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Glover MA, Fiegen AP, Bullock GS, Nicholson KF, Trasolini NA, Waterman BR. Management of Shoulder Instability in the Overhead Athletes. Clin Sports Med 2024; 43:683-703. [PMID: 39232574 DOI: 10.1016/j.csm.2024.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury.
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Affiliation(s)
- Mark A Glover
- Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Anthony P Fiegen
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristen F Nicholson
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas A Trasolini
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Hoenecke H, Fiske JW, Tamayo AE, D'Lima DD. Evolution of the throwing shoulder: why apes don't throw well and how that applies to throwing athletes. J Shoulder Elbow Surg 2024; 33:1404-1417. [PMID: 38316235 DOI: 10.1016/j.jse.2023.12.010] [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] [Received: 09/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Humans have unique characteristics making us the only primate that can throw well while most other primates throw predominately underhand with poor speed and accuracy. The purpose of this study is to illuminate the uniquely human characteristics that allow us to throw so well. When treating an injury such as a labral tear or capsule tear, this study hopes the reader can gain a better understanding of the issues that lead to the tear and those that may determine the success of treatment besides the actual repair. METHODS In addition to a review of scientific and medical literature, information was obtained from interviews and experience with primate veterinarians, anthropologists, archeologists, and professional baseball players. These sources were used to study the connection between evolutionary throwing activities and current sports medicine issues. RESULTS Arm acceleration requires a functional kinetic chain, rapid motor sequences, and the ability to absorb elastic energy in the shoulder. Successful treatment of the throwing shoulder requires awareness of the shoulder's position in the kinetic chain and correction of defects in the ability to execute the kinetic chain. Some problems in the shoulder could reflect regression to a more primitive anatomy or dyskinesis. Return of performance requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy. For example, tissue remodeling after rotator cuff repair continues for months to years; however, the newly formed tissue lacks the same elasticity of the native tendon. This suggests why throwing performance typically does not return for 7 or more months after repair even though there may be structural integrity at 3-4 months. CONCLUSION The shoulder has developed uniquely in modern man for the act of throwing. The anatomic deficiencies in primates for throwing provide an illustration of the more subtle changes that a throwing athlete might have that are detrimental to throwing. Nonhuman primates have been unable to demonstrate the kinetic chain sequence for throwing secondary to the lack of neurologic pathways required. Humans are more sophisticated and precise in their movements but lack robusticity in their bone and muscle architecture, seen especially in the human rotator cuff. Successful treatment of a throwing injury requires familiarity with the conditions that cause the injury or affect the rehabilitation process. The return of performance following injury or surgery requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy from the kinetic chain.
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Affiliation(s)
- Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA.
| | | | | | - Darryl D D'Lima
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
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Haider S, Cabrera A, Thakur U, Xi Y, Chhabra A. Single-Plane 3-Dimensional Isotropic Spin-Echo Magnetic Resonance Imaging Reconstructions of Shoulder Exhibit Superior Correlation to Surgical Findings Than 2-Dimensional Dixon Multiplanar Magnetic Resonance Imaging. J Comput Assist Tomogr 2024; 48:273-282. [PMID: 38013248 DOI: 10.1097/rct.0000000000001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate concordance of multiplanar 2-dimensional magnetic resonance imaging (2D-MRI) versus 3D isotropic MRI for rotator cuff and labral tears with the reference standard of arthroscopic surgical findings. METHODS It was an institutional review board-approved retrospective