Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI

2016 ◽  
Vol 25 (7) ◽  
pp. 2073-2080 ◽  
Author(s):  
Yang-Soo Kim ◽  
Sung-Eun Kim ◽  
Sung-Ho Bae ◽  
Hyo-Jin Lee ◽  
Won-Hee Jee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

Partial-Thickness Rotator Cuff Tears

2005 ◽  
Vol 33 (9) ◽  
pp. 1405-1417 ◽  
Author(s):  
Matthew J. Matava ◽  
Derek B. Purcell ◽  
Jonas R. Rudzki
Keyword(s):  
Rotator Cuff ◽  
Natural History ◽  
Diagnostic Techniques ◽  
Relative Accuracy ◽  
Diagnostic Methods ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Operative Repair ◽  
Partial Thickness ◽  
History Of

Partial-thickness tears of the rotator cuff have been diagnosed with increased frequency because of a heightened awareness of the condition by clinicians and improved diagnostic methods. Research into the causes, natural history, and optimal treatment of this condition lags behind that of full-thickness tears. However, despite the limitations in the existing literature, there has emerged a consensus among shoulder experts that partial-thickness rotator cuff tears should be aggressively treated in the active athlete because of the unfavorable natural history of these lesions and success of accepted surgical algorithms. This review will provide an overview of the theories regarding the origins of partial-thickness rotator cuff tears, discuss the relative accuracy of accepted diagnostic techniques, and summarize the indications and methods of operative repair with an emphasis on the results of various treatment approaches.

Arthroscopic Repair of Partial-Thickness and Small Full-Thickness Rotator Cuff Tears

2014 ◽  
Vol 43 (3) ◽  
pp. 588-596 ◽  
Author(s):  
Seok Won Chung ◽  
Jae Yoon Kim ◽  
Jong Pil Yoon ◽  
Seong Hwa Lyu ◽  
Sung Min Rhee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness

Arthroscopic Challenges in Treating Rotator Cuff Tears of the Shoulder

2009 ◽  
Author(s):  
Maxwell C. Park
Keyword(s):  
Rotator Cuff ◽  
New Technologies ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Healing Environment ◽  
Partial Thickness ◽  
Partial Tears ◽  
Progression Of Disease ◽  
Structural Loss ◽  
Invasive Techniques

Rotator cuff tears can be the source of significant morbidity. Impingement syndrome involving repetitive and prolonged mechanical irritation of the rotator cuff against the roof of the shoulder creates a progression of disease. Chronic tendon inflammation can lead to structural loss of integrity, leading to partial tears, and if left unchecked, full-thickness tears. Currently, the surgeon has the ability to repair full-thickness tears using minimally invasive techniques. However, the persistent tear rate after repair is remarkably high, more than 50% in some studies. One surgical goal is to alter progression of disease, and repair partial-thickness tears, for example. Another goal is to optimize the healing environment with the repair construct itself, accounting for biomechanical considerations. When using an arthroscopic approach, the challenges for treating partial- versus full-thickness tears varies significantly given anatomic restrictions—particularly, during repair of partial-thickness tears, the surgeon is “blind” for portions of the procedure as the arthroscope is typically placed intra-articularly, while instruments are passed from above the tendon, extra-articularly. Ideally, new technologies can be developed to optimize rotator cuff repair and healing in this setting.

scholarly journals Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110351
Author(s):  
Ali S. Farooqi ◽  
Alexander Lee ◽  
David Novikov ◽  
Ann Marie Kelly ◽  
Xinning Li ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Diagnostic Accuracy ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Diagnostic Values ◽  
Tendon Tears ◽  
Sensitivity Specificity

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

scholarly journals Treatment With Glycogen Synthase Kinase 3β Inhibitor Decreases Apoptotic and Autophagic Reactions in Rat Rotator Cuff Tears

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110607
Author(s):  
Yang-Soo Kim ◽  
Yun-Gyoung Lee ◽  
Min-Tae Kim ◽  
Hyo-Jin Lee
Keyword(s):  
Rotator Cuff ◽  
Glycogen Synthase ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Cuff Tear ◽  
Partial Thickness ◽  
Group 3 ◽  
Group 2 ◽  
Gsk 3Β ◽  
Group 1

Background: Apoptosis and autophagy are known to be correlated with the extent of damage in torn rotator cuffs, and there is no biological evidence for self-recovery or healing of the rotator cuff tear. Purpose: To establish in a rat model of partial- and full-thickness rotator cuff tears how a glycogen synthase kinase 3β (GSK-3β) inhibitor affects the expression of apoptotic and autophagic markers. Study Design: Controlled laboratory study. Methods: Twelve-week-old Sprague Dawley rats were divided into 3 groups (n = 16 per group). Group 1 acted as the control, with no treatment; group 2 received partial-thickness (right side) and full-thickness (left side) rotator cuff tears only; and group 3 received the same rotator cuff injuries, with GSK-3β inhibitor injected afterward. The tendons from each group were harvested 42 days after surgery. Evaluation of gene expression, immunohistochemistry, and TUNEL staining (terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling) were performed for the following markers: caspases 3, 8, and 9 as well as Bcl-2 (B-cell lymphoma 2); BAX (Bcl-2-associated X protein); beclin 1; p53; and GSK-3β; which represented apoptotic and autophagic reactions. Statistical analysis was performed using 1-way analysis of variance. Results: In the group 2 rats with partial- and full-thickness tears, there were significant increases in the mRNA levels (fold changes) of all 8 markers as compared with group 1 (control). All these increased markers showed significant downregulation by the GSK-3β inhibitor in partial-thickness tears. However, the response to the GSK-3β inhibitor in full-thickness tears was not as prominent as in partial-thickness tears. The number of TUNEL-positive cells in group 2 (partial, 35.08% ± 1.625% [mean ± SE]; full, 46.92% ± 1.319%) was significantly higher than in group 1 (18.02% ± 1.036%; P < .01) and group 3 (partial, 28.04% ± 2.607% [ P < .01]; full, 38.97% ± 2.772% [ P < .01]), and immunohistochemistry revealed increased expression of all the markers in group 2 as compared with control. Conclusion: The apoptotic and autophagic activity induced in a rat model of an acute rotator cuff tear was downregulated after treatment with a GSK-3β inhibitor, particularly with partial-thickness rotator cuff tears. Clinical Relevance: A GSK-3β inhibitor may be able to modulate deterioration in a torn rotator cuff.

