scholarly journals Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

2009 ◽  
Vol 91 (5) ◽  
pp. 414-416 ◽  
Author(s):  
M Bhatia ◽  
B Singh ◽  
N Nicolaou ◽  
KJ Ravikumar
Keyword(s):  
Rotator Cuff ◽  
Causative Factor ◽  
Rotator Cuff Tears ◽  
Controlled Study ◽  
Distribution Analysis ◽  
Subacromial Impingement ◽  
Subacromial Space ◽  
Retrospective Case ◽  
Significant Difference ◽  
Magnetic Resonance Imaging Mri

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

2019 ◽  
Vol 21 (6) ◽  
pp. 417-426
Author(s):  
Kamil Yamak ◽  
Hüseyin Gökhan Karahan ◽  
Taşkın Altay ◽  
Cemil Kayalı ◽  
Fırat Ozan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
X Rays ◽  
Preoperative Period ◽  
Subacromial Space ◽  
Significant Difference ◽  
The Difference ◽  
Quick Dash

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

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.

Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

2019 ◽  
Vol 1 ◽  
pp. 2-6
Author(s):  
Asad Naqvi ◽  
Timothy Ariyanayagam ◽  
Mir Akber Ali ◽  
Akhila Rachakonda ◽  
Hema N. Choudur
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Strength Training ◽  
Radiology Department ◽  
Resonance Imaging ◽  
Subacromial Space ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

scholarly journals The influence of the Kinesio Taping on selected ultrasonography measurements, and quality of life in patients with rotator cuff lesions

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.

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 Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

scholarly journals The experience with the use of a subacromial balloon in the treatment of patients with large, massive, irreparable rotator cuff tears

2020 ◽  
Vol 11 (4) ◽  
pp. 14-22
Author(s):  
Мaksim F. Lazko ◽  
Alexey P. Prizov ◽  
Fedor L. Lazko ◽  
Evgeny A. Beliak ◽  
Ivan G. Maglaperidze ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Pain Syndrome ◽  
Rotator Cuff Tears ◽  
Average Score ◽  
Subacromial Space ◽  
Rotator Cuff Injuries ◽  
Goutallier Classification ◽  
Upper Extremity Function ◽  
A Prospective Study

Background. Large, massive irreparable rotator cuff tears lead to a significant decrease in the function of the shoulder joint together with the development of a pronounced pain syndrome. Such injuries are difficult to treat, and the number of relapses, when trying to restore them, is quite high. The installation of a subacromial balloon is the method of choice for this group of patients and allows restoring the function of the shoulder joint fairly successfully. Aim: to evaluate the results of the treatment of patients with massive irreparable rotator cuff tears injuries in a prospective study from 2016 to 2018. Methods. The results of the arthroscopic treatment of large, irreparable rotator cuff injuries in 25 patients (with the average age of 67 5 years) with the installation of a subacromial balloon are presented. In all the clinical cases, there was a pronounced (grades 34, according to the Goutallier classification) fatty dystrophy of the rotator cuff muscles (supraspinatus or in combination with subaspinatus). All the patients underwent the subacromial space release with a thorough bursectomy and subsequent installation of a subacromial balloon. Results. The average score on the UCLA scale was 14 3 points (1117) before the operation and 312 points (2933) 12 months after the operation, the results were considered good and excellent. Conclusion. The results obtained allow us to evaluate the described technique as low-traumatic, simple and fast in its accomplishment, aimed at the reduction of the pain syndrome and restoration of the upper extremity function.

Before School Exercise Effects on Fitness and Academic Performance in Schoolchildren: A Retrospective Case-Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Austin J. Kulp ◽  
Xihe Zhu
Keyword(s):  
Academic Performance ◽  
Cardiorespiratory Fitness ◽  
Comparison Group ◽  
Fifth Graders ◽  
Reading Test ◽  
Analysis Of Covariance ◽  
Controlled Study ◽  
Retrospective Case ◽  
Significant Difference ◽  
Before School

Background/Purpose: Before school exercise programs (BSEPs) give students time for breakfast and add time to their daily physical activity. However, the effects of BSEP on physical fitness and academic achievement in the classroom remain unclear. The purpose of this study is to examine the effects of BSEP on cardiorespiratory fitness and academic performance among fourth- and fifth-grade students. Method: A retrospective case-controlled design was used in this study. Fourth and fifth graders (N = 84) were participants, half signed up for BSEP that met once a week for 10 weeks. A retrospectively case-controlled comparison group was generated from the classmates of those in BSEP in the same school. All students took PACER and statewide academic performance assessments. Multivariate analysis of covariance for student cardiorespiratory fitness, and mathematics and reading, were conducted, adjusting for pretest performances. Analysis/Results: There were improvements for both groups in academic performances and cardiorespiratory fitness. The cardiorespiratory fitness and reading test improvements were greater in the BSEP group than those in the comparison group, controlling for their pretests. However, there was no significant difference in student mathematics test performances. Conclusion: Students in BSEP group benefited from participating in the program with greater improvement in cardiorespiratory and reading test performances than the comparison group. These findings suggested that providing a BSEP once a week for 45 min may be beneficial to fourth and fifth graders.

