Traumatic Posterior Rotator Cuff Tear in the Pre-existing Chronic Supraspinatus Tendon Tear

Background: It is estimated that more than 25% of general population more than 60 years old experience rotator cuff tear, acromial impingement syndrome is one of the most common causes. Morphology of acromion is an important extrinsic factor in the development of rotator cuff tear. The traditional classification of the acromion by Bigliani et al. based on supraspinatus outlet view has been widely used, but due to the high requirements for patients to obtain true supraspinatus outlet view and the poor inter-observer reliability, it brings lots of limitations to the clinical use of this classification. In our clinical work, we have noticed that the formation of acromial anterolateral spur on Rockwood tilt view has some relationship to a rotator cuff tear. Objectives: To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear. Methods: From January 2017 to December 2017, 101 cases of shoulder arthroscopic surgeries for impingement syndrome or rotator cuff tear were retrospectively analyzed. We developed a new classification of the acromion based on the Rockwood tilt view as type I flat acromion, type II bump acromion and type III impingement acromion. The status of the supraspinatus tendon was also recorded as no tear, partial-thickness tear, and full-thickness tear. We tested the inter-observer and intra-observer reliability of the new classification system (Kappa value) and analyzed the correlation between the acromion morphology and the rupture of the supraspinatus tendon. Results: In all 101 cases, the most common type was the impingement acromion with 46 patients (45.5%), followed by bump acromion in 37 patients (36.6%), and the flat acromion in 18 patients (17.8%). The inter-observer reliability of the new classification system was significantly better than that of the traditional classification (0.826 vs. 0.281). The incidence of supraspinatus tendon tear in the patients with impingement acromion was significantly higher than that of the other two types of acromion (ϰ2 = 50.316,P < 0.05). Conclusion: The Rockwood tilt view can well demonstrate the exact architecture of the anterolateral acromion spur. The new classification based on Rockwood tilt view has high reliability and good reproducibility. The type III impingement acromion correlates highly with the supraspinatus tendon tear. Level of evidence: Level II.

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Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations

International Orthopaedics ◽

10.1007/s00264-021-05012-6 ◽

2021 ◽

Author(s):

Richard W. Nyffeler ◽

Nicholas Schenk ◽

Philipp Bissig

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Minor Trauma ◽

Inclusion Criteria ◽

Tendon Tear ◽

Cuff Tear ◽

Tendon Ruptures ◽

Tendon Tears

Abstract Purpose A simple fall on the shoulder is often referred to as minor trauma that cannot cause a tendon tear but at best reveal a pre-existing rotator cuff pathology. We wanted to know whether this statement was true. The purpose of our study was therefore to summarize the causes of acute rotator cuff tears reported in the literature and provide a biomechanical explanation for tendon tears diagnosed after a fall. Method We searched PubMed and included studies reporting rotator cuff tears occurring due to a trauma. The number of cases, the tendons involved, the age of the patients, and the nature of trauma were summarized. In addition, we noted any information provided by the authors on the pathogenesis of acute tendon ruptures. Results Sixty-seven articles with a total of 4061 traumatic rotator cuff tears met the inclusion criteria. A simple fall was the most common cause (725 cases) and the supraspinatus tendon was most frequently affected. The postulated pathomechanism is a sudden stretch of the tendon-muscle unit while contracting (eccentric loading). Conclusion A simple fall can cause an acute rotator cuff tear and fall-related tears are not restricted to young individuals. They can affect patients of any age. The stresses occurring within the rotator cuff during an attempt to cushion a fall may locally exceed the tensile strength of the tendon fibers and cause a partial or full-thickness tear.

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Research appling arthroscopy in treatment of some shoulder’s diseases

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.6_7.9 ◽

2019 ◽

pp. 61-67

Author(s):

Dinh Khoa Nguyen ◽

Van Hy Nguyen

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Arthroscopy ◽

Supraspinatus Tendon ◽

Key Words Arthroscopy ◽

Central Hospital ◽

Rotator Cuff Disease ◽

Tendon Tear ◽

Cuff Tear ◽

Difficult Procedure

Background: Shoulder athroscopy is a difficult procedure and have been appling in Hue Central Hospital in recent years. There was not any general research for this yet. Objective: To research symptoms and evaluate the result of shoulder arthroscopy. Subject and methods: Following research 38 patients who underwent shoulder arthroscopy in Hue Central Hospital from 6/2016 to 3/2019, assess after 6 months. Results: Instability shoulder was 61.5%, rotator cuff tear was 30.8% and impingement was 7.7%. Mean age was 43.8 and male was higher than female (p<0.05). Pain symtom is 100% in rotator cuff disease and 30.4% in instability, MRI found out injury 30.4 and 100% in instability and rotator cuff group, respectively. Anterior labral tear was 95.7% in instability group and supraspinatus tendon tear was 91.7% in rotator cuff tear group. Good and excelent result were 85% and 91.3% after 6 month in instability and rotator cuff group, respectively. Conclusion: Result of shoulder arthroscopy was good in Hue Central hospital. Key words: arthroscopy, instability, rotator cuff tear

