Arthroscopic operations in the subacromial space

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

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The influence of the Kinesio Taping on selected ultrasonography measurements, and quality of life in patients with rotator cuff lesions

Scientific Reports ◽

10.1038/s41598-020-75701-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Aneta Bac ◽

Magdalena Wróbel ◽

Katarzyna Ogrodzka-Ciechanowicz ◽

Edyta Michalik ◽

Anna Ścisłowska-Czarnecka

Keyword(s):

Quality Of Life ◽

Rotator Cuff ◽

Statistical Significance ◽

Control Group ◽

Subacromial Space ◽

Kinesio Taping ◽

Significant Difference ◽

Rotator Cuff Lesions ◽

Significant Change

Abstract The assessment of the six-week influence of Kinesio Taping combined with a rehabilitation on selected ultrasonography measurements, the level of disability, and the quality of life in patients with rotator cuff lesions. 60 participants were randomly assigned into a taping group (KT combined with a six-week rehabilitating protocol) and a control group (only rehabilitation protocol). In all patients the following assessments were performed twice: USG, UEFI and NHP questionnaires. In the examination of the subacromial space and the subacromial bursa in the taping group, no statistical significance was observed. A statistically significant change in the thickness of the muscles was obtained only for the thickness of the infraspinatus in the taping group. A statistically significant change was obtained in the assessment of tendinopathy only for the supraspinatus muscle in both groups. Within both groups a statistically significant difference was observed in the average UEFI and NHP scores; however, the differences in the scores obtained between the groups were not statistically significant. The use of KT with a rehabilitation program did not yield statistically significantly better results in the improvement of selected shoulder region indicators, the function of the upper limb and the quality of life.

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Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04197-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marie Protais ◽

Maxime Laurent-Perrot ◽

Mickaël Artuso ◽

M. Christian Moody ◽

Alain Sautet ◽

...

Keyword(s):

Rotator Cuff ◽

Donor Site ◽

Anatomical Study ◽

Donor Site Morbidity ◽

Rotator Cuff Tears ◽

Subacromial Space ◽

Greater Tuberosity ◽

Working Zone ◽

Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

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866 A Lateral Approach Is More Likely to Be Successful Than A Posterior Approach for An Injection to Reach the Subacromial Space

British Journal of Surgery ◽

10.1093/bjs/znab134.331 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

N Cheyne ◽

A Jeelani ◽

M Zeiton ◽

C Tablot ◽

E Holt ◽

...

Keyword(s):

Injection Site ◽

Posterior Approach ◽

Lateral Approach ◽

Subacromial Space ◽

Mean Values ◽

Shoulder Impingement ◽

Diagnosis And Therapy ◽

Subacromial Injection ◽

Mri Scans ◽

Multiple Measurements

Abstract Background Subacromial injections are common for diagnosis and therapy of shoulder impingement secondary to subacromial bursitis. We evaluated the likelihood of a successful subacromial injection from both the posterior and lateral injection sites. Method We reviewed 100 MRI scans of the shoulder and recorded measurements in both the sagittal (representative of posterior injection) and coronal (representative of lateral injection) orientations. We compared these to the lengths of standard needles. Multiple measurements were taken: Results Measuring along the angle of the acromion demonstrated shorter mean distances from the lateral injection site. The distance from skin to mid-point of the acromion) provided mean values of 51.4mm for posterior and 40.1mm for lateral. A standard 40mm (green) needle would reach the midpoint of the acromion in 58% of lateral measurements and 23% from posterior. Conclusions Injections are more likely to enter the subacromial space from a lateral rather than a posterior entry point.

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The Evolution and Role of the Bursal Acromial Reconstruction

Video Journal of Sports Medicine ◽

10.1177/26350254211001367 ◽

2021 ◽

Vol 1 (2) ◽

pp. 263502542110013

Author(s):

Daniel M. Curtis ◽

W. Michael Pullen ◽

Kevin Helenius ◽

Michael T. Freehill

Keyword(s):

Glenohumeral Joint ◽

Total Shoulder Arthroplasty ◽

Treatment Options ◽

Clinical Problem ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Subacromial Space ◽

Promising Alternative ◽

Diagnostic Arthroscopy ◽

Superior Capsular Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

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Ultrasonographic measures of subacromial space in patients with rotator cuff disease: A systematic review

Journal of Clinical Ultrasound ◽

10.1002/jcu.20783 ◽

2010 ◽

Vol 39 (3) ◽

pp. 146-154 ◽

Cited By ~ 40

Author(s):

Amee L. Seitz ◽

Lori A. Michener

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Subacromial Space ◽

Rotator Cuff Disease

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Complications in General Glenohumeral and Subacromial Space Procedures

Complications in Arthroscopic Shoulder Surgery ◽

10.1007/978-3-030-24574-0_2 ◽

2019 ◽

pp. 11-24

Author(s):

Mathias Wellmann

Keyword(s):

Subacromial Space

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The experience with the use of a subacromial balloon in the treatment of patients with large, massive, irreparable rotator cuff tears

Clinical Practice ◽

10.17816/clinpract19268 ◽

2020 ◽

Vol 11 (4) ◽

pp. 14-22

Author(s):

Мaksim F. Lazko ◽

Alexey P. Prizov ◽

Fedor L. Lazko ◽

Evgeny A. Beliak ◽

Ivan G. Maglaperidze ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Pain Syndrome ◽

Rotator Cuff Tears ◽

Average Score ◽

Subacromial Space ◽

Rotator Cuff Injuries ◽

Goutallier Classification ◽

Upper Extremity Function ◽

A Prospective Study

Background. Large, massive irreparable rotator cuff tears lead to a significant decrease in the function of the shoulder joint together with the development of a pronounced pain syndrome. Such injuries are difficult to treat, and the number of relapses, when trying to restore them, is quite high. The installation of a subacromial balloon is the method of choice for this group of patients and allows restoring the function of the shoulder joint fairly successfully. Aim: to evaluate the results of the treatment of patients with massive irreparable rotator cuff tears injuries in a prospective study from 2016 to 2018. Methods. The results of the arthroscopic treatment of large, irreparable rotator cuff injuries in 25 patients (with the average age of 67 5 years) with the installation of a subacromial balloon are presented. In all the clinical cases, there was a pronounced (grades 34, according to the Goutallier classification) fatty dystrophy of the rotator cuff muscles (supraspinatus or in combination with subaspinatus). All the patients underwent the subacromial space release with a thorough bursectomy and subsequent installation of a subacromial balloon. Results. The average score on the UCLA scale was 14 3 points (1117) before the operation and 312 points (2933) 12 months after the operation, the results were considered good and excellent. Conclusion. The results obtained allow us to evaluate the described technique as low-traumatic, simple and fast in its accomplishment, aimed at the reduction of the pain syndrome and restoration of the upper extremity function.

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