Comparison of scapular upward rotation during arm elevation in the scapular plane in healthy volunteers and patients with rotator cuff tears pre- and post-surgery

Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.

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Muscle Activity Before and After Subacromial Injection

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0524 ◽

2021 ◽

pp. 1-7

Author(s):

Lucas Ettinger ◽

Matthew Shaprio ◽

Andrew Karduna

Keyword(s):

Rotator Cuff ◽

Muscle Activation ◽

Rotator Cuff Tears ◽

Subacromial Impingement ◽

Upper Trapezius ◽

Subacromial Injection ◽

Shoulder Muscle ◽

Shoulder Muscles ◽

Before And After ◽

Arm Elevation

Context: Shoulder muscle activation in patients with subacromial impingement is highly cited and variable in the literature. Differences between studies could be due to artifacts introduced by normalization practices in the presence of pain. Ultimately, this lack of knowledge pertaining to pathogenesis limits the clinical treatment and restoration of muscular function. Design: A total of 21 patients with stage 2 subacromial impingement and 21 matched controls were recruited for EMG testing of their affected shoulder during an arm elevation task. The patients were tested before and after receiving an injection to their subacromial bursa. Methods: The EMG from 7 shoulder muscles were measured before and after treatment during humeral motion in the scapular plane. Results: Our findings indicate an increase in anterior deltoid, middle deltoid, and upper trapezius activity following the injection; further, this trend extended to the controls. The control subjects had a greater activation of the latissimus dorsi at peak arm elevation when compared with the patient group postinjection. Conclusions: Our results indicate that a reduction in subacromial pain is associated with changes in shoulder muscle recruitment, primarily of the deltoid. This change in deltoid activity may lend evidence to rotator cuff function in patients without rotator cuff tears.

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Pseudoparalysis and pseudoparesis of the shoulder

Obere Extremität ◽

10.1007/s11678-021-00658-5 ◽

2021 ◽

Author(s):

Roland Stefan Camenzind ◽

Laurent Lafosse ◽

Thibault Lafosse

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Rotator Cuff Tear ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Cuff Tear ◽

Active Range Of Motion ◽

Definition Of ◽

Shoulder Elevation ◽

Scapular Plane

Abstract Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction <45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (>50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

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Electromyographic activities of the biceps during arm elevation in shoulders with rotator cuff tears

Acta Orthopaedica Scandinavica ◽

10.3109/17453679808999258 ◽

1998 ◽

Vol 69 (6) ◽

pp. 575-579 ◽

Cited By ~ 21

Author(s):

Tadato Kido ◽

Eiji Itoi ◽

Norikazu Konno ◽

Akihisa Sano ◽

Masakazu Urayama ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Arm Elevation

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Effect of Arm Elevation and Rotation on the Strain in the Repaired Rotator Cuff Tendon

The American Journal of Sports Medicine ◽

10.1177/03635465010290061901 ◽

2001 ◽

Vol 29 (6) ◽

pp. 788-794 ◽

Cited By ~ 47

Author(s):

Yuji Hatakeyama ◽

Eiji Itoi ◽

Rabindra L. Pradhan ◽

Masakazu Urayama ◽

Kozo Sato

Keyword(s):

Rotator Cuff ◽

Internal Rotation ◽

Sagittal Plane ◽

External Rotation ◽

Tensile Force ◽

The Other ◽

Rotator Cuff Tendon ◽

Cuff Tear ◽

Arm Elevation ◽

Scapular Plane

In 14 cadaveric shoulders, a rotator cuff tear (2 cm wide and 1.5 cm long) was created and repaired under a 3-kg tensile force with the arm in adduction. Strain on the repaired tendon was measured at 0°, 15°, 30°, and 45° of elevation in the sagittal, scapular, and coronal planes and from 60° of internal rotation to 60° of external rotation. The strain in all of the planes decreased significantly with the arm elevated more than 30°. With 30° of elevation in the scapular and coronal planes, the strain increased in internal rotation and decreased in external rotation. In all of the positions measured, the strain in the sagittal plane was significantly greater than in the other planes. We concluded that more than 30° of elevation in the coronal or scapular plane and rotation ranging from 0° to 60° of external rotation compose the safe range of motion after repair of the rotator cuff.

