjective (pain by visual analog scale) or objective (strength by dynamometer) measures correlate with disease-specific measures and quality-of-life metrics in arthroscopic rotator cuff repair. METHODS The study population included patients who underwent primary arthroscopic rotator cuff repair at a single institution between 2006 and 2009. Within these parameters, data from 166 patients was obtained. Data were collected prospectively and reviewed retrospectively. Preoperative and 1-year postoperative data were compared. Correlation was determined in (1) disease-specific metrics including American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), and Simple Shoulder Test (SST) score and (2) quality of life measured by the Short Form 12. RESULTS Preoperative strength and pain are closely associated with postoperative changes (P < 1 × 10(-5), with β coefficients of 0.8 to 1.0). Change in ASES score was most closely associated with change in pain and change in CS with change in strength (R(2) = 0.82 and R(2) = 0.54, respectively). Only the SST score was found to be statistically linked to changes in both strength and pain (P < .05). CONCLUSIONS Patients, despite sex and age, with good preoperative strength and high preoperative pain will benefit most from arthroscopic rotator cuff repair. The CS best captures changes in strength, and the ASES score best captures changes in pain. Only changes in the SST score show a statistically significant link with changes in both strength and pain. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Vasili Karas
- Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Reuther KE, Thomas SJ, Evans EF, Tucker JJ, Sarver JJ, Ilkhani-Pour S, Gray CF, Voleti PB, Glaser DL, Soslowsky LJ. Returning to overuse activity following a supraspinatus and infraspinatus tear leads to joint damage in a rat model. J Biomech 2013; 46:1818-24. [PMID: 23764174 DOI: 10.1016/j.jbiomech.2013.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 01/08/2023]
Abstract
Large rotator cuff tears (supraspinatus and infraspinatus) are common in patients who perform overhead activities (laborers, athletes). In addition, following large cuff tears, these patients commonly attempt to return to pre-injury activity levels. However, there is a limited understanding of the damaging effects on the uninjured joint tissues when doing so. Therefore, the objective of this study was to investigate the effect of returning to overuse activity following a supraspinatus and infraspinatus tear on shoulder function and the structural and biological properties of the intact tendons and glenoid cartilage. Forty rats underwent 4 weeks of overuse followed by detachment of the supraspinatus and infraspinatus tendons and were then randomized into two groups: return to overuse or cage activity. Ambulatory measurements were performed over time and structural and biological properties of the adjacent tendons and cartilage were evaluated. Results demonstrated that animals returning to overuse activity did not have altered shoulder function but despite this, did have altered cartilage and tendon properties. These mechanical changes corresponded to altered transcriptional regulation of chondrogenic genes within cartilage and tendon. This study helps define the mechanical and biological mechanisms leading to joint damage and provides a framework for treating active cuff tear patients.
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Affiliation(s)
- Katherine E Reuther
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
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