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Gatto L, Fernando A, Patel M, Yeung A, Ackland DC. Subacromial contact after acromioplasty in the rotator cuff deficient shoulder. J Orthop Res 2024; 42:588-597. [PMID: 37812185 DOI: 10.1002/jor.25717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
Subacromial impingement (SAI) is associated with shoulder pain and dysfunction and is exacerbated by rotator cuff tears; however, the role of acromioplasty in mitigating subacromial contact in the rotator cuff deficient shoulder remains debated. This study aimed to quantify the influence of isolated and combined tears involving the supraspinatus on subacromial contact during abduction; and second, to evaluate the influence of acromioplasty on joint space size and subacromial contact under these pathological conditions. Eight fresh-frozen human cadaveric upper limbs were mounted to a computer-controlled testing apparatus that simulated joint motion by simulated force application. Shoulder abduction was performed while three-dimensional joint kinematics was measured using an optoelectronic system, and subacromial contact evaluated using a digital pressure sensor secured to the inferior acromion. Testing was performed after an isolated tear to the supraspinatus, as well as tears involving the subscapularis and infraspinatus-teres minor, both before and after acromioplasty. Rotator cuff tears significantly increased peak subacromial pressure (p < 0.001), average subacromial pressure (p = 0.001), and contact force (p = 0.034) relative to those in the intact shoulder. Following acromioplasty, significantly lower peak subacromial contact pressure, force and area were observed for all rotator cuff tears involving the supraspinatus at 30° of abduction (p < 0.05). Acromioplasty predominantly reduces acromion thickness anteriorly thereby reducing subacromial contact in the rotator cuff deficient shoulder, particularly in early to mid-abduction where superior glenohumeral joint shear force potential is large. These findings provide a biomechanical basis for acromioplasty as an intervention for SAI syndrome and as an adjunct to rotator cuff repairs.
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Affiliation(s)
- Laura Gatto
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Ashen Fernando
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Angus Yeung
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Tan EK, Ahmad Hanif KA, Seri Masran SM, Che-Hamzah F. A Triad of Shoulder Injuries Following Cardioversion: A Case Report. Cureus 2024; 16:e52704. [PMID: 38384611 PMCID: PMC10879726 DOI: 10.7759/cureus.52704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Transthoracic defibrillation and cardioversion are commonly used techniques to resuscitate a patient during acute cardiac arrhythmic events. There are numerous complications associated with these procedures. We report a previously unreported complication where a patient suffered from a supraspinatus tear after cardioversion for ventricular tachycardia. There are numerous complications associated with these procedures. We report a previously unreported complication where a middle-aged Chinese patient with no previous trauma history suffered from a supraspinatus tear after cardioversion for ventricular tachycardia.
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Affiliation(s)
- Eng Kee Tan
- Orthopaedics, Ministry of Health Malaysia, Serdang, MYS
| | | | | | - Fahrudin Che-Hamzah
- Orthopedics and Traumatology, Hospital Pengajar Universiti Putra Malaysia, Serdang, MYS
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De Castro Correia M, Oliveira L, Moita Gonçalves E, Correia R, Andrade I, Borges A, Rodrigues Lopes T, Carvalho JL. Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears. Cureus 2023; 15:e46936. [PMID: 38022354 PMCID: PMC10640680 DOI: 10.7759/cureus.46936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The supraspinatus muscle tendon is the most frequently rotator cuff muscle torn. Reliable shoulder pain relief strategies are needed for patients with severe pain, refractory to conservative management, and without surgical indication. MATERIALS AND METHODS We conducted a retrospective analysis in a Portuguese reference Rehabilitation Centre during the 1st of January 2020 and the 30th of June 2021, including all patients with partial or complete supraspinatus tendon tear, older than 50 years, who presented with severe pain and who were submitted to suprascapular nerve pulsed radiofrequency. RESULTS We included 32 patients in our retrospective analysis, mainly female (53%) with a mean age of 66.50 years old. Most of the patients reported right shoulder pain (21 patients, 66%). The mean baseline pain, reported on the numeric rating scale, was 8.00 ± 0.88. Compared to baseline, mean pain reduced 4.00 ± 3.19 at three months (p<0.001), 3.59 ± 3.13 at six months (p<0.001) and 2.94 ± 2.78 at 12 months (p<0.001). From the 3rd to the 12th month there was an increase of 1.06 ± 2.77 in mean pain (p=0.038). There was no difference (p>0.05) in average pain at 0, 3, 6, or 12 months between patients who were simultaneously submitted to an intra-articular shoulder injection. DISCUSSION Our analysis revealed 36% average shoulder pain reduction for, at least, 12 months following suprascapular nerve pulsed radiofrequency, with a peak pain reduction of 50% at three months. Slow fading of pain reduction in the following nine months was seen, however, compared to baseline, pain reduction was always statistically significant. Cortico-anaesthetic intra-articular shoulder injections seem not to add benefit in shoulder pain reduction when performed simultaneously with suprascapular nerve pulsed radiofrequency. CONCLUSION Suprascapular nerve pulsed radiofrequency seems to be an effective strategy for shoulder pain reduction, in patients with severe pain, refractory to other management modalities. Nonetheless, larger prospective studies, analyzing shoulder functionality and quality of life lost scores, besides pain reduction, should be pursued.