scholarly journals ROLE AND CORELATION OF ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING IN EVALUATION OF ROTATOR CUFF IN PATIENTS WITH SHOULDER PAIN

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Niti More ◽  
R P Bansal ◽  
Mukesh Kumar Sharma ◽  
Bijendra Kumar Meena ◽  
Abhishek Gupta
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Age Groups ◽  
Rotator Cuff Tears ◽  
Joint Effusion ◽  
Full Thickness ◽  
Mri Findings ◽  
Partial Thickness ◽  
Labral Tears ◽  
Sensitivity Specificity

Background: Shoulder pain is one of the most common musculoskeletal complain encountered in general practice with an estimated point prevalence of 6.9 to 26% in the general population. The aim of the study was to determine the accuracy of ultrasonography in detecting rotator cuff tears taking MRI findings as the standard. Available literature related to the present study was reviewed and salient features of each pathology discussed. Methods: This observational, prospective study was carried out in the Department of Radiodiagnosis, National Institute Of Medical Sciences & Research, Jaipur, Rajasthan. A total of 80 patients from all age groups with symptomatology related to rotator cuff of the shoulder joint, on the basis of inclusion criteria, were examined by USG and MRI from a period of January 2019 to June 2020. Results: USG had good sensitivity (82 to 93%), specificity (92 to 97%), PPV (85 to 87%), NPV (91 to 98%) and accuracy (90 to 96%) as compared MRI for diagnosing supraspinatus lesions. The sensitivity and accuracy of USG for detecting full thickness tears was better than the same for partial thickness tears and tendinosis. Conclusion: In our study, USG examination had excellent sensitivity, specificity and accuracy as compared MRI for diagnosing full thickness rotator cuff tears. It was also fairly accurate in detecting partial thickness tears and tendinosis. It was comparable to MRI in diagnosing and quantifying joint effusion and acromioclavicular degenerative changes. USG scored over MRI in diagnosing calcific tendinosis while some findings, such as labral tears, were only detected by MRI. Keywords: MRI, USG, Shoulder pain.

scholarly journals Preoperative Fatty Infiltration of the Teres Minor Negatively Affects Postoperative Outcomes in Patients With Rotator Cuff Pathology

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096010
Author(s):  
Erik J. Sarkissian ◽  
Michelle Xiao ◽  
Geoffrey D. Abrams
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Level Of Evidence ◽  
Partial Thickness ◽  
Goutallier Classification ◽  
Teres Minor

Background: The teres minor is a critical component of the rotator cuff and serves as one of the few external rotators of the humerus. Information is lacking regarding the effect of teres minor atrophy in isolation and in the setting of concomitant full-thickness rotator cuff tears on outcomes in patients undergoing rotator cuff surgery. Purpose: To investigate the effect of preoperative teres minor fatty infiltration on postoperative clinical outcomes in patients with and without full-thickness rotator cuff pathology. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients undergoing primary arthroscopic shoulder surgery between 2014 and 2016 was performed. Preoperative magnetic resonance imaging was used to determine fatty infiltration for each rotator cuff muscle using the modified Goutallier classification. American Shoulder and Elbow Surgeons (ASES) as well as the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained preoperatively and during follow-up. Exclusion criteria included prior surgery on the ipsilateral shoulder or a diagnosis of inflammatory arthropathy. For analysis, patients were dichotomized to grade 0 or grade 1-4 atrophy of the teres minor as well as to full-thickness or partial-thickness rotator cuff pathology. Results: A total of 36 of 47 (76.6%) patients (mean age, 63 years; range, 45-76 years) were available for postoperative follow-up at a mean of 40 months (range, 30-48 months). Postoperative ASES score was significantly higher and QuickDASH score was significantly lower among all patients in the grade 0 group compared with the grade 1-4 group. Postoperative ASES and QuickDASH scores were not significantly different in patients with partial-thickness rotator cuff tears at any time point. However, the postoperative ASES score was significantly higher and QuickDASH score was significantly lower in the grade 0 versus grade 1-4 group for patients with full-thickness rotator cuff pathology. Conclusion: Preoperative teres minor atrophy in patients undergoing surgery for rotator cuff pathology may impair postoperative clinical outcomes, especially in patients with full-thickness tears.

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