single-center study of consecutive preoperative patients with isotropic 3D-MRI on 3-Tesla scanners, multiplanar 2D-MRI, and shoulder arthroscopy. Scapular plane-oriented contiguous multiplanar reconstructions of 3D-images were evaluated by 2 experienced fellowship-trained musculoskeletal radiologists. Variables included the following: labral tear presence and rotator-cuff tear Ellman grade, thickness, and width. Sensitivities (Sen) and specificities (Spe) were calculated for binary variables. Mean squared errors (MSE) were calculated for ordinal variables. Lower MSE indicated higher concordance. RESULTS Seventy-two patients (43 female) with a mean age of 50.75 ± 9.76 years were evaluated. For infraspinatus-tear presence, 3D-MRI showed higher sensitivity (0.96) and specificity (0.68) than 2D-MRI (Sen = 0.85, Spe = 0.32) ( Psen = 0.005, Pspe = 0.002). For subscapularis-tear presence, 3D-MRI showed higher sensitivity (0.94) and specificity (0.73) compared with 2D-MRI (Sen = 0.83, Spe = 0.56) ( Psen = 0.02, Pspe = 0.04). For supraspinatus-tear presence, there was no significant difference between 3D-MRI (Sen =0.96, Spe = 0.67) compared with 2D-MRI (Sen = 0.98, Spe = 0.83) ( Psen = 0.43, Pspe = 0.63). For infraspinatus-tear thickness, 3D-MRI showed lower MSE (0.35) compared with 2D-MRI MSE (0.82) ( P = 0.01). For subscapularis-tear thickness, 3D-MRI had lower MSE (0.31) compared with 2D-MRI MSE (0.51) ( P = 0.007). However, no difference noted for supraspinatus-tear thickness when comparing 3D-MRI MSE (0.39) and 2D-MRI MSE (0.51) ( P = 0.49). For labral-tear presence, 3D-MRI had a lower MSE (0.20) compared with 2D-MRI MSE (0.57) ( P < 0.001). CONCLUSIONS Three-dimensional MRI of the shoulder is time efficient with a shorter acquisition time and exhibits comparable with superior correlation to surgical findings than 2D-MRI for detection of labral tears and some rotator cuff tears. Three-dimensional MRI may be used in place of traditional 2D-MRI in detection of soft-tissue shoulder injury in centers equipped to do so.
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Carnevale A, Mannocchi I, Schena E, Carli M, Sassi MSH, Marino M, Longo UG. Performance Evaluation of an Immersive Virtual Reality Application for Rehabilitation after Arthroscopic Rotator Cuff Repair. Bioengineering (Basel) 2023; 10:1305. [PMID: 38002429 PMCID: PMC10668954 DOI: 10.3390/bioengineering10111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Few studies have evaluated the effectiveness of shoulder rehabilitation in virtual environments. The objective of this study was to investigate the performance of a custom virtual reality application (VR app) with a stereophotogrammetric system considered the gold standard. A custom VR app was designed considering the recommended rehabilitation exercises following arthroscopic rotator cuff repair. Following the setting of the play space, the user's arm length, and height, five healthy volunteers performed four levels of rehabilitative exercises. Results for the first and second rounds of flexion and abduction displayed low total mean absolute error values and low numbers of unmet conditions. In internal and external rotation, the number of times conditions were not met was slightly higher; this was attributed to a lack of isolated shoulder movement. Data is promising, and volunteers were able to reach goal conditions more often than not. Despite positive results, more literature comparing VR applications with gold-standard clinical parameters is necessary. Nevertheless, results contribute to a body of literature that continues to encourage the application of VR to shoulder rehabilitation programs.
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Affiliation(s)
- Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
| | - Ilaria Mannocchi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Emiliano Schena
- Unit of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy;
| | - Marco Carli
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Mohamed Saifeddine Hadj Sassi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Martina Marino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance. Orthop J Sports Med 2023; 11:23259671231186820. [PMID: 37655246 PMCID: PMC10467408 DOI: 10.1177/23259671231186820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Background The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design Case series; Level of evidence, 4. Methods This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.