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Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

The American Journal of Sports Medicine ◽

10.1177/0363546520929353 ◽

2020 ◽

Vol 48 (9) ◽

pp. 2137-2143 ◽

Cited By ~ 1

Author(s):

Lukas Ernstbrunner ◽

Rany El Nashar ◽

Samy Bouaicha ◽

Karl Wieser ◽

Christian Gerber

Keyword(s):

Rotator Cuff ◽

Case Control Study ◽

Case Control ◽

Rotator Cuff Tears ◽

Matched Pair ◽

Factors Associated ◽

Massive Rotator Cuff Tears ◽

Morphologic Characteristics ◽

Control Study ◽

Scapular Plane

Background: It is unclear which structural parameters determine the development or the absence of chronic pseudoparalysis (PP) in patients with massive rotator cuff tears (mRCTs). Purpose: To determine whether scapular morphologic characteristics and extent of rotator cuff tearing are independent factors associated with chronic PP. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective case-control study, 50 patients with chronic mRCT (≥2 fully detached tendons) and active scapular plane abduction less than 90° (PP group) were age- and sex-matched with a cohort of 50 patients with chronic mRCT and an active scapular plane abduction greater than 90° (non-PP; NPP group). Analysis of standardized, plain radiographs included measurement of the critical shoulder angle (CSA) and the acromiohumeral distance (ACHD) on anteroposterior views and measurement of posterior acromial tilt, anterior and posterior acromial coverage, and posterior acromial height on standardized outlet views. Measurements on magnetic resonance imaging included fatty muscle infiltration, anterior (subscapularis) and posterior (infraspinatus/teres minor) tear extension, and global tear extension (anterior + posterior tear extension) in the parasagittal plane. Results: Overall, no significant difference was found in patients’ demographic characteristics ( P > .05). Univariate analyses confirmed significant differences between the PP and NPP groups in active scapular plane abduction (51°± 22° vs 135°± 29°; P < .001). Multivariate analyses revealed independent factors associated with PP compared with the NPP group: CSA (38.2°± 4.6° vs 35.2°± 3.7°; P = .001); ACHD (4.7 ± 2.2 vs 7.3 ± 2.6 mm; P < .001); posterior acromial height (22 ± 10 vs 17 ± 7 mm; P = .005); and anterior (–9°± 21° vs 25°± 12°; P < .001) and posterior (–18°± 14° vs 2°± 14°; P < .001) tear extension. The NPP group had significantly less involvement and fatty infiltration of the subscapularis (1.4 ± 0.6) compared with the PP group (2.2 ± 0.9) ( P < .001). Conclusion: This study confirms that global RCT extension and the quality of the inferior half of the subscapularis are significantly associated with chronic pseudoparalysis. The study further shows that acromial morphologic characteristics are relevant in the development of pseudoparalysis. Patients with pseudoparalysis have a larger CSA, less ACHD, and a higher positioned acromion in the sagittal plane.

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Enhancement of External Rotation after Latissimus Dorsi Tendon Transfer (LDTT): A Cadaveric Study

Medicina ◽

10.3390/medicina57040305 ◽

2021 ◽

Vol 57 (4) ◽

pp. 305

Author(s):

José M. Silberberg ◽

Alessandro Nilo ◽

Jorge Roces-García

Keyword(s):

Rotator Cuff ◽

Healthy Volunteers ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

External Rotation ◽

Rotator Cuff Tears ◽

Control Group ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Mobility Function

Background and objectives: Massive rotator cuff tears compromise shoulder mobility function and cannot be directly repaired. Latissimus dorsi tendon transfer (LDTT) is a therapeutic alternative suitable for the treatment of rotator cuff tears that helps to restore external shoulder rotation. Cadaver models have been used for studying the effects of LDTT and procedural variations, but, to the best of our knowledge, none of them have been validated. The aim of our study was to validate a novel cadaver model while verifying the effects of LDTT on external rotation. Materials and Methods: Two groups were included in the study: a cadaver group and a control group made up of healthy volunteers, which were used for the validation of the cadaver model. Baseline external rotation measurements were performed with both groups, after which a massive rotator cuff tear was inflicted and repaired with LDTT in the cadaver group. Their postoperative external rotation was evaluated using three different tests. Results: No statistically significant differences were found between the baseline measurements of the two groups, and postoperative external rotation was significantly higher after LDTT in all cases but one. Conclusions: Cadaver models were validated, since they had a similar preoperative external rotation to healthy volunteers. Moreover, they allowed us to demonstrate the effect of LDTT on external shoulder rotation.

