The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge

Scapular dyskinesis can be present in healthy individuals as in patients with shoulder pathology. Altered patterns of scapular kinematics can cause or exacerbate rotator cuff tear pathology. However, more research is needed. Regardless of the cause or the consequence of rotator cuff tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and compromises the success of clinical intervention. The available literature suggests physical therapy as the first treatment for degenerative cuff tears, and scapular dyskinesis should be addressed if present. Non-responsive cases or traumatic tears may require surgery. Postsurgical physical therapy protocols after rotator cuff repair must consider scapular dyskinesia to improve the outcomes. Cite this article: EFORT Open Rev 2021;6:932-940. DOI: 10.1302/2058-5241.6.210043

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Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

The American Journal of Sports Medicine ◽

10.1177/0363546520981559 ◽

2021 ◽

Vol 49 (2) ◽

pp. 305-313

Author(s):

Daniel P. Berthold ◽

Lukas N. Muench ◽

Felix Dyrna ◽

Bastian Scheiderer ◽

Elifho Obopilwe ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Biceps Tendon ◽

Young Patients ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Cuff Tear Arthropathy ◽

Cuff Tear ◽

Fixation Techniques ◽

Long Head

Background: In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. Purpose/Hypothesis: The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. Results: Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT ( P < .001 and P < .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP ( P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA ( P < .001, respectively) and decreased cDF ( P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST ( P = .027) when compared with the box-shaped technique. Conclusion: In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. Clinical Relevance: Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.

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

American Journal of Sonography ◽

10.25259/ajs-22-2018 ◽

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.

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DOES HYPERCHOLESTOLEMIA PREDISPOSE TO ROTATOR CUFF PATHOLOGIES?

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i4.16883 ◽

2017 ◽

Vol 10 (4) ◽

pp. 373 ◽

Cited By ~ 1

Author(s):

Surendra Umesh Kamath ◽

Sunil Murthy

Keyword(s):

Rotator Cuff ◽

Total Cholesterol ◽

Rotator Cuff Tear ◽

Indian Population ◽

Statistical Significance ◽

Elevated Serum ◽

Density Lipoprotein ◽

Rotator Cuff Tears ◽

Control Group ◽

Cuff Tear

Background: Rotator cuff tear are one of most common orthopedic musculoskeletal problem gaining importance due to large health scale expenditure. Causes of rotator cuff tears are multifactorial and unclear. Previous studies have suggested relation between elevated serum lipid profile and rotator cuff tear in western population. We therefore undertook study in our Indian population to correlate association of hypercholesterolemia with rotator cuff tear.Objective: To find association of rotator cuff pathology with hypercholesterolemia in Indian patients.Materials and methods: After obtaining clearance from institutional ethics committee. We prospectively collected fasting lipid samples of population who came to our hospitals with complaints of shoulder pain during our study period. 50 patients had rupture of rotator cuff which was confirmed by ultrasound of involved shoulder. 50 were seen for non-cuff related complaints. We followed strict inclusion and exclusion criteria.Results: Total cholesterol, Triglycerides and low density lipoprotein concentration of patients with rotator cuff tendon tear were on higher side than control group. High density lipoprotein trend showed being lower than control group. 21 of 50 (42%) had high cholesterol (total cholesterol greater than 240mg/dl) than compared to 18 of 50 (36%) in control group. however P value=0.539 and showed no statistical significance between groups.Conclusion: In Indian population there was no correlation between hypercholesterolemia and rotator cuff tear which is statistically significant.Key words Rotator cuff tear, Hypercholesterolemia, Indian population.

