The Effect of Rehabilitation Program for Rotator Cuff Injury According to Functional variables in Female Volleyball Players in Sulaymania Governorate

The research aim at identifying the effect of rehabilitation program using stretching exercises (Proprioceptive Neuromuscular Facilitation) PNF in rotator cuff partial tear in female volleyball players according to functional variables. The researchers used the experimental method on (9) volleyball players with partial tear in the rotator cuff. They used the experimental method and the data was collected and treated using proper statistical operations to conclude significant differences between pre and posttests in heart pulse, blood pressure, and muscle mass percentage. Finally the researchers recommended using stretching to facilitated PNF in rehabilitating rotor cuff as well as using these exercises have a positive role in healing all functional variables to their normal state.

A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign

Background Diagnosing partial tears of the medial meniscus (MM) posterior root is difficult. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. As a control, 18 patients who underwent partial meniscectomy for other types of MM tears were evaluated. Isolated partial MMPRTs were classified into the following three types: type A, accurate partial stable tear (cleavage < 1/2 of root width); type B, bridged unstable root tear (cleavage ≥ 1/2 of root width); type C, complex horn tear expanded to the root. Conventional MRI-based findings of MMPRTs were evaluated between two groups (n = 23). Posterior root irregularity, bone marrow spot, and ocarina-like appearance showing several condensed circles in triangular meniscal horn (ocarina sign) were also evaluated. Results Posterior root irregularity and bone marrow spot were frequently observed in the partial MMPRTs (47.8%), compared with the other MM tears (P = 0.007 and 0.023, respectively). The ocarina sign was detected in 69.6% of patients with partial MMPRTs. A significant difference between two groups was observed in a positive ratio of ocarina sign (P < 0.001). Types A, B, and C of the partial tear/damage were observed in three, eight, and seven patients, respectively. The ocarina sign was the most common MRI finding in each type of partial MMPRT. Conclusions This study demonstrated that a characteristic MRI finding, “ocarina sign,” was frequently observed in patients with partial tear/damage of the MM posterior root. The ocarina sign was the most common MRI finding in several types of partial MMPRTs. Our results suggest that the ocarina sign may be useful to diagnose unnoticed partial MMPRTs. Level of evidence: IV, retrospective comparative study.

Assessment of Rotator Cuff Partial Tear Treatment with Ultrasound Guided Platelet Rich Plasma Injection

Background Rotator cuff tears are a common orthopedic problem, and often these tears are so-called partial tears of the rotator cuff. A partial tear of the rotator cuff is an area of damage or degeneration to the rotator cuff tendons, where the tear does not go all the way through the tendons Objectives The aim of the work assessment of rotator cuff partial tear treatment with ultrasound guided platelet rich plasma injection. Patients and Methods Single arm interventional study which was conducted in Ain shams university hospitals in the period between March 2020 and October 2020, 10 confirmed cases of rotator cuff partial tear diagnosed by MRI were included in this study. Their ages ranging from 25 to 70 years old. Results Our study showed statistically significant improvements in 10 patients in VAS pain score, constant shoulder score, PENN shoulder score and OXFORD shoulder score. Conclusion The ultrasound-guided PRP injection for rotator cuff partial thickness tears is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising and wellproved results. PRP has the potential to heal the muscle-tendon unit of the rotator cuff and may be a primary nonsurgical treatment modality for rotator cuff tears.

