Type 2 Superior Labral Anterior Posterior (SLAP) Tear in 55-Year-Old Male with Concomitant Full-Thickness Rotator Cuff Tear Treated with Long Head of the Biceps Tenodesis and Rotator Cuff Repair

2017 ◽  
pp. 159-172
Author(s):  
Robert A. Duerr ◽  
Darren A. Frank
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Full Thickness ◽  
Biceps Tenodesis ◽  
Cuff Tear ◽  
Long Head ◽  
Slap Tear ◽  
Cuff Repair ◽  
Anterior Posterior

scholarly journals Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984591 ◽  
Author(s):  
Avinesh Agarwalla ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
Anthony A. Romeo ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Management Practices ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Biceps Tenodesis ◽  
Rotator Cuff Injuries ◽  
Cuff Repair ◽  
Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

scholarly journals Why Do Patients Decide to Have Surgery for Their Symptomatic Rotator Cuff Tear? A Prospective Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008
Author(s):  
Danielle Weekes ◽  
Weilong Jeffrey Shi ◽  
Christopher Hadley ◽  
Kevin B. Freedman ◽  
Matthew D. Pepe ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Surgical Repair ◽  
Full Thickness ◽  
Younger Patients ◽  
Cuff Tear ◽  
Cuff Repair ◽  
Time Point

Objectives: While rotator cuff pathology may be amenable to conservative therapy, patients with full thickness tears not improving with non-operative treatment are indicated for repair. The decision to undergo surgery is often multifactorial with pain, loss of function, and concern for progression all factoring in the decision-making process. The purpose of this investigation was to evaluate patients main determining factors in deciding to have surgery for their rotator cuff tear, correlate these factors with strength of surgeon recommendation and clinical outcomes. Methods: One hundred and fifty patients undergoing arthroscopic rotator cuff repair (ARCR) were enrolled prospectively. Patients received a questionnaire preoperatively to determine why they decided to proceed with surgical repair. This 13-question survey was developed based on evidence-based review of rotator cuff repair literature and the Delphi technique. Patients were asked to rate each factor with regard to importance in their decision to proceed with repair. Surgeons were given a similar Likert Scale and were queried on how strongly they would recommend surgery for their patients based upon various factors such as MRI findings, age, etc. Pre- and post-operative shoulder function was assessed with the American Shoulder and Elbow Society (ASES) Score. Descriptive statistics were used to evaluate the reasons to proceed with surgery and correlated with outcomes based on ASES scores. Results: The most influential patient reported factors for proceeding with surgical repair were: limited functionality of the shoulder (81%), surgeon recommendation (80%), and daily chronic pain (77%). Patients improved from 42.6 to 77.0 on the ASES from baseline to 6-months (p<0.001). Patients who listed that they were unable to play a favorite sport or hobby as their top reason for surgery demonstrated a significant increase in their ASES score relative to other factors at the 3 month time point (p=0.0014); otherwise, there was no significant difference in outcomes for any other time point based on category importance. Subgroup analysis of males and females and older v. younger patients demonstrated significant findings. Females were more likely to proceed with repair due to inability to sleep and daily, chronic pain (p<.005) relative to males. Younger patients were more likely to proceed with repair for the inability to play a sport/hobby and increased demands of work relative to older patients (p<.005). There was no correlation between any decision factor and final outcome of ASES scores. Younger patients and male patients both demonstrated higher baseline ASES scores (p<.05); however, there was no difference in outcome measures at final follow-up. Conclusion: Prior studies have shown that rotator cuff repair is best at alleviating pain for full thickness rotator cuff tears and may not be as impactful for improving function. Despite this evidence, the majority of patients undergoing rotator cuff repair in our study did so to improve function of their shoulder. While pain, inability to sleep, and inability to participate in ones favorite hobby/sport were important to our patient population, a strong surgeon recommendation had no correlation with our patients decision to proceed with repair. Surgeons should be mindful of these differences between gender and age when counseling patients pre-operatively. Outcomes of ARCR do not appear to be determined by pre-operative decision making on the part of the patient.

scholarly journals An arthroscopic technique for full-thickness rotator cuff repair by transposition of the long head of biceps

2019 ◽  
Vol 105 (2) ◽  
pp. 265-269 ◽  
Author(s):  
Jian Lin ◽  
Weihui Qi ◽  
Zhongtang Liu ◽  
Kai Chen ◽  
Xiaobin Li ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Full Thickness ◽  
Arthroscopic Technique ◽  
Long Head Of Biceps ◽  
Long Head ◽  
Cuff Repair

Functional Recovery After Rotator Cuff Repair: The Role of Biceps Surgery

2018 ◽  
Vol 27 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Bernardo Gialanella ◽  
Francesco Grossetti ◽  
Marina Mazza ◽  
Laura Danna ◽  
Laura Comini
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Full Thickness ◽  
Cuff Tear ◽  
Efficiency And Effectiveness ◽  
Rehabilitation Period ◽  
Final Score ◽  
Cuff Repair

Context: Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair. Objective: To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients. Design: Prospective and observational study. Setting: Outpatient service for rehabilitation. Patients: Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR). Interventions: Motor rehabilitation after surgical treatment of rotator cuff repair. Measures: Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery. Results: Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6 mo postsurgery. Conclusions: This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6 mo postsurgery.