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Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_26_17 ◽

2017 ◽

Vol 7 ◽

pp. 32 ◽

Cited By ~ 11

Author(s):

Vetrivel Chezian Sengodan ◽

Sajith Kurian ◽

Raghupathy Ramasamy

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Platelet Rich Plasma ◽

Rotator Cuff Tears ◽

Lateral Side ◽

Ultrasound Guided ◽

Cuff Tear ◽

Plasma Injection ◽

Partial Rotator Cuff Tear ◽

Shoulder Score

Background: The treatment of symptomatic partial rotator cuff tear has presented substantial challenge to orthopaedic surgeons as it can vary from conservative to surgical repair. Researches have established the influence of platelet rich plasma in healing damaged tissue. Currently very few data are available regarding the evidence of clinical and radiological outcome of partial rotator cuff tear treated with ultrasound guided platelet rich plasma injection in English literature. Materials and Methods: 20 patients with symptomatic partial rotator cuff tears were treated with ultrasound guided platelet rich plasma injection. Before and after the injection of platelet rich plasma scoring was done with visual analogue score, Constant shoulder score, and UCLA shoulder score at 8 weeks and third month. A review ultrasound was performed 8 weeks after platelet rich plasma injection to assess the rotator cuff status. Results: Our study showed statistically significant improvements in 17 patients in VAS pain score, constant shoulder score and UCLA shoulder score. No significant changes in ROM were noted when matched to the contra-lateral side (P < 0.001) at the 3 month follow-up. The study also showed good healing on radiological evaluation with ultrasonogram 8 weeks after platelet rich plasma injection. Conclusion: Ultrasound guided platelet rich plasma injection for partial rotator cuff tears is an effective procedure that leads to significant decrease in pain, improvement in shoulder functions, much cost-effective and less problematic compared to a surgical treatment.

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Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00010 ◽

2021 ◽

Vol 24 (1) ◽

pp. 21-26

Author(s):

Yon-Sik Yoo ◽

Jin-Young Park ◽

Myung-sun Kim ◽

Nam-Su Cho ◽

Yong-Beom Lee ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Mean Value ◽

Calcific Tendinitis ◽

Older Age ◽

Korean Population ◽

Rotator Cuff Tears ◽

Treatment Modalities ◽

Duration Of Symptoms ◽

Cuff Tear

Background: To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear.Methods: Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results: There were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 15.5 months. Mean size of calcific materials was 11.4 mm (range, 0.9-35). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all P<0.05).Conclusions: This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.

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The greater tuberosity radius ratio: maybe a new predictor in diagnosis of rotator cuff tear

10.21203/rs.3.rs-41294/v1 ◽

2020 ◽

Author(s):

Qi Ma ◽

Changjiao Sun ◽

Pu Liu ◽

Sha Wu ◽

Xu Cai

Keyword(s):

Computed Tomography ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Roc Curve ◽

Radius Ratio ◽

Rotator Cuff Tears ◽

Cutoff Value ◽

Greater Tuberosity ◽

Cuff Tear ◽

Computed Tomography Images

Abstract Background The role of the greater tuberosity of humerus in subacromial impingement should be of equal important as the acromion. In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the greater tuberosity radius ratio (GTRR) as a new predictor for the diagnosis of rotator cuff tear. We hypothesized that a larger value of the GTRR could increase the risk of developing rotator cuff tear. Methods This was a retrospective study and clinical data and preoperative computed tomography images of the patients with rotator cuff tears (defined as the RCT group, simple size: 61) or without rotator cuff tears (defined as the control group, simple size: 56) were collected. Three-dimensional models of shoulders were established by multiplanar reconstruction of computed tomography scans. In a standard anteroposterior view, the radius of the best-fit circle of the humeral head (the r) and the radius of the concentric circle passing through the most superolateral edge of the greater tuberosity (the R) were measured for each shoulder. The ratio of R and r (R/r) was defined as the greater tuberosity radius ratio (GTRR). Independent samples t tests were used to find significant differences within the r, the R and the GTRR between groups. Receiver operating characteristic (ROC) curve based on the values of GTRR was performed to determine an applied cutoff value which may be useful in clinical practice. Results There was no significant difference in the values of r or R. However, the mean values of GTRR were 1.339 ± 0.143 (range, 1.087–1.684) and 1.244 ± 0.172 (range, 1.040–1.706) in the two groups respectively (p = 0.002). According to the ROC curve, an optimized cutoff value of GTRR was determined as 1.262, whose sensitivity was 72% and specificity was 65% for diagnosis of rotator cuff tear. Conclusion The greater tuberosity of humerus contributes to the mechanisms of rotator cuff tear. The greater tuberosity radius ratio is recommended as a new predictor for diagnosis of rotator cuff tear, with an optimized cutoff value set as 1.262.

