1
|
Ueda Y, Tanaka H, Tachibana T, Inui H, Nobuhara K, Umehara J, Ichihashi N. Factors determining the short-term clinical outcomes of conservative treatment in patients with supraspinatus tear. J Bodyw Mov Ther 2024; 39:463-468. [PMID: 38876669 DOI: 10.1016/j.jbmt.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION To identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear. METHODS The study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable. RESULTS The average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R2 = 0.44, p < 0.01). CONCLUSION Supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear.
Collapse
Affiliation(s)
- Yasuyuki Ueda
- Department of Physical Therapy, Faculty of Health Science, Takarazuka University of Medical and Healthcare, Hyogo, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiroshi Tanaka
- Institute of Biomechanics, Nobuhara Hospital, Hyogo, Japan
| | | | - Hiroaki Inui
- Institute of Biomechanics, Nobuhara Hospital, Hyogo, Japan
| | | | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
2
|
Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Woods C, Lambert N, Schulte O, Barrett T. Safety and Efficacy of Wharton's Jelly Connective Tissue Allograft for Rotator Cuff Tears: Findings from a Retrospective Observational Study. Biomedicines 2024; 12:710. [PMID: 38672066 PMCID: PMC11048385 DOI: 10.3390/biomedicines12040710] [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: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
With the increasing occurrence of rotator cuff injuries every year, there is a great need for a reliable treatment option. Wharton's Jelly contains several components that can positively impact the replacement and repair of musculoskeletal defects. The overall objective of this study is to evaluate the improvement of patient-reported pain scales after applying Wharton's Jelly (WJ) in rotator cuff defects. Eighty-seven patients with rotator cuff defects who failed at least eight weeks of conservative treatment were selected from the retrospective repository. A total of 2 cc of WJ flowable allograft was applied to the specific affected anatomy, the most common being supraspinatus tendon, biceps tendon insertion, labral tear, and subscapularis tear. No adverse reactions were reported. Statistically significant improvements were found from the initial to Day 90 in all scales. Patient satisfaction was calculated using minimal clinically important differences. No statistically significant differences were found in mean changes between gender, BMI, and age. Scanning electron microscopy images reveal the similarities between the collagen matrix in WJ and the rotator cuff. The significant improvement in patient outcomes coincides with the current literature analyzing WJ applications with other structural defects around the body. WJ is a promising alternative for musculoskeletal defects when the standard of care fails.
Collapse
Affiliation(s)
- Albert Lai
- Desert Physical Medicine and Pain Management, Indio, CA 92201, USA; (A.L.); (R.D.)
| | - Conrad Tamea
- Orthopedic Associates of Tampa Bay, Tampa, FL 33603, USA;
| | - John Shou
- Pharmacology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Anthony Okafor
- Mathematics & Statistics, University of West Florida, Pensacola, FL 32514, USA; (A.O.); (J.S.)
| | - Jay Sparks
- Mathematics & Statistics, University of West Florida, Pensacola, FL 32514, USA; (A.O.); (J.S.)
| | - Renee Dodd
- Desert Physical Medicine and Pain Management, Indio, CA 92201, USA; (A.L.); (R.D.)
| | - Crislyn Woods
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (T.B.)
| | - Naomi Lambert
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (T.B.)
| | - Orion Schulte
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (T.B.)
| | - Tyler Barrett
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (T.B.)
