Value of radiographic measurements in depiction of glenohumeral and acromial anatomical changes in patients with subacromial impingement syndrome and rotator cuff tears

2018 ◽  
pp. 98-108
Author(s):  
V. E. Gazhonova ◽  
Е. M. Bachurina ◽  
M. V. Emelianenko ◽  
I. E. Popova ◽  
T. A. Soina ◽  
...  

The purpose.Optimization of radiographic study of the shoulder in patients with SIS and estimation of the clinical value of radiographic measurements in SIS diagnosis and rotator cuff tears (RCT).Materials and methods.128 patients with a painful shoulder (67 women, 61 men), mean age 57.3 ± 12.8 y.o. and 35 patients without shoulder pain mean age 56 ± 10.4 y.o. underwent a complex study including radiography, MRI, MDCTor MR-arthrography, arthroscopy. Special angles and distances were estimated on a Radiographic Work Station by 2 radiologists (acromion tilt (AT), acromion slope, inferior acromion protrusion, acromio-humeral distance, acromio-humeral index, critical shoulder angle (CSA), lateral acromion angle, transverse acromion angle). Mean values of these parameters were compared between patients with SIS and control group, and between patients with RCT and without . Test-retest reproducibility and inter rater agreement were calculated with Kohen’s kappa. Diagnostic value of the most informative parameters was compared with estimation of AUC under the ROC curve.Results.CSA and AT demonstrated independence with age and excellent test-retest reproducibility. In SIS patients mean values of CSA were statistically higher (35.78 ± 4.64°), AT values – lower (25.90 ± 4.27°), then in controls. In all patients with CSA more then 35, the frequency of RCT was 74%. In patients with RCT were detected higher values of CSA (36.70 ± 2.61°) and lower values of AT (23.67 ± 3.07°), then in patients without tears. Lateral acromion angle (acromion type) demonstrated correlation with patient’s age and moderate reproducibility in test-retest studies.Conclusion.AT (measured on the outlet X-ray view) and CSA (measured in direct views) could be recommended for clinical use for evaluation of patients with SIS and prognosing RCT.

Author(s):  
Tao Huang ◽  
Jian Liu ◽  
Yupeng Ma ◽  
Dongsheng Zhou ◽  
Liang Chen ◽  
...  

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.


2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989515 ◽  
Author(s):  
Ulunay Kanatlı ◽  
Tacettin Ayanoglu ◽  
Erdinc Esen ◽  
Baybars Ataoglu ◽  
Mustafa Ozer ◽  
...  

Purpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group ( p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear ( p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.


2020 ◽  
Author(s):  
Lianxin Li ◽  
Jinlei Dong ◽  
Qinghu Li ◽  
Jinye Dong ◽  
Dongsheng Zhou ◽  
...  

Abstract Background: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT).Methods: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under receiver operating characteristic curve (AUC). Results: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively.Conclusions: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears, but only small improvement of sensitivity. Considering the price and invasion of MRA, MRI is recommended as an initial examination to detect patients suspected with articular-side partial-thickness rotator cuff tears.


2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110668
Author(s):  
Felix Porschke ◽  
Philip Christian Nolte ◽  
Christian Knye ◽  
Christel Weiss ◽  
Stefan Studier-Fischer ◽  
...  

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.


2020 ◽  
Vol 48 (8) ◽  
pp. 1818-1825
Author(s):  
Anil Pulatkan ◽  
Wasim Anwar ◽  
Omer Ayık ◽  
Ergun Bozdag ◽  
Ayse Nur Yildirim ◽  
...  

Background: Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. Purpose: To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. Results: Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively ( P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) ( P = .009). Conclusion: Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. Clinical Relevance: Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ming Li ◽  
Kan Wang ◽  
Haojun Zhang ◽  
Chaohua Fang ◽  
Hua Liu ◽  
...  

