Implication of bone morphology in degenerative rotator cuff lesions: a prospective comparative study between Greater Tuberosity Angle and Critical Shoulder Angle

Purpose: the aim of the present study was to verify the differences in the clinical outcomes of two arthroscopic techniques used to treat calcifying tendinitis of the shoulder: needling versus complete removal of the calcium deposit and tendon repair. Methods: from September 2010 to September 2012, 40 patients with calcifying tendinitis of the rotator cuff were arthroscopically treated by the same surgeon using one of the two following techniques: needling (Group 1) and complete removal of the calcium deposit and tendon repair with suture anchors (Group 2). Both groups followed the same rehabilitation program. The two groups were compared at 6 and 12 months of follow-up for the presence of residual calcifications and for the following clinical outcomes: Constant score, American Shoulder and Elbow Surgeons Evaluation Form (ASES) shoulder score, University of California Los Angeles (UCLA) shoulder rating scale, Simple Shoulder Test (SST) and Visual Analogue Scale (VAS). Results: all the clinical scores (Constant, ASES, UCLA, SST and VAS scores) improved significantly between baseline and postoperative follow-up, both at 6 and at 12 months. no differences at final follow-up were found between the two groups. Conclusions: both the techniques were effective in solving the symptoms of calcifying tendinitis of the shoulder. Clinical scores improved in both groups. Residual calcifications were found in only a few cases and were always less than 10 mm. Level of evidence:Level II, prospective comparative study.

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Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression

The American Journal of Sports Medicine ◽

10.1177/0363546518768276 ◽

2018 ◽

Vol 46 (8) ◽

pp. 1919-1926 ◽

Cited By ~ 13

Author(s):

Felix Dyrna ◽

Neil S. Kumar ◽

Elifho Obopilwe ◽

Bastian Scheiderer ◽

Brendan Comer ◽

...

Keyword(s):

Rotator Cuff ◽

Dynamic Testing ◽

Correlation Coefficients ◽

Biomechanical Study ◽

Rotator Cuff Tears ◽

Shoulder Abduction ◽

Mean Values ◽

Critical Shoulder Angle ◽

Anterior Deltoid ◽

Shoulder Angle

Background: Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. Hypotheses: (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. Results: Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (–27.2%; 95% CI, –43.3% to –11.1%, P = .04), anterosuperior (–51.5%; 95% CI, –70.2% to –32.8%, P < .01), and massive (–48.4%; 95% CI, –65.2% to –31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = −0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. Conclusion: Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. Clinical Relevance: Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

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Letter to the Editor regarding Maillot et al: “Surgical repair of large-to-massive rotator cuff tears seems to be a better option than patch augmentation or débridement and biceps tenotomy: a prospective comparative study”

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2018.12.024 ◽

2019 ◽

Vol 28 (9) ◽

pp. e321-e322

Author(s):

Richard Dimock ◽

A. Ali Narvani

Keyword(s):

Rotator Cuff ◽

Comparative Study ◽

Surgical Repair ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tears ◽

Letter To The Editor ◽

Biceps Tenotomy ◽

Prospective Comparative Study

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Risk Factors, Pathobiomechanics and Physical Examination of Rotator Cuff Tears

The Open Orthopaedics Journal ◽

10.2174/1874325001610010277 ◽

2016 ◽

Vol 10 (1) ◽

pp. 277-285 ◽

Cited By ~ 6

Author(s):

Samuel G. Moulton ◽

Joshua A. Greenspoon ◽

Peter J. Millett ◽

Maximilian Petri

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Physical Examination ◽

Diagnostic Accuracy ◽

Literature Search ◽

Glenohumeral Joint ◽

Rotator Cuff Tears ◽

Critical Shoulder Angle ◽

Common Risk Factors ◽

Shoulder Angle

Background: It is important to appreciate the risk factors for the development of rotator cuff tears and specific physical examination maneuvers. Methods: A selective literature search was performed. Results: Numerous well-designed studies have demonstrated that common risk factors include age, occupation, and anatomic considerations such as the critical shoulder angle. Recently, research has also reported a genetic component as well. The rotator cuff axially compresses the humeral head in the glenohumeral joint and provides rotational motion and abduction. Forces are grouped into coronal and axial force couples. Rotator cuff tears are thought to occur when the force couples become imbalanced. Conclusion: Physical examination is essential to determining whether a patient has an anterosuperior or posterosuperior tear. Diagnostic accuracy increases when combining a series of examination maneuvers.

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Radiographic shoulder parameters and their relationship to outcomes following rotator cuff repair: a systematic review

Shoulder & Elbow ◽

10.1177/1758573219895987 ◽

2020 ◽

pp. 175857321989598

Author(s):

Musa B Zaid ◽

Nathan M Young ◽

Valentina Pedoia ◽

Brian T Feeley ◽

C Benjamin Ma ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Patient Reported Outcomes ◽

Critical Shoulder Angle ◽

Patient Reported ◽

Acromion Index ◽

Bony Morphology ◽

Cuff Repair ◽

Shoulder Angle

Background Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. Methods A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. Results A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. Conclusions Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.

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