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Wang T, Guo J, Mi Y, Xiao Z, Yin B, Lu B, Deng H. States of contra-lateral rotator cuff - Based on bilateral shoulder ultrasound results of 401 patients. J Orthop Sci 2024; 29:964-968. [PMID: 37330353 DOI: 10.1016/j.jos.2023.05.007] [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: 12/27/2022] [Revised: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND For patients with rotator cuff tear (RCT), the contra-lateral shoulders have higher risk of RCT than general population. It has been proved by several previous studies. The focus of this study is to obtain the data of contra-lateral rotator cuff tear in Chinese population, and to find the rules of contra-lateral rotator cuff tear through statistical analysis. METHODS From March 2016 to January 2020, patients who underwent shoulder arthroscopic surgery were included in the study, we conduct bilateral shoulder ultrasound before surgery, patients information collection include gender, age, occupation and whether received contra-lateral rotator cuff surgery within 1-3 years. The above information was statistically analyzed. RESULTS According to the inclusion and exclusion criteria, 401 patients were included. The incidence of contra-lateral rotator cuff tear was 24.3%, 5.58% of them underwent contra-lateral rotator cuff repair surgery within 3 years. The degree of contra-lateral rotator cuff tear was positively correlated with the degree of the primary side; Patients with full-thickness rotator cuff tear were more likely to have contra-lateral rotator cuff tear than patients with partial rotator cuff tear. For patients with supraspinatus tendon tear, the contra-lateral rotator cuff tear risk increases, For patients with subscapularis muscle tear, the contra-lateral rotator cuff tear risk doesn't increases. Contra-lateral rotator cuff tear is related to age, the risk of contra-lateral rotator cuff tear is higher in elderly patients. CONCLUSIONS The contra-lateral RCT data obtained in our study was 24.3%, significantly lower than that of previous studies. The reasons may include ethnic variation, lifestyle, and proportion of heavy physical labor. The condition of contra-lateral rotator cuff is closely related to affected side rotator cuff tear.
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Affiliation(s)
- Tianci Wang
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Jialiang Guo
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Yaru Mi
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Zeng Xiao
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bing Yin
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Bo Lu
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
| | - Heping Deng
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
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Kurtaliaj I, Hoppe ED, Huang Y, Ju D, Sandler JA, Yoon D, Smith LJ, Betancur ST, Effiong L, Gardner T, Tedesco L, Desai S, Birman V, Levine WN, Genin GM, Thomopoulos S. Python tooth-inspired fixation device for enhanced rotator cuff repair. SCIENCE ADVANCES 2024; 10:eadl5270. [PMID: 38941456 PMCID: PMC11212709 DOI: 10.1126/sciadv.adl5270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/23/2024] [Indexed: 06/30/2024]
Abstract
Rotator cuff repair surgeries fail frequently, with 20 to 94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we drew inspiration from the specialized teeth of snakes of the Pythonoidea superfamily, which grasp soft tissues without tearing. To apply this nondamaging gripping approach to the surgical repair of tendon, we developed and optimized a python tooth-inspired device as an adjunct to current rotator cuff suture repair and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, enabling optimization of the clinically relevant device that substantially enhances rotator cuff repair by distributing stresses over the attachment footprint. This approach suggests an alternative to traditional suturing paradigms and may reduce the risk of tendon retearing after rotator cuff repair.
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Affiliation(s)
- Iden Kurtaliaj
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Yuxuan Huang
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David Ju
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Jacob A. Sandler
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Donghwan Yoon
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Lester J. Smith
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Linda Effiong
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Koru Medical Systems, Mahwah, NJ 07430, USA
| | - Thomas Gardner
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Liana Tedesco
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Sohil Desai
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, St. Louis, MO 65409, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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Yeung A, Fernando A, Patel M, Gatto L, Ackland DC. Muscle and joint function in the rotator cuff deficient shoulder. J Orthop Res 2024. [PMID: 38864683 DOI: 10.1002/jor.25909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024]
Abstract
Full-thickness rotator cuff tears can lead to poor coaptation of the humeral head to the glenoid, disrupting muscle forces required for glenohumeral joint stability, ultimately leading to joint subluxation. The aim of this study was to evaluate muscle forces and glenohumeral joint translations during elevation in the presence of isolated and combined full-thickness rotator cuff tears. Eight fresh-frozen upper limbs were mounted to a computer-controlled testing apparatus that simulated joint motion by simulated muscle force application. Scapular-plane abduction was performed, and glenohumeral joint translations were measured using an optoelectronic system. Testing was performed in the native shoulder, a following an isolated tear to the supraspinatus, as well as combined tears involving the supraspinatus and subscapularis, as well as supraspinatus, infraspinatus, and teres minor. Rotator cuff tears significantly increased middle deltoid force at 30°, 60°, and 90° of abduction relative to that in the native shoulder (p < 0.05). Significantly greater superior translations were observed relative to the intact shoulder due to combined tears to the supraspinatus and infraspinatus at 30° of abduction (mean increase: 1.6 mm, p = 0.020) and 60° of abduction (mean increase: 4.8 mm, p = 0.040). This study illustrates the infraspinatus-teres minor complex as a major humeral head depressor and contributor to glenohumeral joint stability. An increase in deltoid force during abduction occurs in the presence of rotator cuff tears, which exacerbates superior migration of the humeral head. The findings may help in the development of clinical tests in rotator cuff tear diagnostics, in surgical planning of rotator cuff repair, and in planning of targeted rehabilitation.
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Affiliation(s)
- Angus Yeung
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
| | - Ashen Fernando
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
| | - Minoo Patel
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Australia
| | - Laura Gatto
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
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Croci E, Hess H, Genter J, Baum C, Kovacs BK, Nüesch C, Baumgartner D, Gerber K, Müller AM, Mündermann A. Severity of rotator cuff disorders and additional load affect fluoroscopy-based shoulder kinematics during arm abduction. J Orthop Traumatol 2024; 25:30. [PMID: 38850466 PMCID: PMC11162404 DOI: 10.1186/s10195-024-00774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/25/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Rotator cuff disorders, whether symptomatic or asymptomatic, may result in abnormal shoulder kinematics (scapular rotation and glenohumeral translation). This study aimed to investigate the effect of rotator cuff tears on in vivo shoulder kinematics during a 30° loaded abduction test using single-plane fluoroscopy. MATERIALS AND METHODS In total, 25 younger controls, 25 older controls and 25 patients with unilateral symptomatic rotator cuff tears participated in this study. Both shoulders of each participant were analysed and grouped on the basis of magnetic resonance imaging into healthy, rotator cuff tendinopathy, asymptomatic and symptomatic rotator cuff tears. All participants performed a bilateral 30° arm abduction and adduction movement in the scapular plane with handheld weights (0, 2 and 4 kg) during fluoroscopy acquisition. The range of upward-downward scapular rotation and superior-inferior glenohumeral translation were measured and analysed during abduction and adduction using a linear mixed model (loads, shoulder types) with random effects (shoulder ID). RESULTS Scapular rotation was greater in shoulders with rotator cuff tendinopathy and asymptomatic rotator cuff tears than in healthy shoulders. Additional load increased upward during abduction and downward during adduction scapular rotation (P < 0.001 in all groups but rotator cuff tendinopathy). In healthy shoulders, upward scapular rotation during 30° abduction increased from 2.3° with 0-kg load to 4.1° with 4-kg load and on shoulders with symptomatic rotator cuff tears from 3.6° with 0-kg load to 6.5° with 4-kg load. Glenohumeral translation was influenced by the handheld weights only in shoulders with rotator cuff tendinopathy (P ≤ 0.020). Overall, superior glenohumeral translation during 30° abduction was approximately 1.0 mm with all loads. CONCLUSIONS The results of glenohumeral translation comparable to control but greater scapular rotations during 30° abduction in the scapular plane in rotator cuff tears indicate that the scapula compensates for rotator cuff deficiency by rotating. Further analysis of load-dependent joint stability is needed to better understand glenohumeral and scapula motion. LEVEL OF EVIDENCE Level 2. TRIAL REGISTRATION Ethical approval was obtained from the regional ethics committee (Ethics Committee Northwest Switzerland EKNZ 2021-00182), and the study was registered at clinicaltrials.gov on 29 March 2021 (trial registration number NCT04819724, https://clinicaltrials.gov/ct2/show/NCT04819724 ).