Background. The clinical evidence is conflicted on whether platelet-rich plasma (PRP) therapies have a positive effect on tendon healing and improved functional outcomes. Purpose. To evaluate the potentials of intraoperative injection PRP on the speed and quality of healing in patients undergoing arthroscopic repair for small to medium rotator cuff tears. Methods. A total of 86 patients scheduled for arthroscopic single-row repair of small to medium rotator cuff tears were assigned to undergo either PRP injection (PRP group) or conventional repair (control group). The PRP group ( N = 43 ) consisted of patients who received an intraoperative injection of liquid PRP. The control group ( N = 43 ) consisted of patients who did not receive that treatment. The visual analogue scale (VAS) for pain before treatment and at 1, 14 days, 3, 6, and 24 months after surgery were recorded. The clinical outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scores before treatment and at 3, 6, and 24 months after surgery and magnetic resonance imaging or ultrasound examination at 24 months. Patient satisfaction and retear rate were also assessed. Results. No statistical differences in baseline characteristics such as age, gender, dominant arm, and tear size were observed between the two groups ( P > 0.05 ). For the PRP group, the mean operation time was 40.22 minutes, and for the control group, the mean operation time was 36.3 minutes. There was a statistically significant difference ( P = 0.036 ). After surgery, all VAS measurements significantly decreased over time until final follow-up in both groups. No significant difference between the 2 groups was found for any VAS pain measurement at any time point except for the VAS at 1 day postoperatively, which was significantly lower in the PRP group ( 2.39 ± 1.03 ) than that in the control group ( 3.21 ± 1.85 ) ( P = 0.014 ). Analysis of the PRP and control groups demonstrated a statistically significant improvement in UCLA and Constant scores from baseline to the 3-, 6-, and 24-month follow-up assessments ( P < 0.05 ). However, no significant intergroup differences were observed in the clinical scores between the three follow-up time points ( P > 0.05 ). At the 24-month follow-up, patient satisfaction rates reached 95.65% and 93.48% for the PRP and control groups, respectively. The retear rate of the PRP group (2/43, 4.65%) was lower than that of the control group (6/43, 13.95%). Conclusions. Although the pain at 1 day after surgery and the retear rate in the PRP group were significantly lower than those in the control group, the liquid PRP injection did not promote better clinical outcomes at the 2-year follow-up.


2021 ◽  
Vol 104 (4) ◽  
pp. 003685042110599
Author(s):  
Lianxin Li ◽  
Jinlei Dong ◽  
Qinghu Li ◽  
Jinye Dong ◽  
Bingzhi Wang ◽  
...  

Background: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). Methods: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). Results: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65–0.90), 0.96 (95% CI, 0.91–0.98), 68.14 (95% CI, 33.20–139.84) and 0.96 (95% CI, 0.94–0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65–0.87) and 0.97 (95% CI, 0.84–0.99), 47.82 (95% CI, 8.29–275.89) and 0.89 (95% CI, 0.86–0.92), respectively. Conclusions: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.


Author(s):  
Surendra Umesh Kamath ◽  
Sunil Murthy

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.   


2005 ◽  
Vol 19 (2) ◽  
pp. 134-138 ◽  
Author(s):  
Anna Carolina Aguiar Cassanho ◽  
Aletéia Massula Fernandes ◽  
Luciane Dias de Oliveira ◽  
Claudio Antonio Talge Carvalho ◽  
Antonio Olavo Cardoso Jorge ◽  
...  

The aim of this study was to evaluate in vitro the antimicrobial activity of glass ionomer (GIC) and zinc oxide-eugenol (ZOE) cements against Candida albicans. Standardized GIC and ZOE specimens were maintained in contact with C. albicans suspension (1 <FONT FACE=Symbol>´</FONT> 10(6) cells/ml) at 37°C for 24 h, 48 h or 7 days. A control group without any testing cement was included. After the incubation period, aliquots of 0.1 ml were plated on Sabouraud's agar, and then the number of colonies was counted. The results were expressed as values of logarithms of colony-forming units per milliliter (log CFU/mL) and were analyzed statistically by Kruskal-Wallis ANOVA. After 48 h of incubation, the ZOE group presented no growth of C. albicans. GIC and control groups presented similar mean values at all tested periods. According to the results obtained, it could be concluded that, under the experimental conditions, ZOE cement was more effective in vitro against C. albicans than GIC.


2021 ◽  
Vol 12 ◽  
Author(s):  
Mohammad Taheri ◽  
Somayeh Sangseifid ◽  
Pariya Shahani ◽  
Mohammad Mahdi Eftekharian ◽  
Shahram Arsang-Jang ◽  
...  

Acquired immune-mediated polyneuropathies are classified to some subtypes among them are acute and chronic inflammatory demyelinating polyradiculoneuropathies (AIDP and CIDP). These two conditions share some common signs and underlying mechanisms. Based on the roles of Suppressor of cytokine signaling (SOCS) genes in the modulation of immune system reactions, these genes might be involved in the pathogenesis of these conditions. We evaluated expression of SOCS1-3 and SOCS5 genes in the leukocytes of 32 cases of CIDP, 19 cases of AIDP and 40 age- and sex-matched controls using real time PCR method. The Bayesian regression model was used to estimate differences in mean values of genes expressions between cases and control group. Expression levels of SOCS1 and SOCS2 were significantly lower in male patients compared with controls. This sex-specific pattern was also observed for SOCS3 down-regulation. Based on the area under curve values in Receiver Operating Characteristics (ROC) curve, diagnostic powers of SOCS1, SOCS2, SOCS3 and SOCS5 genes in the mentioned disorder were 0.61, 0.73, 0.68 and 0.58, respectively. Expression of none of genes was correlated with age of enrolled cases. The current study shows evidences for participation of SOCS genes in the pathophysiology of acquired immune-mediated polyneuropathies.


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