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Affiliation(s)
| | - Luís Oliveira
- Physical Medicine and Rehabilitation, North Rehabilitation Center, Vila Nova de Gaia, PRT
| | - Eugénio Moita Gonçalves
- Physical Medicine and Rehabilitation, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Rodrigo Correia
- Physical Medicine and Rehabilitation, North Rehabilitation Center, Vila Nova de Gaia, PRT
| | - Inês Andrade
- Physical Medicine and Rehabilitation, Alcoitão Rehabilitation Medicine Center, Lisbon, PRT
| | - Andre Borges
- Physical Medicine and Rehabilitation, Trás-os-Montes E Alto Douro Hospital Center, Vila Real, PRT
| | - Tiago Rodrigues Lopes
- Physical Medicine and Rehabilitation, Espregueira-Mendes Sports Center, Porto, PRT
- Physical Medicine and Rehabilitation, North Rehabilitation Center, Vila Nova de Gaia, PRT
| | - José Luís Carvalho
- Physical Medicine and Rehabilitation, North Rehabilitation Center, Vila Nova de Gaia, PRT
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Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance. Orthop J Sports Med 2023; 11:23259671231186820. [PMID: 37655246 PMCID: PMC10467408 DOI: 10.1177/23259671231186820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Background The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design Case series; Level of evidence, 4. Methods This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.
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Affiliation(s)
- Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey
| | | | - Gian Mario Micheloni
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Andrea Giorgini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
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El-Amin SF, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears. J Clin Med 2022; 11:2661. [PMID: 35566785 PMCID: PMC9100979 DOI: 10.3390/jcm11092661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study describes measurements between the coracoid, glenoid, and humerus; characterizes coracoid shape, rotator cuff fatty infiltration, and quantitatively evaluates coracoid impingement and its association with anterosuperior rotator cuff tears (ASCT). 193 shoulder magnetic resonance imaging (MRI) scans demonstrating: rotator cuff tear; isolated tear of the supraspinatus; tear of supraspinatus and subscapularis, were included. MRI measurements included coracohumeral interval (CHI), coracoid overlap (CO), coracoid recess (CR), coracoglenoid angle (CGA), and coracoglenoid interval (CGI) on axial slices; acromiohumeral interval (AHI) on coronal slices; and coracohumeral interval (CHI) and coracoacromial ligament (CAL) thickness on sagittal slices. The coracoid shape was classified as flat, curved, or hooked. An Independent T-test was used to compare the MRI measurements and the different rotator cuff tear groups. In 79% of the patients with ASCT tears, the coracoid was curved. Axial CHI, CGA, sagittal CHI, and AHI were decreased in ASCT when compared to no tears and isolated supraspinatus tears (p < 0.05). CO was increased in ASCT compared to no tears and isolated supraspinatus tears (p < 0.05). Patients with an ASCT had a significantly increased subscapularis and supraspinatus Goutallier fatty infiltration score when compared to no tear and isolated supraspinatus tears (p < 0.05). These quantitative measurements may be useful in identifying patients at risk for ASCT. Level of Evidence III.
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Affiliation(s)
- Saadiq F. El-Amin
- El-Amin Orthopaedic and Sports Medicine Institute, Lawrenceville, GA 30043, USA
- Regenerative Sports Medicine, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA;
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy;
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Orthopedica” Department, Hospital of Salerno, 84124 Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
| | - Matthew C. Mai
- Florida Bone & Joint Specialists, Gulf Breeze, FL 32561, USA;
| | - Hugo C. Rodriguez
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, USA; (H.C.R.); (D.C.)