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The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre- and post-surgery: a systematic review

Quality of Life Research ◽

10.1007/s11136-021-02921-2 ◽

2021 ◽

Author(s):

Nicolò Panattoni ◽

Umile Giuseppe Longo ◽

Sergio De Salvatore ◽

Nadia Saray Castro Castaneda ◽

Laura Risi Ambrogioni ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Psychosocial Factors ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Rotator Cuff Tears ◽

Post Surgery ◽

Patient Reported

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Chronic Pseudoparalysis Needs to Be Distinguished From Pseudoparesis: A Structural and Biomechanical Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520969858 ◽

2020 ◽

pp. 036354652096985

Author(s):

Lukas Ernstbrunner ◽

Rany El Nashar ◽

Philippe Favre ◽

Samy Bouaicha ◽

Karl Wieser ◽

...

Keyword(s):

Rotator Cuff ◽

Fatty Infiltration ◽

Biomechanical Model ◽

Biomechanical Analysis ◽

Neurological Deficits ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Level Of Evidence ◽

Radiographic Measurements ◽

Scapular Plane

Background: Chronic pseudoparalysis is generally defined as the inability to actively elevate the arm above 90° with free passive range of motion and no neurological deficits. It has been suggested that this arbitrary cutoff needs to be refined. Purpose: To analyze whether there are structural and biomechanical differences in patients with chronic pseudoparalysis and those with chronic pseudoparesis. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective study, 50 patients with chronic massive rotator cuff tears (mRCTs; ≥2 tendons) and free passive and active scapular plane abduction <90° were divided into 2 groups: pseudoparalysis group (n = 24; active scapular plane abduction, <45°) and pseudoparesis group (n = 26; active scapular plane abduction, >45° and <90°). Radiographic measurements included the critical shoulder angle, acromiohumeral distance, posterior acromial tilt, anterior and posterior acromial coverages, and posterior acromial height on outlet views. Measurements on magnetic resonance imaging (MRI) included fatty infiltration of the rotator cuff muscles, anterior (subscapularis) and posterior (infraspinatus/teres minor) tear extensions, and global (anterior + posterior) tear extension in the parasagittal plane. A published musculoskeletal model was used to simulate the effect of different mRCTs on the muscle force required for scapular plane abduction. Results: Plain radiographs revealed no differences between patients with chronic pseudoparalysis and those with pseudoparesis. MRI assessment showed significant differences between patients with chronic pseudoparalysis and those with pseudoparesis with respect to fatty infiltration of the subscapularis (2.9 vs 1.6; P < .001) and infraspinatus (3.6 vs 3.0; P < .001) muscles, and anterior (−23° vs 4°; P < .001), posterior (−23° vs −14°; P = .034), and global rotator cuff (225° vs 190°; P < .001) tear extensions. The anterior tear extension in patients with chronic pseudoparalysis always involved more than 50% of the subscapularis, which was associated with an odds ratio of 5 for inability to actively abduct more than 45°. The biomechanical model was unable to find a combination of muscles that could balance the arm in space when the tear extended beyond the supraspinatus and the cranial subscapularis. Conclusion: This study confirms that chronic pseudoparalysis and pseudoparesis are associated with different structural lesions. In the setting of a chronic mRCT, involvement of more than 50% of the subscapularis tendon with fatty infiltration of stage 3 is associated with pseudoparalysis of active scapular plane abduction <45°. The key function of the subscapularis was confirmed in the biomechanical model.

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Functional outcome of patients undergoing open rotator cuff repair

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203733 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1082

Author(s):

Albin Savio ◽

Nishara M. S.

Keyword(s):

Rotator Cuff ◽

Functional Outcome ◽

Rotator Cuff Repair ◽

Open Repair ◽

Constant Score ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Common Source ◽

Post Surgery ◽

Cuff Repair

Background: Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon rather than injury from sports or trauma. Rotator cuff tear can be treated arthroscopically, arthroscopically assisted (mini-open) or by an open procedure. Because of the technical demands of arthroscopic repair many surgeons consider open repair for the treatment of rotator cuff tears. This study was done to evaluate the functional outcome of shoulder after open rotator cuff repair.Methods: 26 patients with partial and complete rotator cuff tears underwent open rotator cuff repair and acromioplasty. Cases were followed up at 3 months and 6 months intervals and shoulder function was assessed using Constant-Murley scoring system and compared with the preoperative scores and analyzed using SPSS software.Results: Mean preoperative constant score was 33.95±7.545 while the mean constant score at 6 months post-surgery was 79.83±8.51 which was highly significant according to paired t test. The difference between preoperative, 3 months and 6 months constant scores of complete and partial tear patients was found to be statistically significant.Conclusions: There was highly significant increase in Constant-Murley score after 6 months in patients treated by open rotator cuff repair. Open repair still stands as an effective treatment for rotator cuff tears and doing acromioplasty during the procedure adds to better outcome after surgery.

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