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review

2021 ◽  
pp. 175857322198908
Author(s):  
Selim Ergün ◽  
Yiğit Umur Cırdı ◽  
Said Erkam Baykan ◽  
Umut Akgün ◽  
Mustafa Karahan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Case Reports ◽  
Biceps Tendon ◽  
Case Series ◽  
Biceps Tenodesis ◽  
Long Head Of Biceps ◽  
Long Head ◽  
Cuff Repair ◽  
Popeye Deformity

Background Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. Methods Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases “suprapectoral,” “subpectoral,” “tenodesis,” and “long head of biceps tendon”. Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. Results From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. Discussion Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area. Level of evidence: IV.

scholarly journals Prevalence and Risk Factors of Neuropathic Pain in Patients with a Rotator Cuff Tear

2018 ◽  
Vol 1 (21;1) ◽  
pp. E173-E180 ◽  
Author(s):  
Sangbong Ko
Keyword(s):  
Neuropathic Pain ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Full Thickness ◽  
Cuff Tear ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Tear Size

Background: Until now, few studies had investigated the neuropathic pain component in patients with a rotator cuff tear (RCT). Objectives: The aim of the study was to identify the neuropathic pain component in patients with RCT and to determine the factors correlated with neuropathic pain in patients with RCT. Study Design: Prospective, cohort, prognostic study. Setting: Study patients who required arthroscopic rotator cuff repair were analyzed in a hospital setting. Methods: We prospectively studied 101 patients who were less than 60 years old with fullthickness tears requiring arthroscopic rotator cuff repair and met the inclusion and exclusion criteria. Multiple regression analysis was performed to identify variables that independently affected neuropathic pain in patients with a RCT. We use Douleur neuropathique 4 questionnaire (DN4) to assess neuropathic pain, which was ≥ 4 points of the DN4 questionaire. The visual analog scale (VAS) for the most severe pain within 4 weeks before admission and mean pain level during the last 4 weeks were checked. The atrophy grades of the rotator cuff muscles were classified on magnetic resonance images according to the Goutallier classification. The size and medial retraction of the RCT were measured during arthroscopic repair for RCT. Results: Sixteen (15.8%) of the 101 patients had neuropathic pain according to the cutoff values on the DN4 questionnaire for diagnosing neuropathic pain. The neuropathic pain group had significantly higher prevalence of smoking (P = 0.042), more mean VAS during last 4 weeks (P = 0.008), larger cuff tear (P = 0.003), more medial retraction of cuff (P = 0.016), and severe fatty degeneration of rotator cuff muscles (supraspinatus, P < 0.001; subscapularis, P < 0.001; and infraspinatus, P = 0.003) than the nonneuropathic pain group. The multiple logistic regression analyses showed that more mean VAS during the last 4 weeks and tear size of a rotator cuff were independent of other factors for the neuropathic pain of the patients with a full-thickness RCT. Limitations: Small sample size is the first limitation of this study. Conclusions: The prevalence of neuropathic pain in patients with a full-thickness RCT requiring arthroscopic rotator cuff repair was 15.8 % according to the DN4 questionnaire. The neuropathic pain component was more relevant to the severity of pain and tear size in the patients with a full-thickness RCT. It is important to be aware of the existence of neuropathic pain when treating a patient presenting with pain due to a RCT because accompanying neuropathy with a RCT could have a worse effect on repair of a RCT. IRB approval and clinical trial registration number: CR-15-045 Key words: Shoulder, rotator cuff tear, arthroscopic rotator cuff repair, neuropathic pain

scholarly journals Long head BIceps TEnodesis or tenotomy in arthroscopic rotator cuff repair: BITE study protocol

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Derek Friedrich Petrus van Deurzen ◽  
◽  
Vanessa Antoinet Bernice Scholtes ◽  
Nienke Willemien Willigenburg ◽  
Navin Gurnani ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Study Protocol ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Biceps Tenodesis ◽  
Long Head ◽  
Arthroscopic Rotator Cuff ◽  
Long Head Biceps ◽  
Cuff Repair
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