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Hanspeter Hess
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Jeremy Genter
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Cornelia Baum
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik Zurich, Zurich, Switzerland
| | | | - Corina Nüesch
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Kate Gerber
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Hochreiter B, Germann C, Feuerriegel GC, Sutter R, Selman F, Gressl M, Ek ET, Wieser K. Natural History of Quantitative Fatty Infiltration and 3D Muscle Volume After Nonoperative Treatment of Symptomatic Rotator Cuff Tears: A Prospective MRI Study of 79 Patients. J Bone Joint Surg Am 2024; 106:690-699. [PMID: 38386719 DOI: 10.2106/jbjs.23.01083] [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] [Indexed: 02/24/2024]
Abstract
BACKGROUND The severity of fatty infiltration (FI) predicts the treatment outcome of rotator cuff tears. The purpose of this investigation was to quantitatively analyze supraspinatus (SSP) muscle FI and volume at the initial presentation and after a 3-month minimum of conservative management. We hypothesized that progression of FI could be predicted with initial tear size, FI, and muscle volume. METHODS Seventy-nine shoulders with rotator cuff tears were prospectively enrolled, and 2 magnetic resonance imaging (MRI) scans with 6-point Dixon sequences were acquired. The fat fraction within the SSP muscle was measured on 3 sagittal slices, and the arithmetic mean was calculated (FI SSP ). Advanced FI SSP was defined as ≥8%, pathological FI SSP was defined as ≥13.5%, and relevant progression was defined as a ≥4.5% increase in FI SSP . Furthermore, muscle volume, tear location, size, and Goutallier grade were evaluated. RESULTS Fifty-seven shoulders (72.2%) had normal FI SSP , 13 (16.5%) had advanced FI SSP , and 9 (11.4%) had pathological FI SSP at the initial MRI scan. Eleven shoulders (13.9%) showed a ≥4.5% increase in FI SSP at 19.5 ± 14.7 months, and 17 shoulders (21.5%) showed a ≥5-mm 3 loss of volume at 17.8 ± 15.3 months. Five tears (7.1%) with initially normal or advanced FI SSP turned pathological. These tears, compared with tears that were not pathological, had significantly higher initial mediolateral tear size (24.8 compared with 14.3 mm; p = 0.05), less volume (23.5 compared with 34.2 mm 3 ; p = 0.024), more FI SSP (9.6% compared with 5.6%; p = 0.026), and increased progression of FI SSP (8.6% compared with 0.5%; p < 0.001). An initial mediolateral tear size of ≥20 mm yielded a relevant FI SSP progression rate of 81.8% (odds ratio [OR], 19.0; p < 0.001). Progression rates of 72.7% were found for both initial FI SSP of ≥9.9% (OR, 17.5; p < 0.001) and an initial anteroposterior tear size of ≥17 mm (OR, 8.0; p = 0.003). Combining these parameters in a logistic regression analysis led to an area under the receiver operating characteristic curve (AUC) of 0.913. The correlation between FI SSP progression and the time between MRI scans was weak positive (ρ = 0.31). CONCLUSIONS Three risk factors for relevant FI progression, quantifiable on the initial MRI, were identified: ≥20-mm mediolateral tear size, ≥9.9% FI SSP , and ≥17-mm anteroposterior tear size. These thresholds were associated with a higher risk of tear progression: 19 times higher for ≥20-mm mediolateral tear size, 17.5 times higher for ≥9.9% FI SSP , and 8 times higher for ≥17-mm anteroposterior tear size. The presence of all 3 yielded a 91% chance of ≥4.5% progression of FI SSP within a mean of 19.5 months. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Georg C Feuerriegel
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Farah Selman
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Maximilian Gressl
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Center, Monash University, Melbourne, Victoria, Australia
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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6
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Olson JJ, Hill JR, Wang J, Sefko JA, Teefey SA, Middleton WD, Keener JD. Predictors of pain development for contralateral asymptomatic degenerative rotator cuff tears based on features of an ipsilateral painful cuff tear: a prospective longitudinal cohort study. J Shoulder Elbow Surg 2024; 33:234-246. [PMID: 37844830 DOI: 10.1016/j.jse.2023.09.008] [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: 05/14/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Prior rotator cuff disease natural history studies have focused on tear-related factors that predict disease progression within a given shoulder. The purpose of this study was to examine both patient- and tear-related characteristics of a painful rotator cuff tear that predict future pain development and functional impairment in a shoulder with a contralateral asymptomatic cuff tear. METHODS This was a prospective longitudinal cohort study of patients aged ≤65 years who underwent surgery for a painful degenerative rotator cuff tear and possessed an asymptomatic contralateral tear. Patients were followed up prospectively by shoulder ultrasound, physical examination, and functional score assessment. The primary outcome was change in the American Shoulder and Elbow Surgeons (ASES) score at 2 years. Secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, Patient-Reported Outcomes Measurement Information System (PROMIS) score, Hospital Anxiety Depression Scale (HADS) depression and anxiety scores, and Veterans RAND-12 (VR-12) mental component score (MCS). RESULTS Sixty-five patients were included, with a mean follow-up period of 37 months (range, 24-42 months). In 17 patients (26%), contralateral shoulder pain developed at a median of 15.2 months (interquartile range [IQR], 10.5 months). No difference in age, sex, Charlson Comorbidity Index, or occupational demand was noted between patients in whom pain developed and those in whom pain did not develop. In the presenting painful shoulder, there was no difference in baseline tear size, muscle degeneration, or biceps pathology between groups. The mean baseline tear length (8.6 mm vs. 3.8 mm, P = .0008) and width (8.4 mm vs. 3.2 mm, P = .0004) were larger in asymptomatic shoulders in which pain subsequently developed compared with those in which pain did not develop. However, there was no difference in mean tear enlargement (P = .51 for length and P = .90 for width). There were no differences in baseline ASES, WORC, Patient-Reported Outcomes Measurement Information System (PROMIS), or HADS depression and anxiety scores between shoulders in which pain developed and those in which pain did not develop; however, patients in whom pain developed reported a lower baseline VR-12 MCS (53.3 vs. 57.6, P = .04). Shoulders in which pain developed had higher visual analog scale pain scores (2.9 [standard deviation (SD), 2.5] vs. 0.6 [SD, 1.0]; P = .016), lower ASES scores 75 [SD, 33] vs. 100 [SD, 11.6]; P = .001), and significant changes in all WORC scales with pain onset compared with those that remained asymptomatic. The study showed no significant difference in changes in the HADS anxiety and depression scores but found a significant increase in the VR-12 MCS in patients in whom pain developed (7.1 [interquartile range, 12.6] vs. -1.9 [interquartile range, 8.7]; P = .036). CONCLUSION In one-quarter of patients with painful cuff tears, pain developed in a contralateral asymptomatic cuff tear that resulted in a measurable decline in function within 3 years. Our analysis showed that only the baseline tear size of the asymptomatic shoulder was predictive of pain development. There were no tear-related features of the presenting painful rotator cuff tear or indices of mental health and physical function or occupational demand that were predictive of future pain development at short-term follow-up.
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Affiliation(s)
- Jeffrey J Olson
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - J Ryan Hill
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jinli Wang
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Julianne A Sefko
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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7
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Jácome-López R, Tejada-Gallego J, Silberberg JM, García-Sanz F, García-Muro-San José F. Glenohumeral internal rotation deficit in general population with shoulder pain: A descriptive observational study. Medicine (Baltimore) 2023; 102:e36551. [PMID: 38115341 PMCID: PMC10727574 DOI: 10.1097/md.0000000000036551] [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: 06/15/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Glenohumeral internal rotation deficit (GIRD) is one of the most important factors influencing injury risk in the arm of overhead athletes. Some studies have shown that the GIRD of athletes with shoulder pain was higher than those without shoulder pain, establishing a relation between shoulder pain and GIRD. However, there are no studies that relate to GIRD and shoulder pain or the risk factors that affect GIRD in the population with this ailment. This study aimed to: determine if GIRD could be found clinically and between which values it oscillates in patients with shoulder pain, and explore if there are any potential associations between GIRD and some sociodemographic data, and orthopedic or radiological findings. A descriptive observational study design was adopted to determine if GIRD could be found clinically in patients with shoulder pain and to gain further evidence in the potential associations between GIRD and sociodemographic data, and orthopedic or radiological findings. All those patients without exclusion criteria between October 1,2020 and March 31,2021 were included. Exclusion criteria consisted of being under 18 years old but younger than 80 years old, showing shoulder pain in both shoulders and having a joint prosthesis in at least one of the 2 shoulders, tumor, or infection. A total of 67 patients aged between 25 and 75 years (52.7 ± 11.8 years, 36 male and 31 female). More than 82% of patients with shoulder pain showed a GIRD higher than 20º. The mean GIRD was 37.6 ± 17.09º. The 95th percentile was 66.22º. From sociodemographic data could be extracted that: patients who have children showed a lower GIRD, patients with right shoulder pain, or whose dominance coincided with a painful shoulder showed a higher GIRD. The orthopedic findings revealed that patients with a positive Jobe test showed a lower GIRD. The linear model considering both sociodemographic and orthopedic findings showed that GIRD was reduced by having children and by BMI. GIRD shows a high incidence in patients with shoulder pain. The descendant, BMI, and positive Jobe test were negatively associated with the GIRD.
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Affiliation(s)
- Rafael Jácome-López
- Physiotherapy Unit, Clínica Universidad de Navarra, c/ Marquesado de Sta. Marta, Madrid, Spain
- CEU International Doctoral School (CEINDO), University San Pablo-CEU, C/Tutor, Madrid, Spain
| | - Javier Tejada-Gallego
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, c/ Marquesado de Sta. Marta, Madrid, Spain
| | - José María Silberberg
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, c/ Marquesado de Sta. Marta, Madrid, Spain
| | - Fernando García-Sanz
- Physiotherapy Service, Clínica CEMTRO, Av. Ventisquero de la Condesa, Mirasierra, Madrid, Spain
| | - Francisco García-Muro-San José
- Department of Physiotherapy, Faculty of Medicine, University San Pablo-CEU, Urbanización Montepríncipe, Boadilla del Monte, Spain
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8
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Thery C, Antoni M, Dujeux C, Eichler D, Meyer N, Clavert P. Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2865-2871. [PMID: 36879163 DOI: 10.1007/s00590-023-03487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Few data are available about the impact of operative time on outcome of rotator cuff repair. AIM The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. METHODS Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1 year. The significance threshold was set at p = 0.05. RESULTS A total of 219 Patients, with a mean age of 54.6 years (range 40-70 years), were included. Mean operative time 44.9 min (range 14-140 min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1 year: increasing operative time by 1 min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1 year (p = 0.2577), tendon healing at 1 year (p = 0.295) or onset of complications during follow-up (p = 0.193). DISCUSSION The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60 min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. LEVEL OF EVIDENCE Level III: Retrospective Cohort Design. Therapeutic Study.
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Affiliation(s)
- Charles Thery
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Maxime Antoni
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France.
| | - Clément Dujeux
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - David Eichler
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Nicolas Meyer
- Pole de Santé Publique, Secteur Méthodologie et Biostatistiques, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Philippe Clavert
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
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Lowry V, Desmeules F, Zidarov D, Lavigne P, Roy JS, Cormier AA, Tousignant-Laflamme Y, Perreault K, Lefèbvre MC, Décary S, Hudon A. "I wanted to know what was hurting so much": a qualitative study exploring patients' expectations and experiences with primary care management. BMC Musculoskelet Disord 2023; 24:755. [PMID: 37749557 PMCID: PMC10521438 DOI: 10.1186/s12891-023-06885-x] [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: 02/27/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The management of shoulder pain is challenging for primary care clinicians considering that 40% of affected individuals remain symptomatic one year after initial consultation. Developing tailored knowledge mobilization interventions founded on evidence-based recommendations while also considering patients' expectations could improve primary care for shoulder pain. The aim of this qualitative study is to explore patients' expectations and experiences of their primary care consultation for shoulder pain. METHODS In this qualitative study, participants with shoulder pain and having consulted a primary care clinician in the past year were interviewed. All the semi-structured interviews were transcribed verbatim, and inductive thematic analysis was performed to identify themes related to the participants' expectations and experiences of primary care consultations for shoulder pain. RESULTS Thirteen participants with shoulder pain were interviewed (8 women, 5 men; mean age 50 ± 12 years). Eleven of them initially consulted a family physician or an emergency physician, and two participants initially consulted a physiotherapist. Four overarching themes related to patients' expectations and experiences were identified from our thematic analysis: 1) I can't sleep because of my shoulder; 2) I need to know what is happening with my shoulder; 3) But… we need to really see what is going on to help me!; and 4) Please take some time with me so I can understand what to do!. Several participants waited until they experienced a high level of shoulder pain before making an appointment since they were not confident about what their family physician could do to manage their condition. Although some participants felt that their physician took the time to listen to their concerns, many were dissatisfied with the limited assessment and education provided by the clinician. CONCLUSIONS Implementing evidence-based recommendations while considering patients' expectations is important as it may improve patients' satisfaction with healthcare. Several participants reported that their expectations were not met, especially when it came to the explanations provided. One unexpected finding that emerged from this study was the waiting period between the onset of shoulder pain and when patients decided to consult their primary care clinician.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4.
