Hidden degloving rotator cuff tears secondary to glenohumeral dislocation

2018 ◽  
Vol 27 (8) ◽  
pp. 1456-1461
Author(s):  
Lorenzo Merlini ◽  
Matthew Yalizis ◽  
Yannick Carrillon ◽  
Hugo Bothorel ◽  
Mo Saffarini ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Glenohumeral Dislocation

scholarly journals Patients >40 years with a glenohumeral dislocation have a lower incidence of Symptomatic Rotator Cuff Tear than previously reported and can be managed safely without routine advanced imaging

2020 ◽  
Author(s):  
Chibuzo Manafa ◽  
Ahmed Barakat ◽  
Felicity Auld ◽  
Joideep Phadnis
Keyword(s):  
Rotator Cuff ◽  
Cost Analysis ◽  
Rotator Cuff Tears ◽  
Advanced Imaging ◽  
Surgical Interventions ◽  
Group 2 ◽  
Over 40 Years ◽  
Glenohumeral Dislocation ◽  
Selective Referral ◽  
Group 1

Abstract Background Incidence of rotator cuff tears (RCT) following primary anterior glenohumeral dislocation in patients over 40 years is thought to be high. Current guidelines recommend specialist clinic review and advanced imaging for all patients. The aim of this study was to report the incidence of symptomatic RCT in a large cohort of patients and to assess the safety and efficacy of a physiotherapy led virtual protocol where patients were selectively investigated and treated based on symptoms. Methods 238 consecutive patients over 40 years of age with a primary anterior glenohumeral dislocation were identified between January 2015 and June 2018 (42 months). All patients were managed initially through a physiotherapy led virtual clinic with selective referral of patients with red flag symptoms to a specialist shoulder clinic. Advanced imaging (MRI or USS) was performed at the discretion of the shoulder specialist following patient assessment. The incidence of symptomatic RCT was assessed and compared between two groups (Group 1: 40-70 years, Group 2: >70 years). All surgical interventions were recorded. Patients were assessed at a mean of 22 months (range 10-54) using the Oxford shoulder score; patient satisfaction and return to pre-injury functional level. Cost analysis was performed to compare management using this protocol versus published guidelines.Results A total of 238 patients were identified with mean age of 65 years (range 40-96). 69% (n=164/238) were symptomatic and were referred to specialist clinic. The other 31% (n=74/238) were asymptomatic and were discharged to physiotherapy. Of those referred to a specialist clinic, only 46% (n=75/164) were sent for advanced imaging following clinical examination. The incidence of symptomatic RCTs was 31% (n=51/164) in this group and only 22% (n=11/51) of those underwent subsequent surgical repair of their rotator cuff. Of those patients discharged to physiotherapy, 62% (n=47/74) responded to the questionnaire with 89% fully satisfied, 85% returned to pre-injury level and mean Oxford score was 42 (33-38, SD 3.2) indicating excellent shoulder function. With all patients pooled excluding those lost to follow-up (n=27), the incidence of symptomatic RCTs was 24% (51/211). The incidence in group 1 was 16% (n=22/137) and was significantly lower than in group 2 which was 39% (n=29/74) (p<0.05). Cost analysis demonstrated 49% cost reduction using this protocol.Conclusion Incidence of symptomatic cuff tears following a primary glenohumeral dislocation in patients over 40 years was lower than previously reported. A protocol based on selective referral and investigation for symptomatic patients was cost effective and safe.

Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

2018 ◽  
Vol 1 ◽  
pp. 9
Author(s):  
Harshad Arvind Vanjare ◽  
Jyoti Panwar
Keyword(s):  
Rotator Cuff ◽  
Negative Predictive Value ◽  
Rotator Cuff Tear ◽  
Predictive Value ◽  
Rotator Cuff Tears ◽  
Mri Findings ◽  
Cuff Tear ◽  
Experienced Operator ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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

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.

scholarly journals Tendon transfers for irreparable rotator cuff tears

2021 ◽  
Author(s):  
John R. Adam ◽  
Shashi K.T. Nanjayan ◽  
Melissa Johnson ◽  
Amar Rangan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Tendon Transfers
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