- Larkin Community Hospital, South Miami, FL 33143, USA
| | - Victoria Jaso
- Ross University School of Medicine, Miramar, FL 33156, USA;
| | - Dylan Cannon
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, USA; (H.C.R.); (D.C.)
| | - Ashim Gupta
- BioIntegrate, Lawrenceville, GA 30043, USA;
- Future Biologics, Lawrenceville, GA 30043, USA
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Veterans in Pain (V.I.P.), Valencia, CA 91354, USA
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Thepsoparn M, Thanphraisan P, Tanpowpong T, Itthipanichpong T. Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears. Orthop J Sports Med 2021; 9:23259671211024937. [PMID: 34485587 PMCID: PMC8414632 DOI: 10.1177/23259671211024937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. Purpose To compare pain relief, functional improvement, and complications after an intratendinous PRP injection versus a subacromial corticosteroid injection for partial supraspinatus tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 32 patients with partial supraspinatus tears were randomly assigned to receive a leukocyte-poor PRP (LP-PRP) injection or a corticosteroid injection. One patient withdrew from the PRP group, leaving 15 patients in the PRP group and 16 patients in the corticosteroid group. The ultrasound-guided procedures were performed by a single experienced pain physician. Pain relief and functional improvement were evaluated using the visual analog scale (VAS) and the Oxford Shoulder Score (OSS), respectively. Treatment efficacy and complications were documented, and the 2 groups were compared at 1- and 6-month follow-up. Results There were no differences in VAS and OSS scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group had on both the VAS and OSS at 6-month follow-up (VAS: 14.5 ± 15.4 vs 37.5 ± 24.9, respectively; OSS: 16.2 ± 3.9 vs 25.0 ± 10.2, respectively; P < .01 for both). Both groups showed significant improvement in VAS and OSS scores from before treatment to 1-month follow-up (mean difference, 35.67 and 11.47 points, respectively, for the PRP group; mean difference, 29.69 and 11.13 points, respectively, for the corticosteroid group; P < .01 for all). The VAS and OSS scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and OSS scores between 1- and 6-month follow-up (mean difference, 15.87 and 7.40 points, respectively; P < .01 for both). There were no complications in either group. Conclusion An injection using either a corticosteroid or LP-PRP resulted in a similar reduction in pain and improvement in function at 1 month in patients with a partial supraspinatus tear. However, PRP showed superior benefits over the corticosteroid at 6-month follow-up.
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Affiliation(s)
- Marvin Thepsoparn
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phark Thanphraisan
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thun Itthipanichpong
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Rybalko D, Bobko A, Amirouche F, Peresada D, Hussain A, Patetta M, Sood A, Koh J, Goldberg B. Biomechanics in an Incomplete Versus Complete Supraspinatus Tear: A Cadaveric Study. Orthop J Sports Med 2020; 8:2325967120964476. [PMID: 33330732 PMCID: PMC7720321 DOI: 10.1177/2325967120964476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Degenerative and traumatic changes to the rotator cuff can result in massive and irreparable rotator cuff tears (RCTs). Purpose/Hypothesis: The study objective was to conduct a biomechanical comparison between a small, incomplete RCT and a large, complete RCT. We hypothesized that the incomplete supraspinatus (SS) tear would lead to an incremental loss of abduction force and preserve vertical position of the humeral head, while a complete SS tear would cause superior humeral migration, decrease functional deltoid abduction force, and increase passive range of motion (ROM). Study Design: Controlled laboratory study. Methods: Six cadaveric shoulders were evaluated using a custom testing apparatus. Each shoulder was subjected to 3 conditions: (1) intact/control, (2) 50%, full-thickness, incomplete SS tear, and (3) 100%, complete SS tear. Deltoid abduction force, superior humeral head migration, and passive ROM were measured in static conditions at 0°, 30°, and 60° of glenohumeral abduction, respectively. Results: The intact SS resulted in a mean deltoid abduction force of 2.5, 3.3, and 3.8 N at 0°, 30°, and 60° of abduction, respectively. Compared with the intact shoulder, there was no significant difference in mean abduction force seen in the incomplete tear, while the force was significantly decreased by 52% at 30° of abduction in the complete tear (P = .009). Compared with the incomplete tear, there were significant decreases in abduction force seen in the complete tear, by 33% and 48% (0.9 N and 1.1 N) at 0° and 30° of abduction, respectively (P = .04 and .004). The intact configuration experienced a mean superior humeral head migration of 1.5, 1.4, and 1.1 mm at 0°, 30°, and 60° of abduction, respectively. The complete tear resulted in a superior migration of 3.0 and 4.4 mm greater than the intact configuration at 0° and 30° of abduction, respectively (P = .001). There was a 5° and 10° increase in abduction ROM with 50% and 100% tears, respectively (P = .003 and .03). Conclusion: An incomplete SS tear does not significantly alter the biomechanics of the shoulder, while a large, complete SS tear leads to a significant superior humeral migration, a decreased deltoid abduction force, and a mild increase in passive ROM. Clinical Relevance: Our findings demonstrate the effects of large SS tears on key biomechanical parameters, as they progress from partial tears.
