Application of Ultrasound Diagnosis Technology Based on Statistical Analysis in Rehabilitation Treatment of Shoulder Sports Injuries

Objective. This study uses statistics to analyze the diagnostic significance of ultrasonic exploration for rotator cuff injuries. Methods. For this study, 50 patients with rotator cuff injury or shoulder impingement syndrome admitted to the hospital from September 2017 to January 2019 were selected as the targets of this discussion. The general clinical materials of the patients were retrospectively analyzed, and ultrasound was performed for them. The results of the examination and arthroscopy are compared with the final pathological results. Results. The diagnostic sensitivity of ultrasound in the diagnosis of partial rupture and complete rupture of the supraspinatus tendon was 100%, and the specificity was 55.55%. The diagnostic sensitivity of partial rupture and complete rupture of the subscapular tendon was 100%, and the specificity was 42.8%; there was no significant difference compared with the joint mirror examination, and there was no statistical significance. Conclusion. The thesis adopts ultrasound exploration for patients with rotator cuff injuries with high diagnostic sensitivity. It is a reliable and effective clinical diagnosis method, which is worthy of clinical application and promotion.

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The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal

Frontiers in Surgery ◽

10.3389/fsurg.2021.624100 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pierfrancesco Luciani ◽

Luca Farinelli ◽

Luca De Berardinis ◽

Antonio Gigante

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Biceps Tendon ◽

Reverse Shoulder Arthroplasty ◽

Supraspinatus Tendon ◽

Biomechanical Study ◽

Rotator Cuff Tears ◽

Rotator Cuff Injuries ◽

Superior Capsular Reconstruction ◽

Significant Difference

Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure.Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM).Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system.Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario.Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM.Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.

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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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Transmural supraspinatus tendon tear caused by suture anchor tip 19-month postacromioclavicular joint stabilisation

BMJ Case Reports ◽

10.1136/bcr-2021-242511 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242511

Author(s):

Manuel Waltenspül ◽

Karl Wieser ◽

Samy Bouaicha

Keyword(s):

Case Report ◽

Rotator Cuff ◽

Suture Anchor ◽

Supraspinatus Tendon ◽

Anatomical Location ◽

Ac Joint ◽

Tendon Tear ◽

Paediatric Patients ◽

Lateral Clavicle ◽

Rotator Cuff Injuries

Rotator cuff injuries present rarely in paediatric patients due to the tendon strength at this age. There are reports of ruptures caused by either irritation of the lateral clavicle or acromioclavicular (AC) joint in fractures or after usage of hook plates. In this case report, we present a patient with an acute complete supraspinatus rupture caused by a suture anchor tip from a previously performed AC joint stabilisation. After the diagnosis of a new complete supraspinatus, the causative prominent suture anchor was removed, and the tendon subsequently repaired. This case highlights the close anatomic relation of the AC joint and the rotator cuff, which is imperative to adequately address in injuries to this anatomical location.

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Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119864590 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986459 ◽

Cited By ~ 1

Author(s):

Tim Leschinger ◽

Katharina Besch ◽

Cansu Aydin ◽

Manfred Staat ◽

Martin Scaal ◽

...

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Neutral Position ◽

Management Options ◽

Significant Difference ◽

Intact Condition ◽

Point Condition ◽

Biomechanical Comparison

Background: Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition. Purpose: To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( P > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.

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Prevalence and Grading of Rotator Cuff and Labral Injuries in Shoulder Pain and Instability using MRI: ACross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48773.14845 ◽

2021 ◽

Author(s):

Ashok Srikar Chowdhary ◽

Naresh Babu Lakshmipathi Nikhil ◽

Nidhi Hemendra Chandrakar ◽

Nidhi Raj Buddaraju

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Biceps Tendon ◽

Supraspinatus Tendon ◽

Sectional Study ◽

Rotator Cuff Injuries ◽

Rotator Cuff Injury ◽

Biceps Pulley ◽

Study Population ◽

Long Head

Introduction: Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. Aim: To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. Materials and Methods: This study was a cross-sectional study of patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. The study population consisted of 54 patients with either shoulder pain or instability who underwent MRI of shoulder. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the commonest cause of pain. Tendinosis was the commonest type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The commonest grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the commonest type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. Conclusion: Rotator cuff injuries are the commonest cause of shoulder pain and are seen more frequently after the fifth decade. Shoulder instability is most commonly seen in young male adults. Tendinosis is the commonest type of rotator cuff injury. Supraspinatus tendon is the most commonly injured tendon. Anterior instability is the commonest type of shoulder instability. Biceps pulley lesions result in long head of biceps tendon instability, microinstability and internal impingement. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatmentplanning.

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Features of Partial Rotator Cuff Tears Diagnostics

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2019-25-2-143-149 ◽

2019 ◽

Vol 25 (2) ◽

pp. 143-149 ◽

Cited By ~ 2

Author(s):

A. N. Logvinov ◽

D. O. Ilyin ◽

P. M. Kadantsev ◽

O. V. Makarieva ◽

M. E. Burtsev ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Articular Surface ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Joint Surface ◽

Subacromial Space ◽

Diagnostic Significance ◽

Combined Application ◽

Shoulder Range Of Motion

Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.