| |
Collapse
|
3
|
LaPorte ZL, Cherian NJ, Eberlin CT, Dean MC, Torabian KA, Dowley KS, Martin SD. Operative management of rotator cuff tears: identifying disparities in access on a national level. J Shoulder Elbow Surg 2023; 32:2276-2285. [PMID: 37245619 DOI: 10.1016/j.jse.2023.04.007] [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: 12/19/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The purpose of this study was to identify nationwide disparities in the rates of operative management of rotator cuff tears based on race, ethnicity, insurance type, and socioeconomic status. METHODS Patients diagnosed with a full or partial rotator cuff tear from 2006 to 2014 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample database using International Classification of Diseases, Ninth Revision diagnosis codes. Bivariate analysis using chi-square tests and adjusted, multivariable logistic regression models were used to evaluate differences in the rates of operative vs. nonoperative management for rotator cuff tears. RESULTS This study included 46,167 patients. When compared with white patients, adjusted analysis showed that minority race and ethnicity were associated with lower rates of operative management for Black (adjusted odds ratio [AOR]: 0.31, 95% confidence interval [CI]: 0.29-0.33; P < .001), Hispanic (AOR: 0.49, 95% CI: 0.45-0.52; P < .001), Asian or Pacific Islander (AOR: 0.72, 95% CI: 0.61-0.84; P < .001), and Native American patients (AOR: 0.65, 95% CI: 0.50-0.86; P = .002). In comparison to privately insured patients, our analysis also found that self-payers (AOR: 0.08, 95% CI: 0.07-0.10; P < .001), Medicare beneficiaries (AOR: 0.76, 95% CI: 0.72-0.81; P < .001), and Medicaid beneficiaries (AOR: 0.33, 95% CI: 0.30-0.36; P < .001) had lower odds of receiving surgical intervention. Additionally, relative to those in the bottom income quartile, patients in all other quartiles experienced nominally higher rates of operative repair; these differences were statistically significant for the second quartile (AOR: 1.09, 95% CI: 1.03-1.16; P = .004). CONCLUSION There are significant nationwide disparities in the likelihood of receiving operative management for rotator cuff tear patients of differing race/ethnicity, payer status, and socioeconomic status. Further investigation is needed to fully understand and address causes of these discrepancies to optimize care pathways.
Collapse
Affiliation(s)
- Zachary L LaPorte
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Nathan J Cherian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA.
| | - Christopher T Eberlin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Michael C Dean
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Kaveh A Torabian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Kieran S Dowley
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| |
Collapse
|
4
|
Aratikatla A, Sidhu J, Maffulli N, Gupta M, Potty AG, Gupta A. Allogenic Umbilical Cord Tissue for Rotator Cuff Injuries. Sports Med Arthrosc Rev 2023; 31:73-79. [PMID: 37976128 DOI: 10.1097/jsa.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Highly prone to injury, the rotator cuff greatly contributes to the stability and mobility of the shoulder. Clinicians prioritize conservative treatment, resorting to surgery only when necessary, although they are hindered by inherent limitations. Biological therapies, including perinatal tissue, such as umbilical cord (UC) tissue, hold promise for treating rotator cuff injuries (RCIs) in the field of regenerative medicine. This article qualitatively presents the in vitro, preclinical, clinical, and ongoing scientific literature exploring the application of UC tissue and associated mesenchymal stem cells in the context of RCIs. Employing the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines, a systematic review was conducted. These studies have presented substantial evidence indicating that UC tissue and UC-derived mesenchymal stem cells are safe and potentially efficacious for managing RCIs, though more adequately powered randomized controlled trials are warranted to further establish efficacy and justify clinical use.