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Affiliation(s)
- Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey
| | | | - Gian Mario Micheloni
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Andrea Giorgini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
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Reinholz AK, Till SE, Arguello AM, Barlow JD, Okoroha KR, Camp CL. Advances in the Treatment of Rotator Cuff Tears: Management of Rotator Cuff Tears in the Athlete. Clin Sports Med 2023; 42:69-79. [PMID: 36375871 PMCID: PMC10009818 DOI: 10.1016/j.csm.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Unique biomechanical factors in the overhead and throwing athlete lead to a spectrum of rotator cuff pathology, usually with progressive lateralization of the supraspinatus footprint. Initial comprehensive nonoperative management is indicated for all athletes. Progression to arthroscopic debridement, repair of concomitant injuries, and possible rotator cuff repair with a transosseous equivalent technique are the current management strategies for athletes when nonoperative management fails.
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Affiliation(s)
- Anna K Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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The Applicability of Provocative Functional Tests in the Diagnosis of Rotator Cuff Muscle Injuries of the Best University Athletes. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7728277. [PMID: 36277881 PMCID: PMC9584688 DOI: 10.1155/2022/7728277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
Rotator cuff disease, external and internal impingement syndromes, low shoulder stability, various types of trauma, and overuse injuries are all related to sports activities. In order to check symptoms in patients with disability and shoulder pain, clinicians use different methods and diagnostic imaging assessment. The research is aimed at evaluating whether there is a difference between provocation function tests (PFT) and ultrasonographic (US) testing of muscles within the rotator cuff in elite collegiate athletes. Patients (
) were recruited from university team sports selections and tested with a standardized US examination of the shoulder and five PFTs (Speed’s test, Neer’s test, Hawkins test, lift-off test, Yergason’s test). Based on the VAS pain assessment scale, 60 subjects had some pain, which was taken for further processing in the work (124 subjects did not have the presence of pain and were excluded from further processing). The US examination was conducted using Voluson 730 apparatus, by a linear probe, with the frequency in the range of 6-12 MHz. The chi-square test showed significant differences between PFT and the occurrence of shoulder muscle tendinitis for the following variables: Speed’s test and subscapularis tendinitis (
) and Speed’s test and infraspinatus tendinitis (
); Neer test and biceps brachii caput longum tendinitis (
), Neer test and supraspinatus tendinitis (
) and Neer test and infraspinatus tendinitis (
); lift-off test and subscapularis tendinitis (
); and Yergason’s test and biceps brachii caput longum tendinitis (
) and Yergason’s test and subscapitis tendinitis (
). The greatest effect of differences was observed in Neer’s test and biceps brachii caput longum tendinitis (
), while the other effects can be described as medium and small in most cases. It can be concluded that functional tests are good predictors of soft tissue changes in the muscles of the rotator cuff of the shoulder. Further monitoring and analysis are needed on a larger number of athletes.
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Requejo-Salinas N, Lewis J, Michener LA, La Touche R, Fernández-Matías R, Tercero-Lucas J, Camargo PR, Bateman M, Struyf F, Roy JS, Jaggi A, Uhl T, Bisset L, Wassinger CA, Donatelli R, Haik MN, Lluch-Girbés E. International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study. Braz J Phys Ther 2022; 26:100395. [PMID: 35366589 DOI: 10.1016/j.bjpt.2022.100395] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, United States
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain; Neuroscience and Craniofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; Research Institute of Physical Therapy and Pain, University of Alcala, Alcala de Henares, Madrid, Spain.