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada.
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Institut Universitaire Sur La Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Québec, Canada
| | - Patrick Lavigne
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Audrey-Anne Cormier
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Marie-Claude Lefèbvre
- Groupe de Médecine Familiale Universitaire (GMF-U) Maisonneuve-Rosemont, Montréal, Canada
| | - Simon Décary
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne Hudon
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada
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10
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Davis DL, Almardawi R, Beamer BA, Ryan AS, Terrin ML. Shoulder pain, health-related quality of life and physical function in community-dwelling older adults. FRONTIERS IN AGING 2023; 4:1176706. [PMID: 37483647 PMCID: PMC10359925 DOI: 10.3389/fragi.2023.1176706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
The impact of shoulder pain on health-related quality of life and physical function among community-dwelling older adults (>60 years) not seeking medical care is not well understood. Forty-four community-dwelling older adult volunteers with low comorbidity were stratified into two groups by the presence (n = 18) or absence (n = 26) of shoulder pain. Participants completed the 36-Item Short Form and American Shoulder and Elbow Surgeon surveys and received shoulder range of motion and magnetic resonance imaging testing. Participants with shoulder pain perceived more difficulty accomplishing usual tasks secondary to their physical and emotion health and displayed inferior shoulder function, relative to participants without shoulder pain. This study suggests that shoulder pain reduces quality of life and physical function in the population of community-dwelling older adults not seeking medical evaluation for their symptoms.
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Affiliation(s)
- Derik L. Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ranyah Almardawi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Brock A. Beamer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore Geriatric Research and Education Clinical Center (GRECC), Veterans Affairs Medical Center, Baltimore, MD, United States
| | - Alice S. Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore Geriatric Research and Education Clinical Center (GRECC), Veterans Affairs Medical Center, Baltimore, MD, United States
| | - Michael L. Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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11
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Alfano F, Moya DÁ, Gómez DJ. [Translated article] Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T271-T278. [PMID: 36863514 DOI: 10.1016/j.recot.2023.02.019] [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: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. METHODS Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. RESULTS When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side. CONCLUSIONS Our study has found a high correlation of the presence of a postero-superior rotator cuff injury after presenting a glenohumeral dislocation between the shoulder that has suffered the event and the presumably healthy contralateral shoulder. Nevertheless, we have not found this same correlation with subscapularis tendon injury and medial biceps dislocation.
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Affiliation(s)
- F Alfano
- Hospital Privado Gipuzkoa Asunción Klinika, Tolosa, Gipuzkoa, Spain.
| | - D Á Moya
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - D J Gómez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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12
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Zhou T, Han C, Weng X. Present situation and development prospects of the diagnosis and treatment of rotator cuff tears. Front Surg 2023; 10:857821. [PMID: 37440927 PMCID: PMC10333593 DOI: 10.3389/fsurg.2023.857821] [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: 01/19/2022] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Rotator cuff tears are an important cause of shoulder pain and are caused by degeneration or trauma of the shoulder tendon at the anatomical neck of the humeral head. The understanding and research of rotator cuff tears have a history of hundreds of years, and their etiology, diagnosis, and treatment have a complete system, but some detailed rules of diagnosis and treatment still have room for development. This research paper briefly introduces the diagnosis and treatment of rotator cuff tears. The current situation and its valuable research direction are described.
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Affiliation(s)
- Tianjun Zhou
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chang Han
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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13
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Zheng ET, Lowenstein NA, Collins JE, Matzkin EG. Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair. Am J Sports Med 2023:3635465231169254. [PMID: 37167606 DOI: 10.1177/03635465231169254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Most patients experience sleep disturbances before rotator cuff repair, with these symptoms largely improving postoperatively. However, the relationship between the resolution or persistence of sleep disturbance and patient-reported outcomes after rotator cuff repair remains unknown. PURPOSE To compare outcomes after rotator cuff repair between patients who reported a preoperative sleep disturbance and those who did not. Outcomes at various time points after surgery were also assessed in relation to the persistence or resolution of sleep disturbance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing primary arthroscopic rotator cuff repair at a tertiary academic center were prospectively enrolled in a registry database. Patient characteristics were obtained preoperatively and validated patient-reported outcome measures (PROMs) were obtained pre- and postoperatively, including the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 12-Item Health Survey Physical and Mental components. Sleep disturbance was evaluated via responses to Simple Shoulder Test question 2. Patients with and without sleep disturbance were compared before and after surgery. RESULTS In total, 293 patients were prospectively enrolled. A total of 262 (89.8%) patients reported a sleep disturbance preoperatively. Of these, 221 (84.4%) reported a resolution of sleep disturbance by 2 years postoperatively. After adjustment for age, workers' compensation status, and Cofield tear size, patients with a preoperative sleep disturbance reported significantly worse baseline PROMs, apart from the Veterans RAND 12-Item Health Survey Mental component, before surgery. However, postoperatively, these patients had greater improvement in PROMs, and no significant remaining differences were seen at follow-up between patients with and without preoperative sleep disturbance. Among patients who reported a preoperative sleep disturbance, those whose symptoms resolved postoperatively had superior PROM scores as well as significantly greater improvements from preoperative baseline values compared with patients with persistent sleep disturbances after surgery. CONCLUSION Patients with preoperative sleep disturbances reported worse baseline functional scores before rotator cuff repair compared with patients without sleep disturbance. These disturbances largely resolved after surgery, with postoperative outcomes comparable with those of patients who reported no preoperative sleep concerns. Patients whose sleep disturbances resolved postoperatively also reported superior PROM scores compared with patients whose sleep disturbances persisted postoperatively.
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Affiliation(s)
- Evan T Zheng
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Horan MP, Hanson JA, Rakowski DR, Patel RB, Vidal LB, Millett PJ. Outcomes and Survivorship 5 Years After Arthroscopic Rotator Cuff Repair in Active Patients 70 Years and Older. Orthop J Sports Med 2023; 11:23259671231168888. [PMID: 37250743 PMCID: PMC10214071 DOI: 10.1177/23259671231168888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Rotator cuff tears are common in the elderly population and are associated with increased pain, decreased function, and decreased enjoyment of recreational activities. Purpose To evaluate clinical outcomes at a minimum of 5 years after arthroscopic repair of full-thickness rotator cuff tears in recreational athletes aged ≥70 years at the time of surgery. Study Design Case series; Level of evidence, 4. Methods Included were recreational athletes aged ≥70 years who underwent arthroscopic rotator cuff repair (RCR) from December 2005 to January 2016. Patient and surgery characteristics were collected prospectively and retrospectively reviewed. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health survey (SF-12) questionnaire (Physical Component Summary and Mental Component Summary), and patient satisfaction. Kaplan Meier survivorship analysis was performed, with failure defined as revision RCR or retear on magnetic resonance imaging (MRI). Results Overall, 71 shoulders (n = 67 patients [44 men, 23 women]; mean age, 73.4 years [range, 70.1-81.3 years]) were included in this study. Follow-up data was obtained for 65 of the 69 available shoulders (94%) at a mean of 7.8 years (range, 5-15.3 years). Mean age at follow-up was 81.2 years (range, 75.7-91.0). One RCR was revised after a traumatic accident, and another had a symptomatic, MRI-confirmed retear. One patient had lysis of adhesions for stiffness 3 months postoperatively. All PRO scores improved from pre- to postoperatively-ASES, from 55.3 to 93.6; SANE, from 62 to 89.6; QuickDASH, from 32.9 to 7.3; and SF-12 Physical Component Summary, from 43.3 to 53 (P < .001 for all)-and the median satisfaction score was 10 out of 10. Postoperatively, 63% of the patients returned to their original fitness program and 33% of patients modified their recreational activity. Survivorship analysis showed a 98% survival rate at 5 years and a 92% rate at 10 years. Conclusion Sustained improvement in function, reduced pain, and return to activities was seen after arthroscopic RCR in active patients ≥70 years old. Despite one-third of patients modifying their recreational activity, the cohort reported high levels of satisfaction and general health.
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Affiliation(s)
| | | | | | - Ravi B. Patel
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
| | - Leslie B. Vidal
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
| | - Peter J. Millett
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
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15
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Barret H, Langlais T, Laumonerie P, Faruch M, Mansat P, Bonnevialle N. Which preoperative factors influence the patient's short-term subjective assessment after rotator cuff repair? Orthop Traumatol Surg Res 2023; 109:103490. [PMID: 36442808 DOI: 10.1016/j.otsr.2022.103490] [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: 08/15/2021] [Revised: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing. HYPOTHESIS Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing. METHODS With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV>85%); and 47 patients in the second group (SSV<85%). RESULTS In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p=0.002], fatty infiltration [-3.65 (-6.24 -1.06) p=0.006] and workers compensation [-19.15 (-24.04; -14.27) p<0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) CONCLUSIONS: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction. LEVEL OF EVIDENCE IV, cohort study.