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MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness

International Journal of Molecular Sciences ◽

10.3390/ijms20225742 ◽

2019 ◽

Vol 20 (22) ◽

pp. 5742 ◽

Cited By ~ 1

Author(s):

Jih-Yang Ko ◽

Wei-Shiung Lian ◽

Tsai-Chen Tsai ◽

Yu-Shan Chen ◽

Chin-Kuei Hsieh ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Function ◽

Pathological Feature ◽

Subacromial Bursa ◽

Shoulder Disorder ◽

Shoulder Stiffness ◽

Cuff Tear ◽

Rotator Cuff Lesion

Rotator cuff lesion with shoulder stiffness is a major cause of shoulder pain and motionlessness. Subacromial bursa fibrosis is a prominent pathological feature of the shoulder disorder. MicroRNA-29a (miR-29a) regulates fibrosis in various tissues; however, the miR-29a action to subacromial bursa fibrosis remains elusive. Here, we reveal that subacromial synovium in patients with rotator cuff tear with shoulder stiffness showed severe fibrosis, hypertrophy, and hyperangiogenesis histopathology along with significant increases in fibrotic matrices collagen (COL) 1A1, 3A1, and 4A1 and inflammatory cytokines, whereas miR-29a expression was downregulated. Supraspinatus and infraspinatus tenotomy-injured shoulders in transgenic mice overexpressing miR-29a showed mild swelling, vascularization, fibrosis, and regular gait profiles as compared to severe rotator cuff damage in wild-type mice. Treatment with miR-29a precursor compromised COL3A1 production and hypervascularization in injured shoulders. In vitro, gain of miR-29a function attenuated COL3A1 expression through binding to the 3’-untranslated region (3′-UTR) of COL3A1 in inflamed tenocytes, whereas silencing miR-29a increased the matrix expression. Taken together, miR-29a loss is correlated with subacromial bursa inflammation and fibrosis in rotator cuff tear with shoulder stiffness. miR-29a repressed subacromial bursa fibrosis through directly targeting COL3A1 mRNA, improving rotator cuff integrity and shoulder function. Collective analysis offers a new insight into the molecular mechanism underlying rotator cuff tear with shoulder stiffness. This study also highlights the remedial potential of miR-29a precursor for alleviating the shoulder disorder.

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Into-Tunnel Repair Versus Onto-Surface Repair for Rotator Cuff Tears in a Rabbit Model

The American Journal of Sports Medicine ◽

10.1177/0363546518764685 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1711-1719 ◽

Cited By ~ 8

Author(s):