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marcus Bateman
- Derby Shoulder Unit, Orthopaedic Outpatient Department, Royal Derby Hospital, Derby, United Kingdom
| | - Filip Struyf
- Department Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, London Borough of Harrow, London, United Kingdom
| | - Timothy Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, United States
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, South East Queensland, Australia
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, United States
| | | | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, University of Valencia, Valencia, Spain
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Moser HL, Abraham AC, Howell K, Laudier D, Zumstein MA, Galatz LM, Huang AH. Cell lineage tracing and functional assessment of supraspinatus tendon healing in an acute repair murine model. J Orthop Res 2021; 39:1789-1799. [PMID: 32497311 PMCID: PMC7714710 DOI: 10.1002/jor.24769] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Rotator cuff supraspinatus tendon injuries are common with high rates of anatomic failure after surgical repair. The purpose of the study was to define clinically relevant features of a mouse model of supraspinatus tendon injury to determine painful, functional, and structural outcomes; we further investigated two cell populations mediating healing using genetic lineage tracing after full detachment and repair of the supraspinatus tendon in mice. The pain was assessed using the mouse grimace scale and function by gait analysis and tensile testing. Histological and microCT analyses were used to determine enthesis/tendon and bone structure, respectively. Lineage tracing was carried out using inducible Cre lines for ScxCreERT2 (tendon cells) and αSMACreERT2 (myofibroblasts and mesenchymal progenitors). Mice only expressed pain transiently after surgery despite long-term impairment of functional and structural properties. Gait, tensile mechanical properties, and bone properties were significantly reduced after injury and repair. Lineage tracing showed relatively few Scx lin tendon cells while αSMA lin cells contributed strongly to scar formation. Despite surgical reattachment of healthy tendon, lineage tracing revealed poor preservation of supraspinatus tendon after acute injury and loss of tendon structure, suggesting that tendon degeneration is also a key impediment of successful rotator cuff repair. Scar formation after surgery is mediated largely by αSMA lin cells and results in permanently reduced functional and structural properties.
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Affiliation(s)
- Helen L. Moser
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA,Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland
| | - Adam C. Abraham
- Columbia University Irving Medical Center, Department of Orthopedic Surgery, New York, NY 10032, USA
| | - Kristen Howell
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Damien Laudier
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Matthias A. Zumstein
- Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland,Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, 3006 Bern, Switzerland
| | - Leesa M. Galatz
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Alice H. Huang
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
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Abstract
PURPOSE OF REVIEW This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players. RECENT FINDINGS Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance. Rotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.
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Affiliation(s)
- Rami G. Alrabaa
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
| | - Mario H. Lobao
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
| | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY 10032 USA
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Moser HL, Doe AP, Meier K, Garnier S, Laudier D, Akiyama H, Zumstein MA, Galatz LM, Huang AH. Genetic lineage tracing of targeted cell populations during enthesis healing. J Orthop Res 2018; 36:3275-3284. [PMID: 30084210 PMCID: PMC6320286 DOI: 10.1002/jor.24122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/06/2018] [Indexed: 02/04/2023]
Abstract
Rotator cuff supraspinatus tendon injuries are clinically challenging due to the high rates of failure after surgical repair. One key limitation to functional healing is the failure to regenerate the enthesis transition between tendon and bone, which heals by disorganized scar formation. Using two models of supraspinatus tendon injury in mouse (partial tear and full detachment/repair), the purpose of the study was to determine functional gait outcomes and identify the origin of the cells that mediate healing. Consistent with previous reports, enthesis injuries did not regenerate; partial tear resulted in a localized scar defect adjacent to intact enthesis, while full detachment with repair resulted in full disruption of enthesis alignment and massive scar formation between tendon and enthesis fibrocartilage. Although gait after partial tear injury was largely normal, gait was permanently impaired after full detachment/repair. Genetic lineage tracing of intrinsic tendon and cartilage/fibrocartilage cells (ScxCreERT2 and Sox9CreERT2 , respectively), myofibroblasts (αSMACreERT2 ), and Wnt-responsive stem cells (Axin2CreERT2 ) failed to identify scar-forming cells in partial tear injury. Unmineralized enthesis fibrocartilage was strongly labeled by Sox9CreERT2 while Axin2CrERT2 labeled a subset of tendon cells away from the skeletal insertion site. In contrast to the partial tear model, Axin2CreERT2 labeling showed considerable contribution of Axin2lin cells to the scar after full detachment/repair. Clinical Significance: Clinically relevant models of rotator cuff tendon injuries in mouse enable the use of genetic tools; lineage tracing suggests that distinct mechanisms of healing are activated with full detachment/repair injuries versus partial tear. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3275-3284, 2018.