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Uekama K, Miyazaki T, Maesako S, Kaieda H, Taniguchi N. Clinical significance of the elbow forward translation motion in patients with rotator cuff tears. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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17
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Diaz MA, Munassi S, Teytelbaum DE, Pipitone A, Baker CE. An Injectable Calcium Phosphate Bone Graft Substitute Improves the Pullout Strength of Various Suture Anchor Designs in an Osteoporotic Bone Model. Arthrosc Sports Med Rehabil 2023; 5:e423-e433. [PMID: 37101877 PMCID: PMC10123442 DOI: 10.1016/j.asmr.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/05/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose To compare various suture anchor designs with and without calcium phosphate (CaP) augmentation in an osteoporotic foam block model and decorticated proximal humerus cadaveric model. Methods This was a controlled biomechanical study, consisting of 2 parts: (1) an osteoporotic foam block model (0.12 g/cc; n = 42) and (2) a matched pair cadaveric humeral model (n = 24). Suture anchors selected were an all-suture anchor, PEEK (polyether ether ketone)-threaded anchor, and a biocomposite-threaded anchor. For each study arm, one half the samples were first filled with injectable CaP and the other half were not augmented with CaP. For the cadaveric portion, the PEEK- and biocomposite-threaded anchors were assessed. Biomechanical testing consisted of a stepwise, increasing load protocol for a total of 40 cycles, followed by ramp to failure. Results For the foam block model, the average load to failure for anchors with CaP was significantly greater when compared with anchor fixation augmented without CaP; the all-suture anchor was 135.2 ± 20.2 N versus 83.3 ± 10.3 N (P = .0006); PEEK was 131 ± 34.3 N versus 58.5 ± 16.8 N (P = .001); and biocomposite was 182.2 ± 64.2 N versus 80.8 ± 17.4 N (P = .004). For the cadaveric model, the average load to failure for anchors augmented with CaP was again greater than anchor fixation without CaP; PEEK anchors went from 41.1 ± 21.1 N to 193.6 ± 63.9 N (P = .0034) and biocomposite anchors went from 70.9 ± 26.6 N to 143.2 ± 28.9 N (P = .004). Conclusions Augmenting various suture anchors with CaP has shown to significantly increase pull-out strength and stiffness in an osteoporotic foam block and time zero cadaveric bone model. Clinical Relevance Rotator cuff tears are common in the elderly patients, in whom poor bone quality jeopardizes treatment success. Exploring methods that increase the strength of fixation in osteoporotic bone to improve outcomes in this patient population is important.
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Affiliation(s)
- Miguel A. Diaz
- Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A
| | - Steven Munassi
- Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A
| | | | - Anthony Pipitone
- Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A
| | - Christopher E. Baker
- Florida Orthopaedic Institute, Tampa, Florida, U.S.A
- Address correspondence to Christopher E. Baker, M.D., Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Tampa, FL 33637.
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Alfano F, Moya DÁ, Gómez DJ. Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022:S1888-4415(22)00340-X. [PMID: 36462725 DOI: 10.1016/j.recot.2022.11.005] [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: 11/13/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. METHODS Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. RESULTS When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side. CONCLUSIONS Our study has found a high correlation of the presence of a postero-superior rotator cuff injury after presenting a glenohumeral dislocation between the shoulder that has suffered the event and the presumably healthy contralateral shoulder. Nevertheless, we have not found this same correlation with subscapularis tendon injury and medial biceps dislocation.
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Affiliation(s)
- F Alfano
- Hospital Privado Gipuzkoa Asunción Klinika, Tolosa, Gipuzkoa, España.
| | - D Á Moya
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - D J Gómez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Green M, Whetter R, Al-Dadah O. Proximal humerus fractures and shoulder dislocations: Prevalence of concomitant rotator cuff tear. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Proximal humerus fractures and shoulder dislocations are relatively common. However, an associated rotator cuff tear is often missed with these injuries. The objective of this study was to assess the prevalence of a concomitant rotator cuff tear associated with common shoulder injuries. Methods: A cross-sectional epidemiological study of three patient populations: Group 1. Proximal Humerus Fractures; Group 2. Shoulder Dislocations; Group 3. Proximal Humerus Fracture-Dislocations. All patients within these three groups presented to and underwent subsequent management of their shoulder injury at a trauma unit. Management included both non-operative and operative intervention. Patients were evaluated for associated rotator cuff tears. Results: This study included a total of 196 patients: Group 1 = 146 Proximal Humerus Fractures; Group 2 = 37 Shoulder Dislocations; Group 3 = 13 Proximal Humerus Fracture-Dislocations. Of the 196 patients in total, 23 (11.7%) sustained a concomitant rotator cuff tear. The highest number of tears was found in Group 1 ( n = 14). However, the highest percentage prevalence of tears was in Group 2 (18.9%). There was noted to be a higher prevalence of rotator cuff tears with increasing age. Twenty-two (95.7%) rotator cuff tears were detected in patients over 50 years of age. The vast majority of rotator cuff tears were detected by ultrasound (78.3%) as opposed to magnetic resonance imaging (21.7%). The majority of tears were full-thickness (60.9%). Of the 23 patients with a concomitant rotator cuff tear, 17 involved a single tendon (73.9%) and supraspinatus was most common (69.6%). Conclusions: A concomitant rotator cuff tear in association with a proximal humerus fracture, shoulder dislocation or proximal humerus fracture-dislocation is relatively common. The overall rotator cuff tear prevalence in this study was 11.9%. Rotator cuff tears are more likely to occur in patients over 50 years old and those sustaining a shoulder dislocation.
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Affiliation(s)
- Matthew Green
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside, UK
| | - Ross Whetter
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside, UK
| | - Oday Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
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20
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Wegner A, Wassenaar D, Busch A, Stanjek M, Mayer C, Jäger M. [Post-traumatic necrosis of the humeral head-Endoprosthesis or joint preservation]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:822-828. [PMID: 36083347 DOI: 10.1007/s00132-022-04307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Humerus fractures play a major role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses. OBJECTIVES The current paper highlights the incidence and cause of osteonecrosis after proximal humerus fractures, with respect to presentation of anatomy and risk factors. METHODS Display of the literature and therapy options for humerus fracture and subsequent necrosis. RESULTS Humerus fractures are the seventh most frequent fractures in humans. The complication rate is 40%, and the described rate of necrosis is up to 34%. Accordingly, the surgical revision rate is at 19% according to recent literature. CONCLUSION The treatment of humerus head fracture must consider numerous variables. The individual type of fracture and the current individual situation of the patient must be included in the process of choosing the right treatment. Modern implants with screw locking features should be used, and for certain circumstances the direct implantation of a prosthesis should be considered. Thereby the expectations of the patient with respect to the postoperative activity level play a major role.
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Affiliation(s)
- A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - D Wassenaar
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - M Stanjek
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - C Mayer
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - M Jäger
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
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21
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Hinsley H, Ganderton C, Arden NK, Carr AJ. Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study. BMJ Open 2022; 12:e059175. [PMID: 36100305 PMCID: PMC9472112 DOI: 10.1136/bmjopen-2021-059175] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To define the population prevalence of rotator cuff tears and test their association with pain and function loss; determine if severity symptom correlates with tear stage severity, and quantify the impact of symptomatic rotator cuff tears on primary healthcare services in a general population cohort of women. DESIGN Cross-sectional observational study. PARTICIPANTS Individuals were part of the Chingford 1000 Women cohort, a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and representative of the population of the UK. MAIN OUTCOME MEASURES Rotator cuff pathology prevalence on ultrasound, shoulder symptoms using the Oxford Shoulder Score and resultant number of general practitioner (GP) consultations. RESULTS The population prevalence of full-thickness tears was 22.2%, which increased with age (p=0.004) and whether it was the dominant arm (Relative Risk 1.64, OR 1.58, 95% CI 1.07 to 2.33, p=0.021).Although 48.4% of full-thickness tears were asymptomatic, there was an association between rotator cuff tears and patient-reported symptoms. Individuals with at least one full-thickness tear were 1.97 times more likely than those with bilateral normal tendons (OR 3.53, 95% CI 2.00 to 5.61, p<0.001) to have symptoms. Severity of symptoms was not related to the severity of the pathology until tears are >2.5 cm (p=0.009).In the cohort, 8.9% had seen their GP with shoulder pain and a full-thickness rotator cuff tear, 18.8% with shoulder pain and an abnormality and 29.3% with shoulder pain. CONCLUSION Rotator cuff tears are common, and primary care services are heavily impacted. As 50% of tears remain asymptomatic, future research may investigate the cause of pain and whether different treatment modalities, aside from addressing the pathology, need further investigation.
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Affiliation(s)
- Hannah Hinsley
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, 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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22
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Rudisill SS, Eberlin CT, Kucharik MP, Linker JA, Naessig SA, Best MJ, Martin SD. Sex Differences in Utilization and Perioperative Outcomes of Arthroscopic Rotator Cuff Repair. JSES Int 2022; 6:992-998. [PMID: 36353439 PMCID: PMC9637640 DOI: 10.1016/j.jseint.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background As the volume and proportion of patients treated arthroscopically for rotator cuff repair increases, it is important to recognize sex differences in utilization and outcomes. Methods Patients who underwent arthroscopic rotator cuff repair between 2010 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Baseline demographic and clinical characteristics were collected, and information concerning utilization, operative time, length of hospital stay, days from operation to discharge, readmission, and adverse events were analyzed by sex. Results Of 42,443 included patients, 57.7% were male and 42.3% were female. Comparably, females were generally older (P < .001) and less healthy as indicated by American Society of Anesthesiologists class (P < .001) and rates of obesity (52.0% vs. 47.8%, P < .001), chronic obstructive pulmonary disease (4.0% vs. 2.7%, P < .001), and steroid use (2.7% vs. 1.6%, P < .001). Females experienced shorter operative times (mean difference [MD] 11.5 minutes, P < .001), longer hospital stays (MD 0.03 days, P < .001), longer times from operation to discharge (MD 0.03 days, P < .001), and more minor adverse events (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.24-2.47) after baseline adjustment. Conversely, rates of serious adverse events (OR, 0.69; 95% CI, 0.55-0.86) and readmissions (OR, 0.88; 95% CI, 0.66-0.97) were lower among females. Disparities in utilization increased over the study period (P = .008), whereas length of stay (P = .509) and adverse events (P = .967) remained stable. Conclusion Sex differences among patients undergoing arthroscopic rotator cuff repair are evident, indicating the need for further research to understand and address the root causes of inequality and optimize care for all.
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23
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Eustace SK, Murphy AN, Hurley DJ, Abul AHA, Kavanagh E. MRI findings in atraumatic shoulder pain-patterns of disease correlated with age and gender. Ir J Med Sci 2022; 192:847-852. [PMID: 35536423 PMCID: PMC10066151 DOI: 10.1007/s11845-022-03012-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The rotator cuff is a group of muscles and tendons which support the shoulder joint. Rotator cuff disease is a frequent cause of morbidity in adulthood. AIMS The aims of his study are to determine the prevalence and patterns of rotator cuff derangement in symptomatic patients using MRI and to attempt to correlate identified patterns of disease with age and gender METHODS: Five hundred ninety-seven patients attending for MRI of the shoulder with atraumatic shoulder pain were included for study. Patients' age and gender was recorded. Record was made of the presence or absence of rotator cuff derangement and of degenerative change in the AC and glenohumeral joints. Correlation was made between age and gender. RESULTS There were 358 males (60%) and 239 females (40%) with a mean age of 49.4 ± 17.1 years. Subacromial bursitis was identified in 517 patients. A normal supraspinatus tendon was identified in 219 patients and supraspinatus full thickness tearing was identified in 102 patients. A normal AC joint was identified in 267 patients while degenerative AC joint changes were identified in 370 patients. A significant correlation was identified between age and rotator cuff derangement (p < .001) and between age and AC joint derangement (p < .001). No significant difference was identified between gender and patterns of cuff derangement CONCLUSION: The extent of rotator cuff and AC joint derangement increases with ageing. Impingement appears to trigger a cascade of events in sequence, from isolated subacromial bursitis through to supraspinatus tendon tearing. Patterns of rotator cuff derangement are similar in men and women.