Xiaoxi Li ◽

Peng Shen ◽

Wei Su ◽

Song Zhao ◽

Jinzhong Zhao

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Bone Healing ◽

Surface Group ◽

The Other ◽

Rotator Cuff Tears ◽

Bone Interface ◽

Cuff Tear ◽

Retear Rate ◽

Surface Repair

Background: Clinically, onto-surface repair is commonly used for rotator cuff tears. The retear rate after rotator cuff repair (RCR) is relatively high, with failure occurring mostly at the tendon-bone connection site. For anterior cruciate ligament (ACL) reconstruction, into-tunnel reconstruction is commonly employed. The retear rate after ACL reconstruction is relatively low, with retears seldom occurring at the tendon-bone interface. No study on into-tunnel RCR has been conducted. Hypothesis: Into-tunnel RCR could promote fibrocartilage regeneration at the tendon-bone interface and has biomechanical advantage over onto-surface repair in a rabbit rotator cuff tear model. Study Design: Controlled laboratory study. Methods: Thirty-six New Zealand White rabbits were used in this study. The supraspinatus tendons were cut from the footprint to create a rotator cuff tear on both shoulders. On one side, the supraspinatus was cut longitudinally into 2 halves, sutured, and pulled into 2 tunnels through the greater tuberosity (into-tunnel repair). On the other side, the tendon was reattached to the surface of the footprint with transosseous sutures (onto-surface repair). Twelve animals were sacrificed, of which 6 were used for a histological examination and the other 6 for biomechanical testing, at 4, 8, and 12 weeks, respectively. Results: The tendon-bone interface in the into-tunnel group showed a different healing pattern from that in the onto-surface group. In the former, most of the tendon tissue in the tunnel was replaced with newly generated fibrocartilage; the rest of the tendon fibers appeared in large bundles with direct connection to the bone. In the latter, fibrocartilage regeneration was seldom found at the tendon-bone interface; the tendon near the bone surface appeared as small fibrils. The biomechanical evaluation revealed a higher ultimate load ( P < .001) and stiffness ( P < .001) at the tendon-bone junction in the into-tunnel group than those in the onto-surface group at 12 weeks. Conclusion: In a rabbit rotator cuff tear model, into-tunnel RCR could result in a different tendon-bone healing pattern, with obvious fibrocartilage regeneration at the interface and higher tendon-bone healing strength than that in onto-surface repair. Clinical Relevance: New RCR patterns may be developed to improve the tendon-bone healing pattern and obtain better tendon-bone healing strength.

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Evaluation of animal models and methods for assessing shoulder function after rotator cuff tear: A systematic review

Journal of Orthopaedic Translation ◽

10.1016/j.jot.2020.02.012 ◽

2021 ◽

Vol 26 ◽

pp. 31-38

Author(s):

Yang Liu ◽

Sai C. Fu ◽

Hio T. Leong ◽

Samuel Ka-Kin Ling ◽

Joo H. Oh ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Animal Models ◽

Rotator Cuff Tear ◽

Shoulder Function ◽

Cuff Tear

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Rotator cuff unloading versus loading exercise program in the conservative treatment of patients with rotator cuff tear: protocol of a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040820 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040820

Author(s):

Larissa Pechincha Ribeiro ◽

Ann Cools ◽

Paula Rezende Camargo

Keyword(s):

Rotator Cuff ◽

Conservative Treatment ◽

Shoulder Pain ◽

Rotator Cuff Tear ◽

Social Life ◽

Rotator Cuff Tears ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Cuff Tear ◽

Shoulder Range Of Motion

IntroductionAtraumatic and degenerative rotator cuff tears are common in individuals over 55 years of age. This condition can have a high impact on social life and is associated with chronic pain, weakness and dysfunction of the upper limb. There is evidence that conservative approaches should be the first treatment option. Conservative treatment usually addresses a variety of therapeutic behaviours without providing scientific arguments for the choice and progression of exercises.ObjectiveTo compare the effects of two different exercise programmes based on the load of the rotator cuff on a population with shoulder pain and rotator cuff tears.Methods and analysisThis is a controlled, randomised, blinded clinical trial. Seventy-eight individuals with shoulder pain and presence of atraumatic and degenerative rotator cuff tear will participate and will be randomly distributed between two groups. The primary outcome will be quality of life (The Western Ontario Rotator Cuff Index), and secondary outcomes will include pain, function (Disabilities of the Arm, Shoulder and Hand), fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire-Brazil), kinesiophobia (Tampa Scale), Pain Catastrophizing Scale, muscle strength of abductors, external and internal rotators of the shoulder, range of motion of arm elevation and patient satisfaction. The treatment will be performed for 12 weeks (2 x/week) acording to the selected group (Rotator Cuff Unloading x Rotator Cuff Loading Exercise Programme).Ethics and disseminationThe study protocol was approved by the Institutional Review Board. The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.Trial registration numberNCT03962231.

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