Collapse
Affiliation(s)
| | - Justin Sidhu
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Ortopaedica" Department, Hospital of Salerno, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, UK
| | - Manu Gupta
- Polar Aesthetics Dental and Cosmetic Centre
| | - Anish G Potty
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX
| | - Ashim Gupta
- Regenerative Orthopaedics, Noida, UP, India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX
- Future Biologics
- BioIntegrate, Lawrenceville, GA
| |
Collapse
|
5
|
Monir JG, Astolfi MM, Sholder D, Kocovic N, Horneff JG, Abboud JA, Schoch BS. Early revision rotator cuff repair: an analysis of outcomes and function. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:321-326. [PMID: 35064337 DOI: 10.1007/s00590-021-03182-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Rotator cuff repair (RCR) is commonly performed and can have good functional outcomes. However, failure of RCR surgery can be challenging for both patient and surgeon alike. This study examines the outcomes of early revision RCR for the management of clinically failed RCRs. METHODS Thirty-six patients undergoing revision RCR within 1 year of primary surgery were evaluated. Range of motion (ROM) and patient-reported outcomes (PROMs) were assessed at baseline, post-primary RCR, and post-revision RCR. RESULTS Patients with a documented repair failure after primary RCR failed to improve in both ROM and PROMs compared to before primary RCR. Following early revision, RCR SANE (p = 0.024, p < 0.001), ASES (p = 0.004, p < 0.001), and SST (p < 0.001, p = 0.001) scores improved significantly compared to pre-primary and pre-revision scores, respectively. Documentation of a new traumatic injury did not affect clinical or functional outcomes compared to atraumatic re-tears. Number of tendons torn was positively correlated with higher SANE scores (r = 0.638, p = 0.008) and negatively correlated with SST score (r = -0.475, p = 0.03) and improvement in forward elevation (r = -0.368, p = 0.03) after primary RCR. There were significant correlations between number of tendons torn and improvement in SANE (r = 0.664, p = 0.007) and ASES scores (r = 0.468, p = 0.043) from post-primary RCR to post-revision RCR. CONCLUSION Early revision after failed RCR can lead to clinically significant improvement in functional outcomes. The presence of a traumatic re-injury does not appear to affect revision RCR outcomes as it does in the primary setting. Patients with early clinical failures of primary RCR may benefit from early revision RCR. LEVEL OF EVIDENCE III: Retrospective Case Series.
Collapse
Affiliation(s)
- Joseph G Monir
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Matthew M Astolfi
- Department of Orthopaedics, Beaumont Royal Oak Hospital, Royal Oak, MI, USA
| | | | - Nikola Kocovic
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Gabriel Horneff
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bradley S Schoch
- Department of Orthopedics, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| |
Collapse
|
6
|
Pogorzelski J, Rupp MC, Scheiderer B, Lacheta L, Schliemann B, Schanda J, Heuberer P, Schneider M, Hackl M, Lorbach O. Management of Irreparable Posterosuperior Rotator Cuff Tears-A Current Concepts Review and Proposed Treatment Algorithm by the AGA Shoulder Committee. J Pers Med 2023; 13:jpm13020191. [PMID: 36836425 PMCID: PMC9964754 DOI: 10.3390/jpm13020191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Posterosuperior rotator cuff tears range among the most common causes of shoulder complaints. While non-operative treatment is typically reserved for the elderly patient with low functional demands, surgical treatment is considered the gold standard for active patients. More precisely, an anatomic rotator cuff repair (RCR) is considered the most desirable treatment option and should be generally attempted during surgery. If an anatomic RCR is impossible, the adequate choice of treatment for irreparable rotator cuff tears remains a matter of debate among shoulder surgeons. Following a critical review of the contemporary literature, the authors suggest the following evidence- and experience-based treatment recommendation. In the non-functional, osteoarthritic shoulder, treatment strategies in the management of irreparable posterosuperior RCT include debridement-based procedures and reverse total shoulder arthroplasty as the treatment of choice. Joint-preserving procedures aimed at restoring glenohumeral biomechanics and function should be reserved for the non-osteoarthritic shoulder. Prior to these procedures, however, patients should be counseled about deteriorating results over time. Recent innovations such as the superior capsule reconstruction and the implantation of a subacromial spacer show promising short-term results, yet future studies with long-term follow-up are required to derive stronger recommendations.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
- Private Practice OC Erlangen-Ebermannstadt, Nägelsbach Str. 25b, 91052 Erlangen, Germany
- Correspondence:
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lucca Lacheta
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Benedikt Schliemann
- Herz Jesu Hospital Münster-Hiltrup, Westfalen Str. 109, 48165 Münster, Germany
| | - Jakob Schanda
- Private Practice Dr. Schanda, Rochusgasse 17/13, 1030 Vienna, Austria
| | - Philipp Heuberer
- Private Practice OrthoCare, Kurbad Str. 14, 1100 Vienna, Austria
| | - Marco Schneider