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Affiliation(s)
- Sarah K Eustace
- Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland.
| | - Alexandra N Murphy
- Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland
| | - Daire J Hurley
- Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland
| | - Ahmed H Alsayegh Abul
- Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland
| | - Eoin Kavanagh
- Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland
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Davis DL, Almardawi R, Terrin ML. Identification of Community-Dwelling Older Adults With Shoulder Dysfunction: A Pilot Study to Evaluate the Disabilities of the Arm, Shoulder and Hand Survey. Geriatr Orthop Surg Rehabil 2022; 13:21514593221129177. [PMID: 36250187 PMCID: PMC9554132 DOI: 10.1177/21514593221129177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The Disabilities of the Arm, Shoulder and Hand (DASH) survey estimates the upper limbs' dysfunction in one score, but limited evidence exists to justify use of DASH to screen older adults for shoulder dysfunction at routine health maintenance primary care visits. We sought (1) to determine if the DASH, American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) surveys are related to one another and (2) to determine the relationship of DASH, ASES and SST scores with 36-Item Short Form (SF-36) subscales, shoulder forward flexion range of motion (FF-ROM) and abduction (ABD-ROM) in older adults. Methods Prospective pilot study of 23 community-dwelling adult volunteers [mean age (± standard deviation), 69.3 ± 6.7 years; range, 61-84 years, with no rotator cuff repair or joint replacement. Shoulder MRI, ROM testing, DASH, ASES, SST, SF-36, Katz activities of daily living (ADLs), and Lawton-Brody instrumental ADLs (IADLs) were completed at one time point. Descriptive and correlation analyses were performed. Results Means: DASH, 17.4 ± 19.5; ASES, 81.3 ± 19.7; SST, 71.7 ± 28.5; Katz ADLs, 5.9 ± .3; Lawton-Brody IADLs, 8.0 ± .0; FF-ROM, 140.2° ± 31.5°; and ABD-ROM, 128.3° ± 31.9°. Nearly 48% had supraspinatus tendon tear. Correlation among DASH, ASES, and SST was strong (|rho ≥.88|; P < .001). DASH, ASES, and SST had strong correlation (|rho ≥.71|;P < .001) with shoulder FF-ROM and ABD-ROM. DASH had near equivalent or slightly stronger correlation for all SF-36 subscales relative to ASES and SST. DASH showed strong or moderate correlation (P < .05) to most SF-36 subscales. Conclusion DASH, ASES and SST strongly correlated with one another. DASH, relative to ASES and SST, has similar correlation to shoulder FF-ROM, ABD-ROM and SF-36 subscales in older adults. Our pilot study suggests that the DASH survey has potential utility to identify occult shoulder dysfunction in community-dwelling older adults who have normal Katz ADLs and Lawton-Brody IADLs if administered during routine health maintenance primary care visits.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ranyah Almardawi
- Department of Epidemiology and Public Health, Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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25
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Jo YH, Kim DH, Lee BG. When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis? Clin Shoulder Elb 2021; 24:272-278. [PMID: 34875733 PMCID: PMC8651594 DOI: 10.5397/cise.2021.00633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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26
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Heritability of musculoskeletal pain and pain sensitivity phenotypes: two generations of the Raine Study. Pain 2021; 163:e580-e587. [PMID: 34686644 DOI: 10.1097/j.pain.0000000000002411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is a need to better understand biological factors that increase the risk of persistent musculoskeletal pain and heightened pain sensitivity. Knowing the heritability (how genes account for differences in people's traits) can enhance the understanding of genetic versus environmental influences of pain and pain sensitivity. However, there are gaps in current knowledge, including the need for intergenerational studies to broaden our understanding of the genetic basis of pain. Data from Gen1 and Gen2 of the Raine Study were used to investigate the heritability of musculoskeletal pain, and pressure and cold pain sensitivity. Participants included parents (Gen 1, n=1092) and their offspring (Gen 2, n=688) who underwent a battery of testing and questionnaires including pressure and cold pain threshold testing and assessments of physical activity, sleep, musculoskeletal pain, mental health and adiposity. Heritability estimates were derived using the Sequential Oliogenic Linkage Analysis Routines (SOLAR) software. Heritability estimates for musculoskeletal pain and pressure pain sensitivity were significant, accounting for between 0.190 and 0.289 of the variation in the phenotype. In contrast, heritability of cold pain sensitivity was not significant. This is the largest intergenerational study to date to comprehensively investigate the heritability of both musculoskeletal pain and pain sensitivity, using robust statistical analysis. This study provides support for the heritability of musculoskeletal pain and pain sensitivity to pressure, suggesting the need for further convergence of genetic and environmental factors in models for the development and/or maintenance of these pain disorders.
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27
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Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
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Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
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Eliason A, Harringe M, Engström B, Sunding K, Werner S. Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. Physiother Theory Pract 2021; 38:2568-2579. [PMID: 34402715 DOI: 10.1080/09593985.2021.1962462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Subacromial pain syndrome is a common musculoskeletal shoulder problem. The accuracy of clinical tests is low and techniques such as ultrasound and magnetic resonance imaging have been added to set up a diagnosis. Previous researchers have usually only examined the symptomatic shoulder. However, there might be similar findings in the asymptomatic shoulder. Objective:The aim of the present study was to investigate the prevalence of structural abnormalities of both shoulders in patients with clinically diagnosed unilateral subacromial pain syndrome using diagnostic ultrasound. Methods: Bilateral ultrasound examinations were performed in 115 consecutive patients, 54 men and 61 women. The patients were recruited from primary care centers in the area of Stockholm, Sweden. Results: Abnormal ultrasound findings were found in both shoulders and increased with age (p = .0004). Bursitis was the most common ultrasound finding and significantly more prevalent in the symptomatic shoulder compared to the asymptomatic shoulder (90%:74%; p = .0021), though 73% of the bursitis were bilateral. Supraspinatus is the most vulnerable tendon of the rotator cuff in both shoulders. In terms of partial-thickness tears and tendinosis, the tendon was affected more commonly in the symptomatic shoulder compared to the asymptomatic shoulder (30%:14%: 14%; p = .0026) and (24%:10%; p = .0054), respectively, but for calcification no significant difference between the shoulders was found (18%:12%; 0.1988). Conclusion: Ultrasound detected shoulder abnormalities were present in both symptomatic and asymptomatic shoulders. Bursitis and partial-thickness tears were more common in the affected shoulder when compared to the unaffected shoulder. Ultrasound as well as clinical examination findings and patient´s history should be taken into consideration when diagnosing patients with subacromial pain syndrome.
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Affiliation(s)
- Anna Eliason
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Health Care Services Stockholm County (SLSO), Region Stockholm
| | - Marita Harringe
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Björn Engström
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Kerstin Sunding
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Park HB, Gwark JY, Kwack BH, Na JB. Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears? J Shoulder Elbow Surg 2021; 30:1856-1865. [PMID: 33197590 DOI: 10.1016/j.jse.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several radiologic parameters representing scapular morphology have been proposed as risk factors for degenerative posterosuperior rotator cuff tear (PSRCT). The causes of PSRCT are multifactorial; many reported risk factors are compound entities. However, no determination, made after adjustment with previously reported risk factors, of which radiologic parameters are independent risk factors for degenerative PSRCT, has been reported. Therefore, this study's purpose was to determine which radiologic parameters representing scapular morphology are independent risk factors for degenerative PSRCT in a general population after adjustment with previously suggested risk factors. METHODS This study involved 629 subjects (629 shoulders) drawn from a cohort of rural residents. PSRCT diagnoses were based on magnetic resonance imaging findings. Logistic regression analysis was used to determine the odds ratios and 95% confidence intervals for the following variables: sex, age, height, weight, waist circumference, dominant-side involvement, smoking, alcohol consumption, manual labor, diabetes, hypertension, metabolic syndrome, thyroid dysfunction, serum lipid profile, high-sensitivity C-reactive protein, and radiologic parameters. The evaluated radiologic parameters were the superior displacement of the humeral head (SDHH) and those representing the scapular morphology. The radiologic parameters representing the scapular morphology were lateral acromial angle, acromial slope, acromial tilt, acromial index, and critical shoulder angle (CSA). Univariate logistic regression analyses for all variables, as well as multivariable logistic regression analyses for variables with significant associations and clinical effect sizes in the univariate logistic regression analyses, were performed. In order to determine the cutoff value for significant radiologic parameters, each pair of candidate cutoff values was obtained as follows: 1 candidate, as the lowest significant ordinal value in a univariate analysis, and the other candidate, according to a receiver operating characteristic curve analysis. Then, the cutoff values were determined by selecting the value in each candidate pair that had the larger area under the receiver operating characteristic curve, using the DeLong test. RESULTS In the multivariable analyses, CSA was significantly associated with degenerative PSRCT after controlling for the following factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH (P ≤ .033). CSA (odds ratio, 1.58 [95% confidence interval, 1.45-1.72]; P < .001) was the only significantly associated radiologic parameter among the studied radiologic parameters representing scapular morphology. CONCLUSION CSA (≥35°) is an independent associated factor for degenerative PSRCT after adjustment for the following suggested risk factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH.