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Affiliation(s)
- Danil Rybalko
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aimee Bobko
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dmitriy Peresada
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Dmitriy Peresada, MD, Department of Orthopaedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room 270, Chicago, IL 60612, USA ()
| | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael Patetta
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jason Koh
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin Goldberg
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Klironomos AP, Lam PH, Walton JR, Murrell GAC. Can handheld dynamometry predict rotator cuff tear size? A study in 2100 consecutive patients. J Shoulder Elbow Surg 2020; 29:1152-1161. [PMID: 31564574 DOI: 10.1016/j.jse.2019.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to determine whether handheld dynamometry measurements could predict rotator cuff tear size in patients who required surgical treatment of their shoulder pathology. METHODS Handheld dynamometer readings were collected prior to surgery and analyzed retrospectively for 2100 consecutive patients. Post hoc, the cohort was divided into patients with rotator cuff tears (n = 1747) and those without rotator cuff tears (n = 353). The tear group was stratified into partial- vs. full-thickness tears and into 4 groups based on tear size area. RESULTS Patients with partial-thickness tears had greater internal rotation (P = .03), external rotation (P < .001), and supraspinatus (P < .001) strength than patients with full-thickness tears. Patients with tears had lower supraspinatus strength than patients without tears (r = -0.82, P < .001). Patients with a larger tear size had lower values of external rotation (r = -1.46, P < .001) and supraspinatus (r = -1.18, P < .001) strength. A model involving internal rotation and supraspinatus strength could predict the presence of a tear with a sensitivity of 82% and specificity of 29%. The correct prediction rate was 73% overall (82% in tear group and 29% in no-tear group). The following formula was found to predict rotator cuff tear size, showing modest correlation with our raw data (r = 0.25, P < .001): Tear size = 482.8 + (3.9 × Internal rotation strength) + (1.6 × Adduction strength) - (7.2 × External rotation strength) - (2.0 × Supraspinatus strength). CONCLUSIONS Handheld dynamometer readings could not reliably predict rotator cuff tear size, showing only modest correlation with our raw data. Handheld dynamometry readings could predict the presence of a tear, although tears in the intact cohort were overestimated (a specificity of 29% and negative predictive value of 25%).
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Affiliation(s)
- Anthony P Klironomos
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Judie R Walton
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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Sabharwal T, Khanduri S, Khan S, Husain M, Singh A, Khan AU, Abbas SZ, Singh H. A Comparative Assessment Between High-resolution Ultrasonography and Field Magnetic Resonance Imaging in Supraspinatus Tear Cases and Its Arthroscopic Correlation. Cureus 2019; 11:e5627. [PMID: 31700730 PMCID: PMC6822911 DOI: 10.7759/cureus.5627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diagnosis of a supraspinatus tear in patients presenting with shoulder pain is a difficult task and often requires the help of an MRI. However, in recent years, high-resolution ultrasonography (USG) has been utilized as a cheaper yet sensitive alternative. The aim of the study is to provide a comparative assessment of supraspinatus tears between USG and MRI in relation to arthroscopic results. Methods A total of 60 patients with shoulder pain for the last three months or more scheduled to undergo arthroscopic surgery for their shoulder disorder were enrolled; those having any congenital deformity of the shoulder or having any contradiction to an MRI were excluded from the assessment. All the patients underwent high-resolution ultrasonography (HRUSG) and MRI evaluation. Both the USG and MRI findings were correlated with the arthroscopic findings. Results On ultrasonography, 34 (56.67%) full-thickness tears and 22 (36.67%) partial-thickness tears of the supraspinatus were detected. On MRI, 36 (60.0%) were diagnosed as a full-thickness tear and 20 (33.33%) as a partial-thickness tear. After arthroscopy, 36 (60.00%) were confirmed as a full-thickness tear and 20 (33.33%) as a partial-thickness tear of the supraspinatus. For a full-thickness tear, the sensitivity and specificity of USG and MRI were 95.0% and 92.5%, and 85% and 92.5%, respectively. For a full-thickness tear, the sensitivity and specificity of the modalities were 94.4% and 100%, respectively. Conclusion HRUSG and MRI both had high comparable accuracy for detection of a supraspinatus tear, however, HRUSG had an edge over MRI in the detection of a partial tear.