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58455 Witten, Germany
| | - Michael Hackl
- Department of Trauma-, Hand- and Elbow Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | | | - Olaf Lorbach
- Schoen-Clinic Lorsch, Department of Shoulder Surgery and Sports Traumatology, Wilhelm-Leuschner-Straße 10, 64653 Lorsch, Germany
| |
Collapse
|
7
|
Hwang A, Zhang L, Ramirez G, Maloney M, Voloshin I, Thirukumaran C. Black Race, Hispanic Ethnicity, and Medicaid Insurance Are Associated With Lower Rates of Rotator Cuff Repair in New York State. Arthroscopy 2022; 38:3001-3010.e2. [PMID: 35817374 DOI: 10.1016/j.arthro.2022.06.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the use of operative rotator cuff repair for rotator cuff pathology in New York State and analyze the racial, ethnic, and income-based disparities in receiving rotator cuff repair. METHODS A retrospective review of the Statewide Planning and Research Cooperative System Database of New York State was conducted to include patients with a new diagnosis of rotator cuff tear between July 1, 2017, and June 30, 2019, with at least 6 months of follow-up. Bivariate analysis using χ2 tests and multivariable logistic regression models were used to determine racial, ethnic, and income-based disparities in the use of surgical treatment with rotator cuff repair. RESULTS A total of 87,660 patients were included in the study. Of these, 36,422 patients (41.5%) underwent surgical treatment with rotator cuff repair. Multivariable analysis showed that Black race (adjusted odds ratio [aOR] 0.78; 95% confidence interval [CI] 0.69-0.87; P < .001), Hispanic/Latino ethnicity (aOR 0.91; 95% CI 0.85-0.97); P = .004), and Medicaid (aOR 0.75; 95% CI 0.70-0.80; P < .001), or other government insurance (aOR 0.82; 95% CI 0.78-0.86; P < .001) were independently associated with lower rates of rotator cuff repair. Male sex (aOR 1.18; 95% CI 1.14-1.22; P < .001), Asian race (aOR 1.27; 95% CI 1.00-1.62; P = .048), workers' compensation insurance (aOR 1.12; 95% CI 1.07-1.18; P < .001), and greater home ZIP code income quartile (aOR 1.19; 95% CI 1.09-1.30; P < .001) were independently associated with greater rates of operative management. Although race was an independent covariate affecting rate of rotator cuff repair, the effects of race were altered when accounting for the other covariates, suggesting that race alone does not account for the differences in rate of surgery for rotator cuff pathology. CONCLUSIONS In this analysis of all adult patients presenting with rotator cuff tears to New York hospital systems from 2017 to 2019, we identified significant racial, ethnic, and socioeconomic disparities in the likelihood of rotator cuff repair surgery for patients with rotator cuff tears. These include lower rates of rotator cuff repair for those Black, Hispanic, and low-income populations as represented by Medicaid insurance and low home ZIP code income quartile. CLINICAL RELEVANCE This study reports disparities in the use of rotator cuff repair for individuals with rotator cuff pathology.
Collapse
Affiliation(s)
- Alan Hwang
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A..
| | - Linda Zhang
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Gabriel Ramirez
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael Maloney
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Ilya Voloshin
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Caroline Thirukumaran
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| |
Collapse
|
8
|
Parikh P, MacDermid JC, Tuli V, Manley M. Distal biceps tendon rupture: Is surgery the best course of treatment? Two case reports. J Hand Ther 2021; 34:463-468. [PMID: 32565099 DOI: 10.1016/j.jht.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Repeated case study. INTRODUCTION Complete rupture of the distal biceps tendon occurs mostly within the middle-aged male population. Surgical repair is traditionally recommended. Given the potential for complications, questions remain whether surgical repair is indicated. PURPOSE To explore non-operative management for full distal biceps tendon ruptures. CASES Two participants with complete tears of the distal biceps tendon confirmed with magnetic resonance imaging/ultrasound had chosen to not undergo surgical repair. First, a 48-year-old police officer was an avid weight lifter and recreational athlete. Second, a 43-year-old detailer has minimal physical activity participation other than work duties and light recreational sports. Strength testing was performed immediately after rupture and at 24 weeks after a structured physical therapy program focused on strengthening and stretching the elbow flexors and supinator. OUTCOMES Initial strength deficits of 17/21% in flexion and 13/19% for supination were detected. In both patients, flexion and supination strength returned to normal limits when compared with the opposite upper extremity. After intervention, functional and disability scores were normal in both cases, and both patients reported return to preinjury repetitive work and weight training. DISCUSSION Although patients are typically counseled that a reason for surgical repair after biceps rupture is substantial loss of flexion and supination strength, these cases indicate that full recovery of strength and function is possible through rehabilitation. CONCLUSION These cases question the traditional wisdom that a surgical repair is needed for all distal biceps ruptures. LEVEL OF EVIDENCE Therapy, level 5. ICD-10 Code: M66.3.