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Affiliation(s)
- Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Byung Hoon Kwack
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Boem Na
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Tazawa R, Kenmoku T, Uchida K, Arendt-Nielsen L, Nagura N, Nakawaki M, Matsumoto T, Inoue G, Takeuchi H, Jimbo T, Nakazawa T, Fukuda M, Takaso M. Increased nerve growth factor expression in the synovial tissues of patients with rotator cuff tears. Mol Pain 2021; 17:17448069211021252. [PMID: 34074169 PMCID: PMC8175831 DOI: 10.1177/17448069211021252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Rotator cuff tears (RCTs) are often associated with severe shoulder pain. Non-steroidal anti-inflammatory drugs, not recommended for long-term use, do not effectively manage RCT-induced pain, resulting in reduced quality of life. To improve management, a better understanding of the fundamental properties of RCT pain is needed. Here, we aimed to compare the expression levels of nerve growth factor (NGF) and cyclooxygenase-2 (COX-2) mRNA in the synovial tissues of patients with RCT-induced pain and patients with non-painful recurrent shoulder dislocation (RSD). Methods The study included 32 patients with RCT who underwent arthroscopic rotator cuff repair and 28 patients with non-painful RSD who underwent arthroscopic Bankart repair. Synovial tissue samples were harvested from subacromial bursa and rotator interval of RCT patients and from the rotator interval of RSD patients. Samples were analyzed quantitatively expression levels for NGF and COX2 mRNA and NGF protein. Results NGF mRNA and protein levels were significantly higher in the rotator interval of RCT patients than in the rotator interval of RSD patients (p = 0.0017, p = 0.012, respectively), while COX2 mRNA levels did not differ significantly between the two patient groups. In RCT patients, COX2 mRNA was more highly expressed in the rotator interval than in the subacromial bursa (p = 0.038), whereas the mRNA and protein levels of NGF did not differ between the two tissues. The expression of NGF mRNA in the synovium of the rotator interval was significantly correlated with the numeric rating scale of pain (ρ = 0.38, p = 0.004). Conclusion NGF mRNA and protein levels were elevated in patients with painful RCT compared with those in patients with non-painful RSD, whereas COX-2 levels were comparable in the two patient groups. These findings provide insights into novel potential strategies for clinical management of RCT.
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Affiliation(s)
- Ryo Tazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomonori Kenmoku
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Naoshige Nagura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mitsufumi Nakawaki
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshihide Matsumoto
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroto Takeuchi
- Department of Rehabilitation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takenori Jimbo
- Department of Rehabilitation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiyuki Nakazawa
- Department of Rehabilitation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Michinari Fukuda
- Department of Rehabilitation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Dixit A, Dandu N, Hadley CJ, Nazarian LN, Cohen SB, Ciccotti MG. Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Shoulder Sports Injuries: A Narrative Review. JBJS Rev 2021; 9:01874474-202104000-00011. [PMID: 33886525 DOI: 10.2106/jbjs.rvw.20.00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Ultrasonography (US) is valued for its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing upper-extremity shoulder injury has expanded, but several features require definition before more widespread adoption can be realized. » In particular, the evaluation of rotator cuff tears (RCTs) with US has been extensively studied, and authors generally agree that US is comparable with magnetic resonance imaging for the detection of full-thickness RCTs, whereas partial-thickness RCTs are more difficult to accurately identify with US. Dynamic evaluation is particularly useful for pathologies such as subacromial impingement and glenohumeral instability. » US has shown particular usefulness for the assessment of athletes, where there is additional motivation to delay more invasive techniques. US has demonstrated promising results as a diagnostic modality for common shoulder injuries in athletes, and it is an important imaging tool that complements a thorough history and physical examination.
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Affiliation(s)
- Anant Dixit
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Navya Dandu
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christopher J Hadley
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Levon N Nazarian
- Thomas Jefferson University Hospital at Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Steven B Cohen
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael G Ciccotti
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Nyffeler RW, Schenk N, Bissig P. Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. INTERNATIONAL ORTHOPAEDICS 2021; 45:1573-1582. [PMID: 33774700 PMCID: PMC8178131 DOI: 10.1007/s00264-021-05012-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Purpose A simple fall on the shoulder is often referred to as minor trauma that cannot cause a tendon tear but at best reveal a pre-existing rotator cuff pathology. We wanted to know whether this statement was true. The purpose of our study was therefore to summarize the causes of acute rotator cuff tears reported in the literature and provide a biomechanical explanation for tendon tears diagnosed after a fall. Method We searched PubMed and included studies reporting rotator cuff tears occurring due to a trauma. The number of cases, the tendons involved, the age of the patients, and the nature of trauma were summarized. In addition, we noted any information provided by the authors on the pathogenesis of acute tendon ruptures. Results Sixty-seven articles with a total of 4061 traumatic rotator cuff tears met the inclusion criteria. A simple fall was the most common cause (725 cases) and the supraspinatus tendon was most frequently affected. The postulated pathomechanism is a sudden stretch of the tendon-muscle unit while contracting (eccentric loading). Conclusion A simple fall can cause an acute rotator cuff tear and fall-related tears are not restricted to young individuals. They can affect patients of any age. The stresses occurring within the rotator cuff during an attempt to cushion a fall may locally exceed the tensile strength of the tendon fibers and cause a partial or full-thickness tear.
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Affiliation(s)
- Richard W Nyffeler
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland. .,Stiftung Lindenhof, Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, 3010, Bern, Switzerland.
| | - Nicholas Schenk
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland.,Praxis Integri, Hirschengraben 7, 3011, Bern, Switzerland
| | - Philipp Bissig
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland
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Abstract
» Regardless of recent advances in rotator cuff repair techniques, the rate of unhealed or recurrent rotator cuff tears remains high, with most recurrent rotator cuff tears occurring within the first 6 months after surgery.
» Factors that can negatively affect tendon healing include older age, greater tear size, tendon retraction, and fatty infiltration. However, several clinical features that are often underestimated, including osteoporosis, diabetes, smoking, and hyperlipidemia, have proven to have an important influence on rotator cuff healing.
» Recent meta-analyses that evaluated studies with Level-I and Level-II evidence have shown an overall increase in retear rates after single-row repair compared with double-row repair. However, to our knowledge, there are no Level-I clinical studies comparing different double-row configurations and, to date, no double-row repair technique has proven to be superior to the others.
» The influence of postoperative rotator cuff healing on clinical outcomes is controversial. Although clinical differences may not be apparent in the short term, healed tendons have had better functional outcomes and greater strength in the midterm.
» In general, a period of immobilization for 2 to 4 weeks, depending on tear size, is recommended. Graded supervised rehabilitation has proven to facilitate tendon healing without associated stiffness compared with early unprotected range of motion.
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Affiliation(s)
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois
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Zhang J, Liu Z, Li Y, You Q, Yang J, Jin Y, Zou G, Tang J, Ge Z, Liu Y. FGF2: a key regulator augmenting tendon-to-bone healing and cartilage repair. Regen Med 2020; 15:2129-2142. [PMID: 33201773 DOI: 10.2217/rme-2019-0080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ligament/tendon and cartilage injuries are clinically common diseases that perplex most clinicians. Because of the lack of blood vessels and nerves, their self-repairing abilities are rather poor. Therefore, surgeries are necessary and also widely used to treat ligament/tendon or cartilage injuries. However, after surgery, there are still many problems that affect healing. In recent years, it has been found that exogenous FGF2 plays an important role in the repair of ligament/tendon and cartilage injuries and exerts a synergistic effect with endogenous FGF2. Therefore, FGF2 can be used as a new type of biomolecule to accelerate tendon-to-bone healing and cartilage repair after injury.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Ziming Liu
- Peking University Institute of Sports Medicine, Beijing 100083, China
| | - Yuwan Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qi You
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Jibin Yang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Ying Jin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Gang Zou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Jingfeng Tang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Zhen Ge
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Yi Liu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
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Schoch BS, Tams C, Eichinger J, Wright TW, King JJ, Friedman RJ. Anatomic total shoulder arthroplasty after healed rotator cuff repair: a matched cohort. J Shoulder Elbow Surg 2020; 29:2221-2228. [PMID: 33070868 DOI: 10.1016/j.jse.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are a common cause of failure after anatomic total shoulder arthroplasty (TSA). The purpose of this study was to evaluate the effect of a healed prior rotator cuff repair (RCR) on outcomes and complications after primary TSA. We hypothesized that patients with a prior healed RCR would have equivalent outcomes and complication rates compared with patients without prior surgery. METHODS A retrospective review of all primary TSAs with a prior RCR was performed using a multicenter database between 2005 and 2017. Thirty shoulders with prior RCR were case matched on a 3:1 ratio with a minimum 2-year follow-up. Range of motion, strength, patient-reported outcome measures, complications, and reoperations were compared. RESULTS Thirty shoulders with a prior RCR were compared with 90 control patients without prior surgery at a mean follow-up of 43 months (range, 24-109 months). Groups demonstrated similar preoperative range of motion and patient-reported outcome measures. Postoperatively, TSAs with a prior healed RCR demonstrated less forward flexion (132° vs. 143°, P = .14) and strength (5.7 vs. 6.4 kg, P = .55) compared with control shoulders with no prior surgery; however, these did not meet statistical significance. Complications were significantly more common in patients with a prior RCR (17% vs. 7%, P = .01). Postoperative rotator cuff tears were significantly more common in TSA with a healed prior RCR (13% vs. 1%, P = .014). CONCLUSIONS TSA after RCR results in similar functional improvements compared with shoulders without prior surgery. However, the risk of a postoperative rotator cuff tear is significantly higher after prior successful RCR. Surgeons should consider this potential complication when indicating these patients for primary TSA.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Josef Eichinger
- Department of Orthopaedics, Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Jospeh J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Richard J Friedman
- Department of Orthopaedics, Medical University of South Carolina, College of Medicine, Charleston, SC, USA
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Cross JA, deVries J, Mocarski M, Ketchum NC, Compty E, Krimmer M, Fritz JM, Vetter CS. Electromyography of the Shoulder Musculature during Passive Rehabilitation Exercises. J Shoulder Elb Arthroplast 2020. [DOI: 10.1177/2471549220960044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Medical professionals remain conflicted about the best rehabilitation protocol a patient should perform after rotator cuff repair surgery. Exercises deemed passive may be activating the shoulder muscles to a moderate level, thus putting the surgical repair construct at risk for re-injury. The purpose of this study was to measure the activation of the rotator cuff and surrounding musculature during exercises used in physical therapy following rotator cuff repair surgery using electromyography (EMG). Methods Muscle activation was recorded in fourteen participants performing sixteen exercises. Four fine wire electrodes (supraspinatus, infraspinatus, subscapularis, teres minor) and six surface electrodes (upper and middle division of the trapezius, anterior, medial and posterior head of the deltoid, biceps brachii) were utilized. EMG activity values for each muscle were normalized to the maximum voluntary isometric contraction and activation levels were assessed. Results Twelve of the sixteen exercises tested were moderately active in the subscapularis muscle. The results show the subscapularis muscle was activated in all three planes of motion. Discussion Most exercises were found to have low activation levels for the supraspinatus, infraspinatus and teres minor muscles. While the exercises examined in this study appear to be safe for the more commonly repaired supraspinatus, caution should be used when administering exercises to individuals with repairs involving the subscapularis.