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Affiliation(s)
- Helen L. Moser
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Anton Ph. Doe
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kristen Meier
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Simon Garnier
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - Damien Laudier
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University School of Medicine Gifu, Gifu Prefecture, Japan
| | - Matthias A. Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Leesa M. Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alice H. Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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13
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Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear. Musculoskelet Surg 2018; 102:13-19. [PMID: 30343476 DOI: 10.1007/s12306-018-0555-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions. METHODS A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3-4 stage of fatty infiltration, and an absent acromion-humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications. Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained. RESULTS Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41-58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2-4); the mean operative time was 70 min (range 45-90). The mean preoperative CS was 55 (range 45-75, SD 17), while the SSV was 40 (range 30-70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62-85, SD 8) and 80 (range 60-90, SD 10) (p < 0.001 with respect to the preoperative scores), respectively. At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery. CONCLUSIONS The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs. LEVEL OF EVIDENCE Level 4, case series with no comparison group.
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14
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Merolla G, Paladini P, Porcellini G. Assessment of return to play in professional overhead athletes subjected to arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow score. Musculoskelet Surg 2018; 102:29-34. [PMID: 29948936 DOI: 10.1007/s12306-018-0547-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The self-administered Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow questionnaire is a reliable and sensitive outcome tool to assess upper extremity athletic performance and functional changes affecting return to play in overhead athletes. We report the results of a study of return to sport in professional overhead athletes at a mean follow-up of 2 years after arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the score. MATERIALS AND METHODS A total number of 38 patients completed the 10-item questionnaire before and after surgery. They were also asked (1) whether they had returned to play; (2) how many months after the operation they had done so; (3) the level of postoperative performance (preinjury or less); and (4) whether they had had to change sport due to their shoulder problems. RESULTS Significant differences were found (1) between preoperative and postoperative scores; (2) between the scores of patients who returned to play at preinjury level and those who merely returned to competition; and (3) between the postoperative subscores of 8/10 items, which were higher in the patients who returned to preinjury performance than in those who merely returned to play; the two items that were not significantly different between these subgroups concerned pain and joint stability. Even though item analysis highlighted a major role for athletic performance in recovery of preinjury performance, it also stressed that the athlete's relationship with coach, agent, and staff and his/her feeling of the extent to which the arm affects current performance significantly contribute to the final score. CONCLUSIONS The KJOC Shoulder and Elbow score provides an accurate and exhaustive assessment of the recovery of the athlete's shoulder in relation to preinjury performance and provides the surgeon with key information on the pros and cons of surgical management.
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Affiliation(s)
- G Merolla
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna Ambito Rimini, Via L.V. Beethoven 5, 47841, Cattolica, Italy.
- Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica, Italy.
| | - P Paladini
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna Ambito Rimini, Via L.V. Beethoven 5, 47841, Cattolica, Italy
| | - G Porcellini
- Orthopaedic and Trauma Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Roos TR, Roos AK, Avins AL, Ahmed MA, Kleimeyer JP, Fredericson M, Ioannidis JPA, Dragoo JL, Kim SK. Genome-wide association study identifies a locus associated with rotator cuff injury. PLoS One 2017; 12:e0189317. [PMID: 29228018 PMCID: PMC5724859 DOI: 10.1371/journal.pone.0189317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/22/2017] [Indexed: 01/10/2023] Open
Abstract
Rotator cuff tears are common, especially in the fifth and sixth decades of life, but can also occur in the competitive athlete. Genetic differences may contribute to overall injury risk. Identifying genetic loci associated with rotator cuff injury could shed light on the etiology of this injury. We performed a genome-wide association screen using publically available data from the Research Program in Genes, Environment and Health including 8,357 cases of rotator cuff injury and 94,622 controls. We found rs71404070 to show a genome-wide significant association with rotator cuff injury with p = 2.31x10-8 and an odds ratio of 1.25 per allele. This SNP is located next to cadherin8, which encodes a protein involved in cell adhesion. We also attempted to validate previous gene association studies that had reported a total of 18 SNPs showing a significant association with rotator cuff injury. However, none of the 18 SNPs were validated in our dataset. rs71404070 may be informative in explaining why some individuals are more susceptible to rotator cuff injury than others.