Collapse
Affiliation(s)
- Pulak Parikh
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | - Joy C MacDermid
- Hand and Upper Limb Centre, St. Joseph Hospital, London, ON, Canada
| | - Vikas Tuli
- Full Radius Orthopaedics, Newmarket, ON, Canada
| | - Michelle Manley
- Spectrum Institute for Health and Rehabilitation, Newmarket, ON, Canada
| |
Collapse
|
9
|
Giovannetti de Sanctis E, Franceschetti E, De Dona F, Palumbo A, Paciotti M, Franceschi F. The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review. J Clin Med 2020; 10:jcm10010051. [PMID: 33375716 PMCID: PMC7795404 DOI: 10.3390/jcm10010051] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.
Collapse
Affiliation(s)
- Edoardo Giovannetti de Sanctis
- Department of Orthopaedics and Traumatology, Catholic University, Agostino Gemelli Hospital, 00164 Rome, Italy
- Correspondence: ; Tel.: +39-331-963-1117
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.D.D.); (A.P.); (M.P.)
| | - Ferdinando De Dona
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.D.D.); (A.P.); (M.P.)
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.D.D.); (A.P.); (M.P.)
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.D.D.); (A.P.); (M.P.)
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy;
| |
Collapse
|
10
|
Effect of localized tendon remodeling on supraspinatus tear propagation. J Biomech 2020; 108:109903. [PMID: 32636012 DOI: 10.1016/j.jbiomech.2020.109903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
Rotator cuff tear propagation is multifactorial and may be due to localized changes in mechanical properties from tendon remodeling based on the inhomogeneous stresses experienced by a tendon with a tear. The objective of this study was to investigate the effect of localized tendon remodeling on tear propagation for simulated supraspinatus tendon tears. A validated computational model of a supraspinatus tendon using subject-specific geometry and material properties with a 1 cm wide anterior tear was used. The medial edge of the supraspinatus tendon was displaced 5 mm to induce tear propagation and cohesive elements were used to model tear propagation. Four remodeling scenarios were investigated: (1) Baseline (no remodeling), (2) Positive remodeling (increased fiber stiffness) and (3) Negative remodeling (decreased fiber stiffness) at tear tips, and (4) Negative remodeling along the medial-lateral tear edge. Output parameters included the amount of tear propagation, critical load to propagate the tear, and maximum principal stress at the tear tips. Positive remodeling at the tear tips resulted in the largest amount of tear propagation (18.4 mm), highest peak maximum principal stress (25.2 MPa), and lowest critical load to propagate the tear (249N). Conversely, negative remodeling at the tear tips resulted in the least amount of tear propagation (16 mm), lowest peak maximum principal stress (17.6 MPa) and highest critical load to propagate the tear (278N). Overall, remodeling at the tear tips has the greatest effect on tear propagation. Therefore, a better method for clinicians to measure tendon stiffness at the tear tips would be helpful to improve outcome of patients.