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Affiliation(s)
- Janelle A Cross
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John deVries
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Nicholas C Ketchum
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eileen Compty
- Froedtert Sports Medicine Center, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Krimmer
- Froedtert Sports Medicine Center, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carole S Vetter
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE. The subacromial balloon spacer for massive irreparable rotator cuff tears: approximately 3 years of prospective follow-up. Musculoskelet Surg 2020; 104:207-214. [PMID: 31250379 DOI: 10.1007/s12306-019-00614-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears (RCT) are still a challenging problem. RCT can result in disability and severe pain. The optimal treatment for this disabling and painful diagnosis remains controversial. The arthroscopic implantation of a biodegradable subacromial balloon spacer is a possible treatment option. In this prospective study, we evaluate the clinical outcome of this balloon spacer after approximately 3 years. METHODS Between March 2014 and December 2015, the biodegradable balloon spacer was implanted into the subacromial space of 46 shoulders of 44 patients with massive irreparable RCT. Pain was evaluated using a numeric rating scale (NRS), and functional outcome was evaluated using the Oxford shoulder score (OSS). Patients were followed prospectively for approximately 3 years. This present study focuses on the comparison between the early and the midterm results up to approximately 3 years. RESULTS All patients were treated by surgical implantation of the subacromial balloon spacer. The comparison between the outcomes of the NRS and the OSS after one and 3 years was made and showed no mutual significant differences, respectively, p = 0.61 and p = 0.08. Significant pain reduction and functional improvement was noticed postoperatively and maintained after approximately 3 years. At last follow-up (mean: 34 months), pain was reduced to a NRS of 3.09 points (95% CI: 2.17-4.01). Functional outcome based on the OSS improved significantly from 21.32 preoperatively to 34.39 (95% CI: 29.17-36.70) at the last follow-up. Correction for estimated confounders did not show significant differences. 82% of the patients were satisfied with the outcome after implantation of the subacromial balloon spacer. No surgical or postoperative medical complications due to implantation of the balloon spacer were reported. CONCLUSIONS Arthroscopic implantation of the biodegradable balloon spacer in the subacromial space is a safe and minimally invasive intervention. It leads to significant reduction in pain and significant improvement of functional daily activities in patients with irreparable RCT during 3 years of follow-up starting postoperative and maintain over time beyond device degradation. A high percentage of patients are satisfied postoperatively. Despite of these positive results after 3 years of follow-up, the specific contribution of the balloon needs further investigation.
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Affiliation(s)
- R S M Piekaar
- The Department of Orthopaedic Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - I C E Bouman
- The Department of Orthopaedic Surgery, Haga Hospital The Hague, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
| | - P M van Kampen
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - F van Eijk
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - P E Huijsmans
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
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Boersma E, Crijns T, Nijhuis-van der Sanden M, Edwards M, Ring D, Janssen S. Accuracy and reliability of MRI-reports to determine which shoulder is symptomatic for workers compensation patients with unilateral symptoms. J Orthop 2020; 21:199-202. [PMID: 32273656 DOI: 10.1016/j.jor.2020.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Shoulder abnormalities on imaging are increasingly common with advancing age.We tested the difference in the accuracy of diagnosing the injured shoulder between surgeons who reviewed MRI reports and who did and did not receive information about the patients. Methods Thirty people aged 40 or older that experienced new shoulder symptoms after an event at work had MRI of both shoulders. Members of the Science of Variation Group (SOVG) were invited to review the radiologist's reports and diagnose the symptomatic side. Ninety-seven surgeons participated. Results Surgeon observers provided with patient information were not more accurate in diagnosing the symptomatic shoulder (Odds Ratio: 0.90; 95% CI: 0.75 to 1.1; P = 0.29). There was slight agreement between surgeons (kappa = 0.10). The sensitivity and specificity for diagnosing the symptomatic side were 51% (CI: 48%-54%) and 67% (CI: 64%-70%) respectively. A binomial test showed that surgeons indicated the injured shoulder slightly more frequently than expected by random chance (59%; P < 0.001). Conclusions Surgeons were only slightly better at indicating the symptomatic side than random chance. Shoulder pain in people aged 40 or older should probably be considered age-related unless there is good objective evidence of acute traumatic pathology. Level of evidence Level II, diagnostic study.
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Affiliation(s)
- Emily Boersma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, the Netherlands
| | - Tom Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - Maria Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of IQ Healthcare, Nijmegen, the Netherlands
| | - Michael Edwards
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - Stein Janssen
- Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands
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Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Muccioli C, Chelli M, Caudal A, Andreani O, Elhor H, Gauci MO, Boileau P. Rotator cuff integrity and shoulder function after intra-medullary humerus nailing. Orthop Traumatol Surg Res 2020; 106:17-23. [PMID: 31882328 DOI: 10.1016/j.otsr.2019.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Antegrade percutaneous intra-medullary nailing (IMN) has a poor reputation in the treatment of humerus fractures. The aim of the present study was to assess rotator cuff integrity and shoulder function after IMN in humerus fracture. HYPOTHESIS Third-generation humeral nails (straight, small diameter, with locked screws) conserve rotator cuff tendon integrity and avoid the shoulder stiffness and pain incurred by 1st generation (large diameter, without self-blocking screw) and 2nd generation nails (curved, penetrating the supraspinatus insertion on the greater tuberosity). METHODS Forty patients (26 female, 14 male; mean age, 60 years (range, 20-89 years)) with displaced humeral fracture (23 proximal humerus, 17 humeral shaft) underwent IMN using a 3rd generation nail (34 Aequalis™ (Tornier-Wright), 6 MultiLoc™ (Depuy-Synthes)). Mean clinical, radiologic and ultrasound follow-up was 8 months (range, 6-18 months); 22 patients agreed to postoperative CT scan. RESULTS There were no revision surgeries for rotator cuff repair or secondary bone displacement. Mean Adjusted Constant Score (ACS) was 93±22% and the Subjective Shoulder Value (SSV) 77±18%. Elevation was 140±36°, external rotation 48±22° and internal rotation was to L3. Ultrasound found: 5 supraspinatus tendon lesions (12.5%) (2 full and 3 deep partial tears) without functional impact (ACS) 91% without vs. 107% with tear; (p=0.12); 2 of the deep partial tears involved excessively lateral and high nail positioning. Eight patients (20%) had painful tendinopathy of the long head of the biceps (LHB) tendon associated with significantly impaired functional scores (ACS 65% vs. 100%; p<0.001); and 4 cases of technical error: 3 of anterior LHB screwing in the groove, and 1 of LHB irritation due to an excessively long posterior screw. CONCLUSION Supraspinatus tendon lesions following IMN with a 3rd-generation humeral nail were rare (12.5%) and asymptomatic; prevalence was not higher than in the general population in the literature (16%). LHB tendinopathy was frequent (20%) and symptomatic, and due to technical error in half of the cases. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Christophe Muccioli
- IULS -Institut Universitaire Locomoteur & Sports- Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Mikaël Chelli
- IULS -Institut Universitaire Locomoteur & Sports- Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | | | | | - Hicham Elhor
- IULS -Institut Universitaire Locomoteur & Sports- Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Marc-Olivier Gauci
- IULS -Institut Universitaire Locomoteur & Sports- Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Pascal Boileau
- IULS -Institut Universitaire Locomoteur & Sports- Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France.
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Steinmann S, Pfeifer CG, Brochhausen C, Docheva D. Spectrum of Tendon Pathologies: Triggers, Trails and End-State. Int J Mol Sci 2020; 21:ijms21030844. [PMID: 32013018 PMCID: PMC7037288 DOI: 10.3390/ijms21030844] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
The biggest compartment of the musculoskeletal system is the tendons and ligaments. In particular, tendons are dense tissues connecting muscle to bone that are critical for the integrity, function and locomotion of this system. Due to the increasing age of our society and the overall rise in engagement in extreme and overuse sports, there is a growing prevalence of tendinopathies. Despite the recent advances in tendon research and due to difficult early diagnosis, a multitude of risk factors and vague understanding of the underlying biological mechanisms involved in the progression of tendon injuries, the toolbox of treatment strategies remains limited and non-satisfactory. This review is designed to summarize the current knowledge of triggers, trails and end state of tendinopathies.
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Affiliation(s)
- Sara Steinmann
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
| | - Christian G. Pfeifer
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Medical Biology, Medical University-Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
- Correspondence: ; Tel.: +49 941 943-1605
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Sung CM, Kim RJ, Hah YS, Gwark JY, Park HB. In vitro effects of alendronate on fibroblasts of the human rotator cuff tendon. BMC Musculoskelet Disord 2020; 21:19. [PMID: 31926548 PMCID: PMC6955091 DOI: 10.1186/s12891-019-3014-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Bone mineral density of the humeral head is an independent determining factor for postoperative rotator cuff tendon healing. Bisphosphonates, which are commonly used to treat osteoporosis, have raised concerns regarding their relationships to osteonecrosis of the jaw and to atypical fracture of the femur. In view of the prevalence of rotator cuff tear in osteoporotic elderly people, it is important to determine whether bisphosphonates affect rotator cuff tendon healing. However, no studies have investigated bisphosphonates’ cytotoxicity to human rotator cuff tendon fibroblasts (HRFs) or bisphosphonates’ effects on rotator cuff tendon healing. The purpose of this study was to evaluate the cytotoxicity of alendronate (Ald), a bisphosphonate, and its effects on HRF wound healing. Methods HRFs were obtained from human supraspinatus tendons, using primary cell cultures. The experimental groups were control, 0.1 μM Ald, 1 μM Ald, 10 μM Ald, and 100 μM Ald. Alendronate exposure was for 48 h, except during a cell viability analysis with durations from 1 day to 6 days. The experimental groups were evaluated for cell viability, cell cycle and cell proliferation, type of cell death, caspase activity, and wound-healing ability. Results The following findings regarding the 100 μM Ald group contrasted with those for all the other experimental groups: a significantly lower rate of live cells (p < 0.01), a higher rate of subG1 population, a lower rate of Ki-67 positive cells, higher rates of apoptosis and necrosis, a higher number of cells with DNA fragmentation, higher caspase-3/7 activity (p < 0.001), and a higher number of caspase-3 positive staining cells. In scratch-wound healing analyses of all the experimental groups, all the wounds healed within 48 h, except in the 100 μM Ald group (p < 0.001). Conclusions Low concentrations of alendronate appear to have little effect on HRF viability, proliferation, migration, and wound healing. However, high concentrations are significantly cytotoxic, impairing cellular proliferation, cellular migration, and wound healing in vitro.