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Superior Capsule Reconstruction With a 3 mm–Thick Dermal Allograft Partially Restores Glenohumeral Stability in Massive Posterosuperior Rotator Cuff Deficiency: A Dynamic Robotic Shoulder Model

The American Journal of Sports Medicine ◽

10.1177/03635465211013364 ◽

2021 ◽

pp. 036354652110133

Author(s):

Lucca Lacheta ◽

Alex Brady ◽

Samuel I. Rosenberg ◽

Travis J. Dekker ◽

Ritesh Kashyap ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Humeral Head ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Neutral Position ◽

Tendon Tear ◽

Cuff Tear ◽

Superior Capsule Reconstruction ◽

Head Translation

Background: Superior capsule reconstruction (SCR) has been shown to improve shoulder function and reduce pain in patients with isolated irreparable supraspinatus tendon tears. However, the effects of SCR on biomechanics in a shoulder with an extensive posterosuperior rotator cuff tear pattern remain unknown. Purpose/Hypothesis: The purpose was to (1) establish a dynamic robotic shoulder model, (2) assess the influence of rotator cuff tear patterns, and (3) assess the effects of SCR on superior humeral head translation after a posterosuperior rotator cuff tear. It was hypothesized that a posterosuperior rotator cuff tear would increase superior humeral head translation when compared with the intact and supraspinatus tendon–deficient state and that SCR would reduce superior humeral head translation in shoulders with massive rotator cuff tears involving the supraspinatus and infraspinatus tendons. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders were tested using a robotic arm. Kinematic testing was performed in 4 conditions: (1) intact, (2) simulated irreparable supraspinatus tendon tear, (3) simulated irreparable supra- and infraspinatus tendon tear, and (4) SCR using a 3 mm–thick dermal allograft (DA). Kinematic testing consisted of static 40-N superior force tests at 0°, 30°, 60°, and 90° of abduction and dynamic flexion, abduction, and scaption motions. In each test, the superior translation of the humeral head was reported. Results: In static testing, SCR significantly reduced humeral superior translation compared with rotator cuff tear at all abduction angles. SCR restored the superior stability back to native at 60° and 90° of abduction, but the humeral head remained significantly and superiorly translated at neutral position and at 30° of abduction. The results of dynamic testing showed a significantly increased superior translation in the injured state at lower elevation angles, which diminished at higher elevation, becoming nonsignificant at elevation >75°. SCR reduced the magnitude of superior translation across all elevation angles, but translation remained significantly different from the intact state up to 60° of elevation. Conclusion: Massive posterosuperior rotator cuff tears increased superior glenohumeral translation when compared with the intact and supraspinatus tendon–insufficient rotator cuff states. SCR using a 3-mm DA partially restored the superior stability of the glenohumeral joint even in the presence of a simulated massive posterosuperior rotator cuff tear in a static and dynamic robotic shoulder model. Clinical Relevance: The biomechanical performance concerning glenohumeral stability after SCR in shoulders with large posterosuperior rotator cuff tears is unclear and may affect clinical outcomes in daily practice.

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The “bridging sign”: A MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

Acta Radiologica ◽

10.1258/ar.2012.120353 ◽

2013 ◽

Vol 54 (1) ◽

pp. 83-88 ◽

Cited By ~ 9

Author(s):

Jin Young Jung ◽

Young Cheol Yoon ◽

Dong Ik Cha ◽

Jae-Chul Yoo ◽

Jee Young Jung

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Rotator Cuff Tear ◽

Supraspinatus Tendon ◽

Subscapularis Tendon ◽

Full Thickness ◽

Tendon Tear ◽

Anterior Portion ◽

Cuff Tear ◽

Sensitivity Specificity

Background In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the “bridging sign”, which has not been previously described. Purpose To describe the “bridging sign” on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the “bridging sign” and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the “bridging sign” was assessed and the sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the “bridging sign” were compared. Results The “bridging sign” was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the “bridging sign” had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of combined FTTs of the SSC tendon and anterior portion of the SSP tendon were 81.0%, 100%, and 86.2%, respectively. The patients with the “bridging sign” had longer duration of shoulder pain and more frequent associated arthroscopic and MR findings than the patients without the “bridging sign”. Conclusion The “bridging sign” is a highly specific finding for combined full-thickness tears of the subscapularis tendon and anterior portion of the supraspinatus tendon, associated with more chronic shoulder pain and more sever rotator cuff tear.