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Affiliation(s)
- Thomas R. Roos
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
- Department of Health Research and Policy, Division of Epidemiology, Stanford University Medical Center, Stanford, CA, United States of America
| | - Andrew K. Roos
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
- Department of Health Research and Policy, Division of Epidemiology, Stanford University Medical Center, Stanford, CA, United States of America
| | - Andrew L. Avins
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America
| | - Marwa A. Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
| | - John P. Kleimeyer
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - John P. A. Ioannidis
- Department of Medicine, Stanford Prevention Research Center and Dept. of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, and Dept. of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, United States of America
| | - Jason L. Dragoo
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - Stuart K. Kim
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
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Arthroscopic Rotator Cuff Repair With Mini-open Subpectoral Biceps Tenodesis. Arthrosc Tech 2017; 6:e1667-e1674. [PMID: 29416964 PMCID: PMC5795267 DOI: 10.1016/j.eats.2017.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
With a range of tear characteristics such as chronicity, degree of fatty atrophy, and number of tendons involved as well as varying patient-specific characteristics including age, injury mechanism, and expectations after treatment to consider, proper and successful treatment of a rotator cuff tear is multifactorial and, consequently, challenging. Although conservative management of a rotator cuff tear may be successful, a more severe tear with involvement of more tendons may warrant surgical intervention. Furthermore, additional pathology including biceps tendinopathy may result in greater patient morbidity and an even more complex treatment decision-making process and surgical technique. The purpose of this Technical Note is to describe our preferred surgical technique for the treatment of a rotator cuff tear involving 2 rotator cuff tendons in conjunction with a lesion of the long head of the biceps tendon.
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17
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Abstract
The overhead pitching motion is a coordinated sequence of movements that subjects the shoulder to extreme forces. The ultimate goal of this complex, dynamic activity is to generate high ball velocity and accuracy. In doing so, repetitive throwing can cause adaptive and pathologic changes in the thrower's shoulder. This article reviews the relevant shoulder anatomy, the kinetic chain, and throwing mechanics, as well as common shoulder injuries and surgical options for the treating orthopedic surgeon.
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Affiliation(s)
- Ryan A Mlynarek
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, Ann Arbor, MI 48109-5328, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, Ann Arbor, MI 48109-5328, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, Shoulder and Sports Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Suite 1000, Ann Arbor, MI 48106, USA.
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18
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Rodeo SA, Nguyen JT, Cavanaugh JT, Patel Y, Adler RS. Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers. Am J Sports Med 2016; 44:3214-3221. [PMID: 27507844 DOI: 10.1177/0363546516657823] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder pain is a common problem in competitive swimmers, but the structural alterations in elite-level competitive swimmers are not well known. HYPOTHESIS Adaptive changes are common in the rotator cuff, bursa, labrum, and capsule in elite swimmers, and such abnormalities are related to factors concerning training and correlate with symptoms. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The study population was the 2008 United States Olympic swimming team. All athletes completed standardized scales on shoulder pain and function and provided data on their training history and history of shoulder pain or injuries. Each athlete also underwent a comprehensive physical examination of both shoulders, followed by an evaluation of the rotator cuff, biceps, and bursa using ultrasound with dynamic images to assess for subcoracoid impingement and subacromial impingement. RESULTS A history of shoulder pain was reported by 29 of 42 (66%) athletes. Morphological changes consistent with tendinosis were common in the biceps (33/46 shoulders; 72%) and supraspinatus/infraspinatus (44/46 shoulders; 96%). Subcoracoid impingement was seen in 17 of 46 shoulders (37%), with subacromial impingement seen in 34 of 41 shoulders (83%). There was an increased odds ratio (OR) for biceps tendinosis in older swimmers (OR, 1.92; 95% CI, 1.23-3.00; P = .004) and in swimmers who had missed a competition because of shoulder pain (OR, 9.76; 95% CI, 1.13-84.3; P = .038). There was an increased OR for rotator cuff tendinosis in swimmers who reported worse scores for pain with activities (OR, 0.10; 95% CI, 0.01-0.78; P = .028) and in those with a positive sulcus sign (OR, 33.2; 95% CI, 3.09-355; P = .004). There was an increased OR for impingement in swimmers with a positive sulcus sign (OR, 5.40; 95% CI, 0.80-36.3; P = .083), worse pain scores (OR, 0.44; 95% CI, 0.22-0.87; P = .019), and a partial rotator cuff tear (OR, 31.2; 95% CI, 3.58-272; P = .002). CONCLUSION We found a high prevalence of rotator cuff and biceps tendinopathy, which was associated with increased symptoms. Tendinosis was also more common in swimmers with a positive sulcus sign, suggesting a role for shoulder laxity.