Muscle Activity Before and After Subacromial Injection

2021 ◽  
pp. 1-7
Author(s):  
Lucas Ettinger ◽  
Matthew Shaprio ◽  
Andrew Karduna
Keyword(s):  
Rotator Cuff ◽  
Muscle Activation ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement ◽  
Upper Trapezius ◽  
Subacromial Injection ◽  
Shoulder Muscle ◽  
Shoulder Muscles ◽  
Before And After ◽  
Arm Elevation

Context: Shoulder muscle activation in patients with subacromial impingement is highly cited and variable in the literature. Differences between studies could be due to artifacts introduced by normalization practices in the presence of pain. Ultimately, this lack of knowledge pertaining to pathogenesis limits the clinical treatment and restoration of muscular function. Design: A total of 21 patients with stage 2 subacromial impingement and 21 matched controls were recruited for EMG testing of their affected shoulder during an arm elevation task. The patients were tested before and after receiving an injection to their subacromial bursa. Methods: The EMG from 7 shoulder muscles were measured before and after treatment during humeral motion in the scapular plane. Results: Our findings indicate an increase in anterior deltoid, middle deltoid, and upper trapezius activity following the injection; further, this trend extended to the controls. The control subjects had a greater activation of the latissimus dorsi at peak arm elevation when compared with the patient group postinjection. Conclusions: Our results indicate that a reduction in subacromial pain is associated with changes in shoulder muscle recruitment, primarily of the deltoid. This change in deltoid activity may lend evidence to rotator cuff function in patients without rotator cuff tears.

The Role of Indian Hedgehog Signaling in Tendon Response to Subacromial Impingement: Evaluation Using a Mouse Model

2021 ◽  
pp. 036354652110622
Author(s):  
Yulei Liu ◽  
Xiang-Hua Deng ◽  
Xueying Zhang ◽  
Ting Cong ◽  
Daoyun Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Hedgehog Signaling ◽  
Molecular Mechanisms ◽  
Healing Process ◽  
Biomechanical Testing ◽  
Indian Hedgehog ◽  
Control Group ◽  
Subacromial Impingement ◽  
Subacromial Space ◽  
Gradual Improvement

Background: The underlying cellular and molecular mechanisms involved in the development of tendinopathy due to subacromial supraspinatus tendon (SST) impingement and the response to subsequent removal of impingement remain unknown. Purpose: To investigate the involvement of Indian hedgehog (IHH) signaling in the development of SST tendinopathy and the subsequent healing process after the relief of subacromial impingement in a novel mouse shoulder impingement model. Study Design: Controlled laboratory study. Methods: A total of 48 male wild-type C57BL/6 mice were used in this study. Supraspinatus tendinopathy was induced by inserting a microsurgical clip into the subacromial space bilaterally. Eleven mice were sacrificed at 4 weeks after surgery to establish impingement baseline; 24 mice underwent clip removal at 4 weeks after surgery and then were euthanized at 2 or 4 weeks after clip removal. Thirteen mice without surgical intervention were utilized as the control group. All SSTs were evaluated with biomechanical testing; quantitative histomorphometry after staining with hematoxylin and eosin, Alcian blue, and picrosirius red; and immunohistochemical staining (factor VIII, IHH, Patched1 [PTCH1], and glioma-associated oncogene homolog 1 [GLI1]). Results: The mean failure force and stiffness in the 4-week impingement group decreased significantly compared with the control group ( P < .001) and gradually increased at 2 and 4 weeks after clip removal. Histological analysis demonstrated increased cellularity and disorganized collagen fibers in the SST, with higher modified Bonar scores at 4 weeks, followed by gradual improvement after clip removal. The IHH-positive area and PTCH1- and GLI1-positive cell percentages significantly increased after 4 weeks of clip impingement (20.64% vs 2.06%, P < .001; 53.9% vs 28.03%, P = .016; and 30% vs 12.19%, P = .036, respectively) and continuously increased after clip removal. Conclusion: The authors’ findings suggest that the hedgehog signaling pathway and its downstream signaling mediator and target GLI1 may play a role in the development and healing process of rotator cuff tendinopathy due to extrinsic rotator cuff impingement. Clinical Relevance: This study suggests the potential for the hedgehog pathway, together with its downstream targets, as candidates for further study as potential therapeutic targets in the treatment of supraspinatus tendinopathy.

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