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Recombinant Human Bone Morphogenetic Proteins-4 Enhanced the Tendon-to-bone Attachment Healing in a Murine Model of Rotator Cuff Tear: A Randomized Controlled Trial

10.21203/rs.3.rs-76730/v1 ◽

2020 ◽

Author(s):

Huabin Chen ◽

Zhanwen Wang ◽

Li Zhou ◽

Bing Wu ◽

Hongbin Lu ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Bone Morphogenetic Proteins ◽

Murine Model ◽

Controlled Trial ◽

Supraspinatus Tendon ◽

Control Group ◽

Cuff Tear ◽

Tendon Insertion ◽

And Control

Abstract Background: Injuries on tendon-to-bone attachment (TBA) are common clinical dilemmas. Bone Morphogenetic Proteins-4 (BMP-4) has been found the potency in chondrogenesis. But there is rare studies focusing the influence of BMP-4 on the TBA healing. Thus, the objective of this study was to explore the effect of BMP-4 on the healing of TBA in murine model of rotator cuff tear.Methods: 120 mature C57BL/6 mice (12 weeks old) were randomly divided into BMP-4 group, noggin (an inhibitor of all BMP activities) group and control group after being established an injury model of supraspinatus tendon insertion. At week 2 and 4 after surgery, the supraspinatus tendon- humerus complex (SSTHC) were harvested for microradiographic, histologic, immunofluorescent and biomechanical evaluations.Results: Radiographic data showed that BMP-4 was able to improve the quality of subchondral bone, manifested as higher BV/TV, Tb.N, TB.Th, and lower Tb.Sp. Histologically, the BMP-4 group at week-2 and -4 showed better BTA healing interface, characterized by better organizational integration and remodeling, thicker fibrocartilage layer and more fibrocartilage cells. Immunoflorescence evaluation demonstrated the number of SOX 9 positive cells in the BMP-4 group was significantly more than that in the control or noggin group at postoperative weeks 2 and 4 (p<0.05 for all). Mechanical testing results demonstrated the failure load and stiffness in the BMP-4 group were significantly higher (p<0.05 for both), while in the noggin group were lower (p<0.05 for both), compared to the control group at postoperative weeks 4.Conclusion: BMP-4 might enhance the TBA healing by promoting the regeneration of fibrocartilaginous enthesis and mineralization, while noggin inhibited this process.Clinical Relevance: BMP-4 may be a potential therapy to augment TBA healing, and finally lead to more rapid rehabilitation and reduce risk of recurrent repair.

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Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model

Journal of Biomechanics ◽

10.1016/j.jbiomech.2003.09.019 ◽

2004 ◽

Vol 37 (5) ◽

pp. 739-749 ◽

Cited By ~ 141

Author(s):

Jonathan A. Gimbel ◽

Jonathan P. Van Kleunen ◽

Samir Mehta ◽

Stephanie M. Perry ◽

Gerald R. Williams ◽

...

Keyword(s):

Mechanical Properties ◽

Animal Model ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Supraspinatus Tendon ◽

Cuff Tear

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Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players

The American Journal of Sports Medicine ◽

10.1177/0363546519878141 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3476-3482

Author(s):

Teruhisa Mihata ◽

Rei Morikura ◽

Akihiko Hasegawa ◽

Kunimoto Fukunishi ◽

Takeshi Kawakami ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Rotator Cuff Tear ◽

Muscle Weakness ◽

Rotator Cuff Tears ◽

Tendon Tear ◽

Baseball Players ◽

Cuff Tear ◽

Partial Thickness ◽

Tendon Tears

Background: Partial-thickness rotator cuff tears are common shoulder injuries in baseball players. For some tears, the symptoms can be relieved through physical therapy or debridement without rotator cuff repair. Purpose: To assess whether partial-thickness rotator cuff tear by itself causes shoulder pain and muscle weakness in baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We studied 87 university baseball players (age, 19.5 ± 0.8 years; baseball career, 11.5 ± 1.6 years). All data were obtained during a full-participation annual medical check in 1 team. Rotator cuff tendons were examined ultrasonographically and allocated to 4 groups: (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, and (4) both supraspinatus and infraspinatus tendon tears. Current shoulder pain and shoulder muscle strength (dominant/nondominant) in abduction, external rotation, and internal rotation were compared by using chi-square and t tests. All players could play baseball with or without shoulder pain in this study. Results: Of the 87 players, 41 (47%) had articular-sided partial-thickness rotator cuff tears diagnosed on ultrasonography; the remaining 46 athletes were tear-free. Of the 41 affected patients, 19 had tears in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and infraspinatus tendons. Tear depth (mean ± SD) was 4.6 ± 2.3 mm in the supraspinatus and 6.2 ± 3.6 mm in the infraspinatus. Neither the rate of shoulder pain nor muscle strength differed significantly among the 4 groups ( P = .96 and P = .15-.70, respectively). Conclusion: Articular-sided partial-thickness rotator cuff tear—by itself—did not cause shoulder pain and muscle weakness in university baseball players. Most so-called articular-sided partial-thickness rotator cuff tears may not be pathologic tendon tears.

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

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.3.121 ◽

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 (p<0.001, p<0.001, p<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.

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