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Affiliation(s)
- Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | | | | | - Yashika Patel
- Hospital for Special Surgery, New York, New York, USA
| | - Ronald S Adler
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
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19
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Changstrom B, Jayanthi N. Clinical Evaluation of the Adult Recreational Tennis Player. Curr Sports Med Rep 2016; 15:437-445. [DOI: 10.1249/jsr.0000000000000315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Abstract
The large amount of force imparted across the shoulder during the act of throwing makes the glenohumeral joint highly susceptible to injury in the athlete performing overhead throwing motions. The bony incongruity of the shoulder enables greater range of motion than any other joint in the body, but it also results in significant strain on the surrounding soft tissues during the throwing motion. Throwers can present with acute injuries, but more commonly they suffer from chronic overuse conditions resulting from repetitive overload. Proper management requires early recognition with treatment directed toward the athlete's safe return to sports. Failure to institute an appropriate management strategy may result in significant complications, including prolonged disability, progression of symptoms, and further injury. We discuss the functional anatomy, pathophysiology, clinical presentation, evaluation, and treatment of common injuries of the glenoid labrum and rotator cuff in the overhead throwing athlete.
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Affiliation(s)
- Travis J Menge
- Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University , Nashville, TN , USA
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21
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Alpert J, Flannery R, Epstein R, Monaco R, Prendergast N. Humeral stress edema: an injury in overhead athletes quarterback with humeral "shin" splints-a case report. Clin J Sport Med 2014; 24:e59-61. [PMID: 24378406 DOI: 10.1097/jsm.0000000000000036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Stress injury to the distal humerus has been reported as a cause of chronic arm pain among competitive tennis players. As the serve is technically similar to an overhead throwing motion, it is conceivable that this injury could occur in other overhead athletes. Overuse injuries, including rotator cuff tears, ulnar collateral ligament injuries, and joint sprains have routinely been reported in quarterbacks, but there are few reported cases of upper extremity bony stress injuries in these athletes. Magnetic resonance imaging aids in the diagnostic evaluation of an upper extremity injury as it can identify numerous structural injuries and early stress changes within bone. Accurately diagnosing stress reactions helps prevent progression toward stress fracture, which is possible if conservative measures are initiated early in the rehabilitation period. In this article, we report the case of an elite college quarterback who presented with localized elbow pain while throwing.
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Affiliation(s)
- Justin Alpert
- *Department of Radiology, UMDNJ-Robert Wood Johnson (RWJ) University Hospital, New Brunswick, New Jersey; and †Department of Family Medicine, Sports Medicine Fellowship, Rutgers/UMDNJ/RWJ, New Brunswick, New Jersey
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22
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Morrow MMB, Van Straaten MG, Murthy NS, Braman JP, Zanella E, Zhao KD. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. BIOMED RESEARCH INTERNATIONAL 2014; 2014:769649. [PMID: 25180192 PMCID: PMC4142383 DOI: 10.1155/2014/769649] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.
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Affiliation(s)
- Melissa M. B. Morrow
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Meegan G. Van Straaten
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Naveen S. Murthy
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elia Zanella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA
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