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Affiliation(s)
- Chang-Meen Sung
- Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Ra Jeong Kim
- Department of Convergence Medical Science, Gyeongsang National University, Jinju, South Korea
| | - Young-Sool Hah
- Institute of Health Sciences, Gyeongsang National University School of Medicine and Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, South Korea
| | - Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea, 51472
| | - Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea, 51472.
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Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Surgery for rotator cuff tears. Cochrane Database Syst Rev 2019; 12:CD013502. [PMID: 31813166 PMCID: PMC6900168 DOI: 10.1002/14651858.cd013502] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This review is one in a series of Cochrane Reviews of interventions for shoulder disorders. OBJECTIVES To synthesise the available evidence regarding the benefits and harms of rotator cuff repair with or without subacromial decompression in the treatment of rotator cuff tears of the shoulder. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and WHO ICRTP registry unrestricted by date or language until 8 January 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) including adults with full-thickness rotator cuff tears and assessing the effect of rotator cuff repair compared to placebo, no treatment, or any other treatment were included. As there were no trials comparing surgery with placebo, the primary comparison was rotator cuff repair with or without subacromial decompression versus non-operative treatment (exercises with or without glucocorticoid injection). Other comparisons were rotator cuff repair and acromioplasty versus rotator cuff repair alone, and rotator cuff repair and subacromial decompression versus subacromial decompression alone. Major outcomes were mean pain, shoulder function, quality of life, participant-rated global assessment of treatment success, adverse events and serious adverse events. The primary endpoint for this review was one year. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. MAIN RESULTS We included nine trials with 1007 participants. Three trials compared rotator cuff repair with subacromial decompression followed by exercises with exercise alone. These trials included 339 participants with full-thickness rotator cuff tears diagnosed with magnetic resonance imaging (MRI) or ultrasound examination. One of the three trials also provided up to three glucocorticoid injections in the exercise group. All surgery groups received tendon repair with subacromial decompression and the postoperative exercises were similar to the exercises provided for the non-operative groups. Five trials (526 participants) compared repair with acromioplasty versus repair alone; and one trial (142 participants) compared repair with subacromial decompression versus subacromial decompression alone. The mean age of trial participants ranged between 56 and 68 years, and females comprised 29% to 56% of the participants. Symptom duration varied from a mean of 10 months up to 28 months. Two trials excluded tears with traumatic onset of symptoms. One trial defined a minimum duration of symptoms of six months and required a trial of conservative therapy before inclusion. The trials included mainly repairable full-thickness supraspinatus tears, six trials specifically excluded tears involving the subscapularis tendon. All trials were at risk of bias for several criteria, most notably due to lack of participant and personnel blinding, but also for other reasons such as unclearly reported methods of random sequence generation or allocation concealment (six trials), incomplete outcome data (three trials), selective reporting (six trials), and other biases (six trials). Our main comparison was subacromial decompression versus non-operative treatment and results are reported for the 12 month follow up. At one year, moderate-certainty evidence (downgraded for bias) from 3 trials with 258 participants indicates that surgery probably provides little or no improvement in pain; mean pain (range 0 to 10, higher scores indicate more pain) was 1.6 points with non-operative treatment and 0.87 points better (0.43 better to 1.30 better) with surgery.. Mean function (zero to 100, higher score indicating better outcome) was 72 points with non-operative treatment and 6 points better (2.43 better to 9.54 better) with surgery (3 trials; 269 participants), low-certainty evidence (downgraded for bias and imprecision). Participant-rated global success rate was 873/1000 after non-operative treatment and 943/1000 after surgery corresponding to (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.96 to 1.22; low-certainty evidence (downgraded for bias and imprecision). Health-related quality of life was 57.5 points (SF-36 mental component score, 0 to 100, higher score indicating better quality of life) with non-operative treatment and 1.3 points worse (4.5 worse to 1.9 better) with surgery (1 trial; 103 participants), low-certainty evidence (downgraded for bias and imprecision). We were unable to estimate the risk of adverse events and serious adverse events as only one event was reported across the trials (very low-certainty evidence; downgraded once due to bias and twice due to very serious imprecision). AUTHORS' CONCLUSIONS At the moment, we are uncertain whether rotator cuff repair surgery provides clinically meaningful benefits to people with symptomatic tears; it may provide little or no clinically important benefits with respect to pain, function, overall quality of life or participant-rated global assessment of treatment success when compared with non-operative treatment. Surgery may not improve shoulder pain or function compared with exercises, with or without glucocorticoid injections. The trials included have methodology concerns and none included a placebo control. They included participants with mostly small degenerative tears involving the supraspinatus tendon and the conclusions of this review may not be applicable to traumatic tears, large tears involving the subscapularis tendon or young people. Furthermore, the trials did not assess if surgery could prevent arthritic changes in long-term follow-up. Further well-designed trials in this area that include a placebo-surgery control group and long follow-up are needed to further increase certainty about the effects of surgery for rotator cuff tears.
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Affiliation(s)
- Teemu V Karjalainen
- Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical EpidemiologyMelbourneVICAustralia3144
| | - Nitin B Jain
- Vanderbilt University School of MedicineDepartments of Physical Medicine and Rehabilitation, and Orthopaedics2201 Children's Way, Suite 1318,NashvilleTennesseeUSA37202
| | - Juuso Heikkinen
- University of OuluDivision of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Medical Research CenterOuluFinland
| | - Renea V Johnston
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Cristina M Page
- Vanderbilt University School of MedicineDepartments of Physical Medicine and Rehabilitation, and Orthopaedics2201 Children's Way, Suite 1318,NashvilleTennesseeUSA37202
| | - Rachelle Buchbinder
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
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Khoschnau S, Milosavjevic J, Sahlstedt B, Rylance R, Rahme H, Kadum B. High prevalence of rotator cuff tears in a population who never sought for shoulder problems: a clinical, ultrasonographic and radiographic screening study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:457-463. [DOI: 10.1007/s00590-019-02593-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
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Barreto RPG, Braman JP, Ludewig PM, Ribeiro LP, Camargo PR. Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. J Shoulder Elbow Surg 2019; 28:1699-1706. [PMID: 31279721 DOI: 10.1016/j.jse.2019.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is commonly used to diagnose structural abnormalities in the shoulder. However, subsequent findings may not be the source of symptoms. The aim of this study was to determine comparative MRI findings across both shoulders of individuals with unilateral shoulder symptoms. MATERIALS AND METHODS We prospectively evaluated 123 individuals from the community who had self-reported unilateral shoulder pain with no signs of adhesive capsulitis, no substantial range-of-motion deficit, no history of upper-limb fractures, no repeated shoulder dislocations, and no neck-related pain. Images in the coronal, sagittal, and axial planes with T1, T2, and proton density sequences were generated and independently and randomly interpreted by 2 examiners: a board-certified, fellowship-trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Absolute and relative frequencies for each MRI finding were calculated and compared between symptomatic and asymptomatic shoulders. Agreement between the shoulder surgeon and the radiologist was also determined. RESULTS Abnormal MRI findings were highly prevalent in both shoulders. Only the frequencies of full-thickness tears in the supraspinatus tendon and glenohumeral osteoarthritis were higher (approximately 10%) in the symptomatic shoulder according to the surgeon's findings. Agreement between the musculoskeletal radiologist and shoulder surgeon ranged from slight to moderate (0.00-0.51). CONCLUSION Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders. Clinicians should be aware of the common anatomic findings on MRI when considering diagnostic and treatment planning.
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Affiliation(s)
- Rodrigo Py Gonçalves Barreto
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Jonathan P Braman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paula M Ludewig
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA; Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil.
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Enger M, Skjaker SA, Nordsletten L, Pripp AH, Melhuus K, Moosmayer S, Brox JI. Sports-related acute shoulder injuries in an urban population. BMJ Open Sport Exerc Med 2019; 5:e000551. [PMID: 31548901 PMCID: PMC6733325 DOI: 10.1136/bmjsem-2019-000551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives More than a third of sports injuries involve the upper extremity. The primary aim was to quantify and describe sports-related shoulder injuries in a general population cohort. A secondary aim was to compare aspects of these injuries to those that were not sports-related. Methods We performed a prospective registration of the activity at the time of shoulder injury in all cases admitted during 1 year in a combined primary care and orthopaedic emergency department serving a defined population. The electronic patient records and patient reported questionnaires were reviewed. Results Twenty-nine per cent (n=781) of 2650 registered shoulder injuries were reported to be sports-related, with the highest proportion in acromioclavicular injuries (>50%). Patients with sports injuries were younger than those injured during other activities (median age 28 and 43 years, respectively, p<0.001), and more often male (78% and 52%, respectively, p<0.001). There was a strong gender disparity in incidence of sports-related shoulder injuries in adolescents and young adults, which was not observed in non-sports shoulder injuries. Football (soccer) (6–29 years), cycling (30–49 years), skiing (50–69 years) and martial arts were the dominating sports activities. Fractures were more common in skiing and cycling than in other major sports in the study. Conclusions Almost a third of the shoulder injuries occurred during sports. The types of sports involved varied with age and gender. The comparison of sport to non-sport shoulder injury incidence rates suggests that the increased risk of shoulder injuries in young males is mainly attributable to sports injuries.
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Affiliation(s)
- Martine Enger
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Knut Melhuus
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stefan Moosmayer
- Department of Orthopaedic Surgery, Martina Hansens Hospital, Baerum, Norway
| | - Jens Ivar Brox
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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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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Could long-term overhead load in painters be associated with rotator cuff lesions? A pilot study. PLoS One 2019; 14:e0213824. [PMID: 30875391 PMCID: PMC6420001 DOI: 10.1371/journal.pone.0213824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/03/2019] [Indexed: 12/30/2022] Open
Abstract
Background Use of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG) Materials and methods 100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed. Results In the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect. Conclusion Long-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort. Level of evidence: III
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Abstract
Degenerative rotator cuff tears are the most common cause of shoulder pain and have a strong association with advanced aging. Considerable variation exists in surgeons' perceptions on the recommended treatment of patients with painful rotator cuff tears. Natural history studies have better outlined the risks of tear enlargement, progression of muscle degeneration, and decline in the function over time. This information combined with the known factors potentially influencing the rate of successful tendon healing such as age, tear size, and severity of muscle degenerative changes can be used to better refine appropriate surgical indications. Although conservative treatment can be successful in the management of many of these tears, risks to nonsurgical treatment also exist. The application of natural history data can stratify atraumatic degenerative tears according to the risk of nonsurgical treatment and better identify tears where early surgical intervention should be considered.
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