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Affiliation(s)
- Tushar Sabharwal
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Sachin Khanduri
- Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Shahla Khan
- Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Mushahid Husain
- Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Anchal Singh
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Ahmad Umar Khan
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Syed Zain Abbas
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Harshika Singh
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
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Mueller AM, Rosso C, Entezari V, McKenzie B, Hasebroock A, Cereatti A, Della Croce U, Nazarian A, Ramappa AJ, DeAngelis JP. The effect of supraspinatus tears on glenohumeral translations in passive pitching motion. Am J Sports Med 2014; 42:2455-62. [PMID: 25201441 DOI: 10.1177/0363546514547348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Supraspinatus tears are common in pitchers. However, the effect of these tears on glenohumeral (GH) mechanics is incompletely understood. PURPOSE/HYPOTHESIS To describe the effect of supraspinatus tears and repairs on GH kinematics during an abbreviated throwing motion using the intact shoulder girdle. The hypothesis was that supraspinatus tears would lead to an increase of GH translation in the coronal plane and supraspinatus repairs would restore GH kinematics. STUDY DESIGN Controlled laboratory study. METHODS Six shoulders from 3 fresh-frozen cadavers were tested in a novel 7 degrees of freedom robotic testing system. Torsos were mounted and the wrist was pinned to an actuator mounted on an upper frame. After the deltoid was removed, the shoulders were studied during an abbreviated throwing motion (ATM) from maximum external rotation to the midcoronal plane to establish a baseline. The ATM was repeated after creation of a 1-cm supraspinatus tear, after creation of a 3-cm supraspinatus tear, and after repair with a transosseous equivalent (TOE) technique. Retroreflective bone markers and high-speed infrared cameras were used to measure GH kinematics and calculate the center of rotation of the GH joint (CORGH) instantaneously. RESULTS The 1- and 3-cm supraspinatus tears did not significantly alter GH translation. The TOE repair shifted the CORGH posteriorly, as evidenced by a significant decrease in the overall GH translation in all 3 planes (P = .003, .019, and .026, for x-y, y-z, and x-z planes, respectively). CONCLUSION In contrast to a TOE repair of the supraspinatus tendon, isolated supraspinatus tears did not perturb GH kinematics in this cadaveric model of the throwing shoulder. CLINICAL RELEVANCE In throwing athletes, treatment of rotator cuff tears should be addressed with caution to avoid an unintended alteration in GH kinematics due to overtightening of the tendon.
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Affiliation(s)
- Andreas M Mueller
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Claudio Rosso
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Vahid Entezari
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Brett McKenzie
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Hasebroock
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ugo Della Croce
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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11
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Namdari S, Donegan RP, Dahiya N, Galatz LM, Yamaguchi K, Keener JD. Characteristics of small to medium-sized rotator cuff tears with and without disruption of the anterior supraspinatus tendon. J Shoulder Elbow Surg 2014; 23:20-7. [PMID: 23937927 DOI: 10.1016/j.jse.2013.05.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/03/2013] [Accepted: 05/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the baseline function and results of arthroscopic cuff repair in shoulders with small and medium-sized full-thickness cuff tears with complete supraspinatus disruption compared with those with an intact anterior supraspinatus tendon. METHODS The study evaluated 112 subjects with small and medium-sized cuff tears. Subjects were grouped according to anterior supraspinatus integrity (83 shoulders intact, group 1; and 29 shoulders with anterior supraspinatus tendon disruption, group 2). Functional assessments included visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and Constant score. Repair integrity was assessed by ultrasound examination. RESULTS Group 2 shoulders had greater mean tear width, length, and area (P < .0001) and greater supraspinatus muscle degenerative changes (P < .0001) compared with shoulders with an intact anterior supraspinatus tendon. There were no differences in demographics or baseline function (ASES score: 45 group 1 vs 46 group 2, P = .79; Constant score: 56 group 1 vs 52 group 2, P = .29) before surgery. There were no differences in any functional parameter (ASES score: 92 group 1 vs 93 group 2, P = .71; Constant score: 84 group 1 vs 85 group 2, P = .84) after surgery. There was no difference in tendon healing rates (93% group 1 vs 86% group 2; P = .26). CONCLUSIONS In the setting of painful small and medium-sized rotator cuff tears, disruption of the anterior supraspinatus tendon was associated with greater tear size and more advanced supraspinatus muscle degeneration. However, anterior supraspinatus tendon integrity had no influence on the clinical presentation or the functional and structural results of cuff repair surgery.
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Affiliation(s)
- Surena Namdari
- Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA
| | - Ryan P Donegan
- Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA
| | - Nirvikar Dahiya
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Leesa M Galatz
- Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA
| | - Ken Yamaguchi
- Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA
| | - Jay D Keener
- Washington University in St. Louis, Department of Orthopedic Surgery, St. Louis, MO, USA.
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