VALUE OF CONVENTIONAL MAGNETIC RESONANCE IN DIAGNOSIS OF ROTATOR CUFF TEAR

Objective: To study on the value of conventional magnetic resonance imaging in the diagnosis of rotator cuff tear in comparison with surgery.Subjects and research methods: Cross-sectional descriptive study on 69 patients with rotator cuff lesions undergoing magnetic resonance imaging at Hanoi Medical University Hospital Departmentof Diagnostic Imaging, all patients have surgery after that.Results: Among the number of patients operated, the highest proportion was the complete tendon rupture group (accounting for 60.9%), followed by the full-thickness tear group (14.5%) and thearticular-surface tear group (14.5%). , the groups of synovial-surface tear, intrasubstance tear, simple tendinopathy accounted for the least percentage. Regarding post-operative comparison: For completetendon tear, the sensitivity of magnetic resonance is 100%, specificity is 95.7%; in full-thickness tear, the sensitivity and specificity of magnetic resonance were 100% and 98.7%. The sensitivityof conventional magnetic resonance in the diagnosis of partial tear such as articular-surface tears, synovial-surface tear is 50-60% and specificity is 74.9-98.7%.Conclusion: Routine magnetic resonance imaging is a valuable method in diagnosing rotator cuff tears. The sensitivity and specificity of magnetic resonance are high in the diagnosis of major tendon tears (complete and full-thickness tears) than in cases of partial tear (articular or synovial surface tear).

Application of virtual touch tissue imaging quantification in diagnosis of supraspinatus tendon injury

OBJECTIVE: To explore the value of virtual touch imaging and quantification (VTIQ) shear wave elastography (SWE) in diagnosis of supraspinatus tendon tear. METHODS: Eighty patients with unilateral supraspinatus tendon tear underwent shoulder arthroscopy were prospective studied. Tendinopathy, partial-thickness tear or full-thickness tear of supraspinatus tendon were diagnosed according 2D ultrasound examination. Sensitivity, specificity and accuracy of ultrasonic diagnosis of supraspinatus tendon tear were calculated by arthroscopy as the gold standard. VTIQ was applied to measure the shear-wave velocity (SWV) of both normal and affected supraspinatus tendon. The differences of SWV in three types of supraspinatus tendon tear and receiver operating characteristic (ROC) curves were analyzed. RESULTS: Among 80 patients, there were 20 tendinopathy, 31 partial tears and 29 full-thickness tears diagnosed by shoulder arthroscopy. Sensitivity, specificity and accuracy of 2D ultrasound in diagnosis of tendinopathy, partial tear and full-thickness tear groups were 78%, 90%and 83%; 71%, 86%and 73%; 86%, 88%and 88%, respectively. SWV of 80 supraspinatus tendon tears was 4.59±1.00 m/s, which was lower than that of normal supraspinatus tendon (4.59±1.00 m/s vs. 6.68±1.05 m/s, P < 0.01). SWV of supraspinatus tendon in tendinopathy, partial tear and full-thickness tear groups respectively were 5.66±0.97, 4.66±1.00, and 3.78±0.55 m/s, all lower than that of the contralateral normal supraspinatus tendon (all P < 0.05). In addition, the analysis of variance and pairwise comparison showed that SWV of supraspinatus tendon among three different degree of injury was statistically significant (all P < 0.001). The cutoff thresholds of SWV was 4.83 m/s to identify tendinopathy tear from partial tear and was 4.08 m/s to identify full-thickness tear from partial-thickness tear. CONCLUSION: VTIQ SWE with SWV might identify degree of supraspinatus tendon tear and improve the value of ultrasonography, which should be further evaluated in large multicenter studies.

Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year follow‐up

Background Surgical treatment of full-thickness rotator cuff (RC) tears is associated with generally good results. There is no consensus regarding treatment of partial thickness tears that fail conservative treatment. The purpose of this study was to look at the efficacy and confirm the safety of dual injection PRP into the shoulder of patients with rotator cuff pathology who have failed conservative treatment with followup to two years. Methods Seventy-one shoulders with MRI confirmed, rotator cuff pathology who failed conservative treatment, had dual PRP injection into the rotator cuff. Global improvement, Quick DASH and VAS scores were collected at 6, 12, and 24 months after treatment and comparison of means was used to analyze changes. Results No adverse events were seen in any patient. Based on global rating scores positive results were seen in 77.9 % of patients at 6 months, 71.6 % at 1 year, and 68.8 % of patients at 2 years. Mean VAS scores improved from 50.2 [CI 44.4–56.0] pre-injection to 26.2 [CI 19.5–32.9] at 6 months, 22.4[CI 16.1–28.7] at 1 year and 18.2 [CI 12.3–24.1] at 2 years (p < 0.0001 for all). The mean Q- DASH scores (0-100, 100 worse) improved from 39.2 [CI 34.3–44.1] for all patients before treatment to 20.7[CI 15.0-26.4] at 6 months, 18.0[CI 12.9–23.1] at 1 year, and 13.8 [CI 8.4–18.8] at 2 years (p < 0.0001 for all). No patient with partial tear had clinical evidence of progression to full thickness tear. When separated into subgroups based on rotator cuff status, all subgroups showed improvement. Patients in the > 50 % partial tear group had the best overall improvement based on Global Rating scores while those in the tendinitis group had the poorest outcomes. Conclusions PRP injection is a safe and effective treatment for RC cuff injury in patients who have failed conservative treatment of activity modification and physical therapy without deterioration of results two years after treatment. Better results are obtained with greater structural tendon damage than in shoulders with inflammation without structural damage. Trial registration This is not a clinical trial.

Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report

Introduction: Stenosing tenosynovitis is a chronic disorder frequently observed in finger triggering of a digit. Regarding the toes, although entrapment of the flexor hallucis longus (FHL) has already been reported in a few cases among sports players, the clinical condition is uncommon. Besides, the case without any specific causes is particularly rare. Case Report: We report the case of a 26-year-old male with FHL entrapment. Even though he was unaware of any cause, he felt tenderness on the posteromedial side of his left ankle, and his great toe was locked in the flex position. Magnetic resonance imaging indicated effusion in the tendon sheath of the FHL and the possibility of a partial tear of the FHL. We hypothesized that the scar tissue secondary to the partial tear of the FHL may have been irritated at the retrotalar pulley below the sustentaculum tali, where the FHL glides. Therefore, posterior ankle arthroscopy was performed for the treatment of the FHL entrapment. Conclusion: Orthopedic surgeons should list this pathology as a differential diagnosis of posterior ankle pain, even in non-athletes. Keywords: ankle arthroscopy, flexor hallucis longus, stenosing tenosynovitis.

Using the Remnant Anterior Cruciate Ligament to Improve Knee Stability: Biomechanical Analysis Using a Cadaveric Model

Background: Injured anterior cruciate ligament (ACL) tissue retains proprioceptive nerve fibers, vascularity, and biomechanical properties. For these reasons, remnant ACL tissue is often preserved during the treatment of ACL injuries. Purpose: To assess through a cadaveric model whether reorienting and retensioning the residual ACL via an osteotomy improves knee stability after partial ACL tear, with substantial remnant tissue and intact femoral and tibial attachments. Study Design: Controlled laboratory study. Methods: In 8 adult cadaveric knees, we measured anterior tibial translation and rotational laxity at 30° and 90° of flexion with the ACL in its native state and in 3 conditions: partial tear, retensioned, and ACL-deficient. The partial-tear state consisted of a sectioned anteromedial ACL bundle. Results: In the native state, the translation was 10 ± 2.7 mm (mean ± SD) at 30° of flexion and 8.4 ± 3.6 mm at 90° of flexion. Anterior translation of the knees in the partial-tear state (14 ± 2.7 mm at 30° and 12 ± 2.7 mm at 90°) was significantly greater than baseline ( P < .001 for both). Translation in the ACL-retensioned state (9.2 ± 1.7 mm at 30° and 7.2 ± 2.1 mm at 90°) was significantly less than in the ACL-deficient state ( P < .001 for both), and translation was not significantly different from that of the intact state. For ACL-deficient knees, translation (20 ± 4.3 mm at 30° and 16 ± 4.4 mm at 90°) was significantly greater than all other states ( P < .001 for all). Although rotational testing demonstrated the least laxity at 30° and 90° of flexion in the retensioned and intact states and the most laxity in the ACL-deficient state, rotation was not significantly different among any of the experimental states. Conclusion: In a cadaveric model of an incomplete ACL tear, a reorienting and retensioning core osteotomy at the tibial insertion of the remnant ACL improved anteroposterior translation of the knee without compromising its rotational laxity. Clinical Relevance: The findings of this study support the concept of ACL tissue reorienting and retensioning in the treatment of ACL laxity as an area for future investigation.