Collapse
|
11
|
Rodriguez-Santiago B, Castillo B, Baerga-Varela L, Micheo WF. Rehabilitation Management of Rotator Cuff Injuries in the Master Athlete. Curr Sports Med Rep 2019; 18:330-337. [PMID: 31503045 DOI: 10.1249/jsr.0000000000000628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Rotator cuff (RTC) injuries are common in master athletes, especially overhead athletes. Risk factors include aging and degeneration as nonmodifiable and volume of activity, muscle weakness, and loss of motion as modifiable. The clinical presentation involves limited range of motion (ROM), pain at rest and at night. Injury classification into traumatic versus nontraumatic and tendinopathy, partial or full-thickness tears helps to establish a treatment plan. RTC injury rehabilitation protocols are criteria-based, multimodal, and divided into four phases. The acute phase addresses pain, inflammation, ROM, and RTC protection. The recovery phase addresses kinetic chain abnormalities, flexibility, and strength, and the functional phase involves exercises directed toward specific sport activities. Return to sports is based on clinical recovery, kinetic chain principles, and adequate sports technique. Nonsurgical management is recommended in most cases, and surgical management is considered if symptoms progress, especially for full-thickness tears.
Collapse
Affiliation(s)
- Belmarie Rodriguez-Santiago
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - Brenda Castillo
- Physical Medicine and Rehabilitation Department-MossRehab, Elkins Park, PA
| | - Luis Baerga-Varela
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - William F Micheo
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| |
Collapse
|
12
|
Park I, Lee HJ, Kim SK, Park MS, Kim YS. Factors Related to Preoperative Shoulder Pain in Patients with Atraumatic Painful Rotator Cuff Tears. Clin Shoulder Elb 2019; 22:128-134. [PMID: 33330208 PMCID: PMC7714281 DOI: 10.5397/cise.2019.22.3.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma. Methods We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors. Results Shoulder pain was associated with young age (p=0.01), male sex (p=0.01) and the presence of diabetes mellitus (p<0.001). Measurements of rotator cuff tear characteristics including tear size (p=0.53), muscle atrophy (p=0.16) and the number of torn tendons (p=0.34) did not correlate with shoulder pain. Symptom duration (p=0.60) and range of motion (p>0.05) also showed no correlation with VAS for pain. Conclusions Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.
Collapse
Affiliation(s)
- In Park
- Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Ki Kim
- Yonsei Hangmac Surgical Clinic, Goyang, Korea
| | - Min-Sik Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
13
|
Micallef J, Pandya J, Low AK. Management of rotator cuff tears in the elderly population. Maturitas 2019; 123:9-14. [PMID: 31027684 DOI: 10.1016/j.maturitas.2019.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/23/2022]
Abstract
Rotator cuff tears (RCTs) are a common cause of shoulder pain and weakness in the elderly (age > 65yrs) and result in reduced quality of life, loss of income and a burden on health care. With the elderly population living longer there is a growing interest in the effective and efficient management of RCTs. In a majority of cases, the initial treatment is conservative, with physical therapy, analgesics and possibly corticosteroid or plasma rich protein injections. There are various surgical options, including rotator cuff repair, superior capsule reconstruction, subacromial decompression and reverse shoulder arthroplasty. The aim of this article is to provide a narrative review of evidence guiding the management options for RCTs in the elderly.
Collapse
Affiliation(s)
| | - Jay Pandya
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
| | - Adrian K Low
- University of Sydney, Sydney Adventist Hospital, Clinical School, Department of Orthopaedic Surgery, Sydney, NSW, Australia.
| |
Collapse
|
14
|
Pogorzelski J, Fritz EM, Godin JA, Imhoff AB, Millett PJ. Nonoperative treatment of five common shoulder injuries: A critical analysis. ACTA ACUST UNITED AC 2018; 13:89-97. [PMID: 29887915 PMCID: PMC5976697 DOI: 10.1007/s11678-018-0449-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
Abstract
Economic pressure highlights the critical need for appropriate diagnosis and treatment of various shoulder pathologies since under-diagnosis and under-treatment can result in increased costs to society in the form of disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient. Therefore, it is crucial to distinguish the indications between operative and nonoperative management, especially in common shoulder pathologies such as rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular joint, and proximal humeral fractures. As a result, a detailed analysis of individual risk factors for potential failures should be performed and treatment should be based on individualized care with consideration given to each patient’s particular injury pattern, functional demands, and long-term goals.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Erik M Fritz
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA
| | - Jonathan A Godin
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Peter J Millett
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
| |
Collapse
|