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Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.2.61 ◽

2019 ◽

Vol 22 (2) ◽

pp. 61-69

Author(s):

Ho-Won Lee ◽

Kyung-Ho Choi ◽

Jung-Youn Kim ◽

Ik Yang ◽

Kyu-Cheol Noh

Keyword(s):

Rotator Cuff ◽

Conservative Treatment ◽

Rating Scale ◽

Platelet Rich Plasma ◽

Constant Score ◽

Statistical Significance ◽

Clinical Results ◽

Control Group ◽

Significant Difference ◽

Rotator Cuff Tendinopathy

Background: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.Methods: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.Results: There was a statistically significant difference in ΔASES3months (ASES3months-ASESfirst) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05).Conclusions: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

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A Single Knotless-anchor for Bursal-side Ellman III Partial Thinkness Rotar Cuff Tears: A Biomechanical Cadaveric Study

10.21203/rs.3.rs-141471/v1 ◽

2021 ◽

Author(s):

Gang Liu ◽

Baolu Zhang ◽

Qian Zhao ◽

Xiaoguang Guo ◽

Yang Liu ◽

...

Keyword(s):

Rotator Cuff ◽

Surgical Techniques ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Loading Test ◽

Double Row ◽

Knotless Anchor ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: Bursal-side partial thickness rotator cuff tears (PTRCTs) are frequent lesions with the treatment of multiple surgical techniques. However, to the best of our knowledge, no single knotless-anchor with two Ethicon 2# repair technique has been reported.Methods: Bursal-side PTRCTs (Ellman type III, 75% thickness of tears) were created in the supraspinatus tendon on 16 fresh-frozen cadaveric shoulders. The specimens were randomized into two groups of 8 each: (1) Group A (Transtendon repairs), a single knotless-anchor repair with two Ethicon 2#, (2) Group B, the Conversion repair (Double-row, DR). Each specimen underwent cyclic loading test from 5 to 100 N by 50 cycles, then followed by an ultimate failure test. The displacement of greater tuberosity (mm) and ultimate (N) were recorded.Results: Compared with the load-to-failure test, there was no significant difference between Group A and B (Group A, 359.25±17.91N; Group B, 374.38±13.75 N, P＞0.05). There were also no significant differences in the rotator cuff displacement of 10 mm(Group A, 190.50±8.52N; Group B, 197.25±6.84, P＞0.05) and 15mm (Group A, 282.25±12.20 N; Group B, 291.13±14.74 N, P＞0.05). However, concerning the displacement of 3 mm and 5mm, we found a significant difference in these two groups (P<0.05).Conclusions: A single knotless-anchor with two Ethicon 2# for Bursal-side Ellman III PTRCTs is a simple, cheap, and effective technique that we could choose.

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Combination of graphene oxide and platelet-rich plasma improves tendon-bone healing in a rabbit model of supraspinatus tendon reconstruction

Regenerative Biomaterials ◽

10.1093/rb/rbab045 ◽

2021 ◽

Author(s):

Dingsu Bao ◽

Jiacheng Sun ◽

Min Gong ◽

Jie Shi ◽

Bo Qin ◽

...

Keyword(s):

Graphene Oxide ◽

Rotator Cuff ◽

Platelet Rich Plasma ◽

Rabbit Model ◽

Supraspinatus Tendon ◽

In Vitro Assays ◽

Tendon Reconstruction ◽

Rotator Cuff Injuries ◽

Tgf Β1

Abstract The treatment of rotator cuff tear is one of the major challenges for orthopedic surgeons. The key to treatment is the reconstruction of the tendon-bone interface (TBI). Autologous platelet-rich plasma (PRP) is used as a therapeutic agent to accelerate the healing of tendons, as it contains a variety of growth factors (GFs) and is easy to prepare. Graphene oxide (GO) is known to improve the physical properties of biomaterials and promote tissue repair. In this study, PRP gels containing various concentrations of GO were prepared to promote TBI healing and supraspinatus tendon reconstruction in a rabbit model. The incorporation of GO improved the ultrastructure and mechanical properties of the PRP gels. The gels containing 0.5 mg/mL GO (0.5GO/PRP) continuously released TGF-β1 and PDGF-AB, and the released TGF-β1 and PDGF-AB were still at high concentrations, ∼1063.451 pg/ml and ∼814.217 pg/ml, respectively, on the 14th day. In vitro assays showed that the 0.5GO/PRP gels had good biocompatibility and promoted BMSCs proliferation and osteogenic and chondrogenic differentiation. After 12 weeks of implantation, the MRI, μCT, and histological results indicated that the newly regenerated tendons in the 0.5GO/PRP group had a similar structure to natural tendons. Moreover, the biomechanical results showed that the newly formed tendons in the 0.5GO/PRP group had better biomechanical properties compared to those in the other groups, and had more stable TBI tissue. Therefore, the combination of PRP and GO has the potential to be a powerful advancement in the treatment of rotator cuff injuries.

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The value of the sagittal-oblique MRI technique for injuries of the anterior cruciate ligament in the knee

Radiology and Oncology ◽

10.2478/raon-2013-0006 ◽

2013 ◽

Vol 47 (1) ◽

pp. 19-25 ◽

Cited By ~ 5

Author(s):

Dragoslav Nenezić ◽

Igor Kocijancic

Keyword(s):

Anterior Cruciate Ligament ◽

Magnetic Resonance ◽

Soft Tissues ◽

Cruciate Ligament ◽

Partial Rupture ◽

Complete Rupture ◽

Scan Time ◽

Lower Accuracy ◽

Significant Difference ◽

Anterior Cruciate

Abstract Background. Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging versus flexion MR technique of ACL imaging and, versus ACL imaging obtained with standard MR protocol of the knee. Patients and methods. In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. Results. Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittaloblique technique were more sensitive (p<0.001) than presentation using standard MR protocol. There was no statistically significant difference between MRI detection of the ruptured ACL between additional techniques (p> 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p<0.001). Conclusions. Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient’s ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient’s knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears.

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