scholarly journals Association Between Rotator Cuff Tears and Superior Migration of the Humeral Head: An MRI-Based Anatomic Study

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Matthew Y. Siow ◽  
Brendon C. Mitchell ◽  
Michael Hachadorian ◽  
Wilbur Wang ◽  
Tracey Bastrom ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Inclusion Criteria ◽  
Rotator Cuff Disease ◽  
Level Of Evidence ◽  
Shoulder Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Relationship

Background: Superior humeral migration has been established as a component of rotator cuff disease, as it disrupts normal glenohumeral kinematics. Decreased acromiohumeral interval (AHI) as measured on radiographs has been used to indicate rotator cuff tendinopathy. Currently, the data are mixed regarding the specific rotator cuff pathology that contributes the most to humeral head migration. Purpose: To determine the relationship between severity of rotator cuff tears (RCTs) and AHI via a large sample of magnetic resonance imaging (MRI) shoulder examinations. Study Design: Cohort study; Level of evidence, 3. Methods: A search was performed for 3-T shoulder MRI performed in adults for any indication between January 2010 and June 2019 at a single institution. Three orthopaedic surgeons and 1 musculoskeletal radiologist measured AHI on 2 separate occasions for patients who met the inclusion criteria. Rotator cuff pathologies were recorded from imaging reports made by fellowship-trained musculoskeletal radiologists. Results: A total of 257 patients (mean age, 52 years) met the inclusion criteria. Of these, 199 (77%) had at least 1 RCT, involving the supraspinatus in 174 (67.7%), infraspinatus in 119 (46.3%), subscapularis in 80 (31.1%), and teres minor in 3 (0.1%). Full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon were associated with significantly decreased AHI (7.1, 5.3, and 6.8 mm, respectively) compared with other tear severities ( P < .001). Having a larger number of RCTs was also associated with decreased AHI (ρ = –0.157; P = .012). Isolated infraspinatus tears had the lowest AHI (7.7 mm), which was significantly lower than isolated supraspinatus tears (8.9 mm; P = .047). Conclusion: Although various types of RCTs have been associated with superior humeral head migration, this study demonstrated a significant correlation between a complete RCT and superior humeral migration. Tears of the infraspinatus tendon seemed to have the greatest effect on maintaining the native position of the humeral head. Further studies are needed to determine whether early repair of these tears can slow the progression of rotator cuff disease.

scholarly journals Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

2018 ◽  
Vol 11 (1_suppl) ◽  
pp. 59-67 ◽  
Author(s):  
Claudia C. Sidler-Maier ◽  
Jennifer A. Mutch ◽  
Martin Sidler ◽  
Dimitra Leivadiotou ◽  
Jubin B. Payandeh ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Latissimus Dorsi ◽  
Negative Impact ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Level Of Evidence ◽  
Latissimus Dorsi Transfer ◽  
Cuff Repair

Background The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° ( p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. Level of evidence Level IV: Therapeutic study (case series)

scholarly journals The effect of obesity on fatty infiltration of the rotator cuff musculature in patients without rotator cuff tears

2017 ◽  
Vol 11 (1_suppl) ◽  
pp. 30-38 ◽  
Author(s):  
Andrew P. Matson ◽  
Christopher Kim ◽  
Swara Bajpai ◽  
Cynthia L. Green ◽  
Thomas W. Hash ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Goutallier Classification ◽  
Mri Scans ◽  
Severely Obese ◽  
Shoulder Mri ◽  
Magnetic Resonance Imaging Mri ◽  
Diagnosis Of Diabetes Mellitus

Background The modified Goutallier classification system describes the fatty infiltration of rotator cuff musculature (RCM) seen on magnetic resonance imaging (MRI) to assist with surgical decision-making for patients with rotator cuff tears (RCT). We describe the relationship between body mass index (BMI) and fatty infiltration in patients without RCT. Methods Twenty-five patients from each of four different BMI ranges (< 25 kg/m2; 25 kg/m2 to 30 kg/m2; 30 kg/m2 to 35 kg/m2; > 35 kg/m2) were randomly selected from 1088 consecutive shoulder MRI scans (T1 parasagittal series). Four physician-readers evaluated MRI scans and assigned modified Goutallier grades (0 to 4) in each of the four rotator cuff muscles, as well as two adjacent muscles. Results Grade distributions varied significantly based on BMI category for infraspinatus ( p = 0.001), teres minor ( p < 0.001), subscapularis ( p = 0.025), teres major ( p < 0.001) and deltoid ( p < 0.001). Higher grades were evident with a diagnosis of diabetes mellitus in three of six muscles ( p < 0.05), hyperlipidaemia in one muscle ( p = 0.021) and greater patient age in three muscles ( p < 0.05). Conclusions Obese and severely obese patients without RCT have more fatty infiltration seen on MRI. Patient factors (older age and diagnosis of diabetes mellitus) can be predictive of fatty infiltration in RCM. Fatty infiltration of RCM is not solely attributable to the presence of a RCT.

scholarly journals Subacromial impingement syndrome

2012 ◽  
Vol 4 (2) ◽  
pp. 18 ◽  
Author(s):  
Masood Umer ◽  
Irfan Qadir ◽  
Mohsin Azam
Keyword(s):  
Rotator Cuff ◽  
Treatment Strategies ◽  
Impingement Syndrome ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement Syndrome ◽  
Subacromial Impingement ◽  
Rotator Cuff Disease ◽  
High Quality ◽  
The Relationship ◽  
Rotator Cuff Tendinopathy

Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However the etiology is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality RCTs are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

scholarly journals Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097050
Author(s):  
Seung-Jun Lee ◽  
Young-Kyoung Min ◽  
Il-Kwon Chung ◽  
Suk-Woong Kang ◽  
Scott A. Banks
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Superior Capsular Reconstruction ◽  
Before And After ◽  
Shoulder Kinematics

Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.

scholarly journals Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear

2019 ◽  
Vol 22 (3) ◽  
pp. 121-127
Author(s):  
Jung-Han Kim ◽  
Hyeong-Won Seo
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Humeral Head ◽  
Fatty Degeneration ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Level Of Evidence ◽  
Cuff Tear ◽  
Subscapularis Tendon Tear ◽  
Tear Size

Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients’ shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear.Methods: We assessed patients’ rotator cuff tear humeral head positions based on humeral?scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated.Results: One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (<i>p</i><0.001, <i>p</i><0.001, <i>p</i><0.001).Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

scholarly journals The association between acromial anatomy and articular-sided partial thickness of rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cen Tao Liu ◽  
Jia Qing Miao ◽  
Hua Wang ◽  
Heng an Ge ◽  
Xian Hui Wang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Pearson Correlation ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Partial Thickness ◽  
History Of ◽  
Mri Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Acromiohumeral Distance ◽  
The Relationship

Abstract Background Acromial anatomy has been found to be correlated with degenerative full-thickness rotator cuff tears in current studies. However, research on the relationship between acromial anatomy and articular-sided partial thickness of rotator cuff tears (PTRCTs) is still lacking. The purpose of this study was to evaluate whether these imaging graphic parameters exhibit any association between acromial anatomy and degenerative articular-sided PTRCTs. Methods Between January 2016 and December 2018, a total of 91 patients without a history of trauma underwent arthroscopy as an articular-sided PTRCT group. In the control group, with age- and sex-matched patients, we selected 91 consecutive outpatient patients who underwent shoulder magnetic resonance imaging (MRI) because of shoulder pain and an MRI diagnosis of only synovial hyperplasia and effusion. MRI was used to measure the acromial type, acromiohumeral distance (AHD), lateral acromial angle (LAA), acromion index (AI), and critical shoulder angle (CSA) by 2 independent observers. Results The acromion type, AHD and LAA showed no difference between degenerative articular-sided PTRCTs and controls (P = 0.532, 0.277, and 0.108, respectively). AI and CSA were significantly higher in degenerative articular-sided PTRCTs (P = 0.002 and 0.003, respectively). A good correlation was found between AI and CSA to measurement(Pearson correlation coefficient = 0.631). Conclusions Our study revealed that higher AI and CSA were found in degenerative articular-sided PTRCTs. Acromial anatomy with a large acromial extension was associated with the occurrence of degenerative articular-sided PTRCTs.

Bursal-Sided Rotator Cuff Tears: Simple Versus Everted Type

2017 ◽  
Vol 46 (2) ◽  
pp. 441-448 ◽  
Author(s):  
Hwan Jin Kim ◽  
Jung Youn Kim ◽  
Young Moon Kee ◽  
Yong Girl Rhee
Keyword(s):  
Rotator Cuff ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Simple Type ◽  
Level Of Evidence ◽  
Greater Tuberosity ◽  
Vas Score ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Background: No studies have focused on the everted type of bursal-sided partial-thickness rotator cuff tears (PTRCTs). Purpose: To evaluate the radiological characteristics, arthroscopic findings, and clinical and structural outcomes after arthroscopic repair of the everted type of bursal-sided PTRCTs. Study Design: Cohort study; Level of evidence, 3. Methods: Two groups of patients with bursal-sided PTRCTs (simple type, 25 shoulders; everted type, 25 shoulders) were enrolled. The mean age was 59.6 years (range, 47-73 years) and 60.8 years (range, 48-72 years) among patients with the simple and everted type, respectively. The mean follow-up period was 2.7 years (range, 2.0-5.1 years). Results: The everted type always exhibited an acromial spur (hat-shaped, 52%; heel-shaped, 48%) and bony changes in the greater tuberosity (bony spur, 52%; sclerotic changes, 48%). Hat-shaped spurs of the acromion were not observed in the simple type. The everted type showed significantly thicker tendon on magnetic resonance imaging (MRI), as the stump was retracted superomedially (mean thickness: 8.1 ± 1.2 mm vs 5.5 ± 1.1 mm for the everted and simple type, respectively). During arthroscopic repair, additional sutures were needed more often for the everted type than for the simple type (64% vs 16%, respectively). After repair, the tendon margin was uneven and ragged in 16% of shoulders with the everted type. Preoperatively, the visual analog scale (VAS) score for pain during motion and range of motion (ROM) were significantly worse in patients with the everted type than in those with the simple type (VAS score, 7.2 vs 5.6, respectively; ROM for forward flexion, 146.8° vs 156.4°, respectively). Postoperatively, no significant differences in the VAS score, ROM, or clinical outcomes were observed between the 2 groups, with no retears on follow-up MRI in either group. Conclusion: The everted type of bursal-sided PTRCTs showed a characteristic hat-shaped acromion, often with bony spurs of the greater tuberosity. On MRI, the tendon stump appeared thickened because of the everted flap. The everted type was more likely to require additional sutures because of an uneven or ragged tendon margin. However, satisfactory clinical and structural outcomes were observed for both the simple and everted types.

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

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.

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 Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

2021 ◽  
Author(s):  
Zaki Arshad ◽  
Henry David Maughan ◽  
Karadi Hari Sunil Kumar ◽  
Matthew Pettit ◽  
Arvind Arora ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Original Research ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Level Of Evidence ◽  
Femoral Version ◽  
Normal Mean ◽  
The Relationship

Abstract Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

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