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.

scholarly journals Features of Partial Rotator Cuff Tears Diagnostics

2019 ◽  
Vol 25 (2) ◽  
pp. 143-149 ◽  
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.

scholarly journals Experience in Arthroscopic Treatment of Massive Rotator Cuff Injuries in Elderly Patients

2014 ◽  
Vol 21 (4) ◽  
pp. 67-69
Author(s):  
A. A Kubashev ◽  
F. L Lazko ◽  
E. A Belyak ◽  
A. P Prizov ◽  
E. Sh Lomtatidze
Keyword(s):  
Rotator Cuff ◽  
Elderly Patients ◽  
Excellent Result ◽  
Fatty Degeneration ◽  
Arthroscopic Treatment ◽  
Subacromial Space ◽  
Treatment Results ◽  
Elbow Arthroscopy ◽  
Rotator Cuff Injuries ◽  
Goutallier Classification

Arthroscopic treatment results for 6 elderly patients (mean age 64 years) with massive (over 5 cm) nonreconstructable rotator cuff tear are presented. In all cases fatty degeneration of the rotator cuff tendon above 3 rd degree by Goutallier classification was present. In all patients elbow arthroscopy with implantation of InSpace Balloon into subacromial space was performed. Mean score by UCLA scale made up 14 (12-15) preoperatively and over 30 in 6 months after intervention that corresponded to a good and excellent result. Preliminary results indicate that applied technique is a simple, mini-invasive and effective intervention enabling to reduce pain and increase range of movements in this group of patients.

scholarly journals A Comparative Evaluation of Rotator Cuff Injuries of the Shoulder Joint using High Resolution Ultrasound and Magnetic Resonance Imaging

2012 ◽  
Vol 10 (1) ◽  
pp. 9-14 ◽  
Author(s):  
MS Shrestha ◽  
A Alam
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Rotator Cuff ◽  
Diagnostic Accuracy ◽  
Shoulder Joint ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Resonance Imaging ◽  
Rotator Cuff Injuries

Introduction: Pathology of the rotator cuff is the cause of most common problems at the shoulder joint and accurate diagnosis is essential for appropriate management. High-resolution real-time ultrasonography and MRI are successful imaging modalities for both rotator cuff and non–rotator cuff disorders and have important implications in the management of rotator cuff pathologies. This study was conducted to Compare the results obtained after the evaluation of rotator cuff injuries of shoulder joint by high resolution Ultrasonography and Magnetic Resonance Imaging. Methods: 50 patients with suspected rotator cuff injuries of the shoulder joint were included in this study over a period of 2years. Patients had presented with various complaints like prolonged pain in the shoulder joint with stiffness, restriction and difficulty in movement of the shoulder joint, traumatic injuries and recurrent dislocations of the shoulder joints. Results: Mean age was 41.6years ( range 15-80 ).Maximum patients were between 41-50 years (24%). 29 were males and 21 were females. In our study diagnostic accuracy of ultrasound in rotator cuff tears was 57. 14% for full thickness tears and 58.33 for partial thickness tears. The diagnostic accuracy of ultrasound in detection of complete tear of the supraspinatus muscle was 57.14% while that of MRI was 100%. Conclusion: High resolution Ultrasound being a dynamic study can be used as the first-line investigation for rotator cuff tear. Full-thickness rotator cuff tears can be identified using ultrasound and MRI with comparable accuracy. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6443 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 9-14

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 Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

2018 ◽  
Vol 46 (14) ◽  
pp. 3486-3494 ◽  
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Joint Function ◽  
Massive Rotator Cuff Tears ◽  
Sham Surgery ◽  
Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

scholarly journals Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984591 ◽  
Author(s):  
Avinesh Agarwalla ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
Anthony A. Romeo ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Management Practices ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Biceps Tenodesis ◽  
Rotator Cuff Injuries ◽  
Cuff Repair ◽  
Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

scholarly journals Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986343 ◽  
Author(s):  
Raffy Mirzayan ◽  
Michael A. Stone ◽  
Michael Batech ◽  
Daniel C. Acevedo ◽  
Anshuman Singh
Keyword(s):  
Rotator Cuff ◽  
Clinical Improvement ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Type Ii ◽  
Bone Contact ◽  
Type Iii ◽  
Goutallier Classification ◽  
Functional Scores ◽  
The Mean

Background:Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated.Hypothesis:The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare).Results:The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; P < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; P < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; P = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; P = .2) or ASES (30.6 vs 37.2; P = .5) for type III grafts.Conclusion:MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered.

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.

Sign in / Sign up

Export Citation Format

Share Document