Top PDF HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

CONCLUSION: High-resolution ultrasonography of shoulder is the first imaging modality of choice in evaluation of suspected rotator cuff tear. USG is noninvasive, widely available, portable, more cost-effective method. It is better tolerated by patients. USG allows comparison with the normal side and has the benefit of being a dynamic form of imaging as compared to the static MRI. It has high sensitivity and specificity for full thickness rotator cuff tear detection compared to partial thickness tears. It is highly sensitive and specific for full thickness tear of supraspinatus tendon, as supraspinatus is the most commonly affected rotator cuff tendon, ultrasonography’s utility is more appreciated. It is sensitive and specific for detection of supraspinatus partial thickness and infraspinatus full thickness tears. But, for detection of infraspinatus partial thickness tears and subscapularis tears, its sensitivity is significantly less.
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Radiol Bras  vol.49 número1

Radiol Bras vol.49 número1

The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.
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Radiol Bras  vol.40 número6 en a09v40n6

Radiol Bras vol.40 número6 en a09v40n6

OBJECTIVE: To evaluate the shoulders of symptomatic or asymptomatic competitive swimmers, quantify- ing the incidence of rotator cuff lesions in these athletes. MATERIALS AND METHODS: Eleven (eight male and three female) symptomatic and asymptomatic, competitive swimmers (master category) in the age range between 28 and 52 years, had both shoulders prospectively evaluated by ultrasonography for determining the prevalence of injuries in correlation with clinical findings. The studies included at least two orthogonal planes of rotator cuff tendons, as well as non-tendinous components of the shoulder joint. Tendinous find- ings were classified into tendinosis, probable full-thickness tears and partial-thickness tears. Non-tendinous findings were classified into present or absent. Additionally to the sonographic studies results, the analysis has taken the presence or absence of symptoms and the patients’ age into consideration. RESULTS: Over- all, the prevalence of symptomatic patients was higher (63.6%; seven athletes), with 75% of patients with bursitis, and 100% of those with partial-thickness tendon tears. Among isolated tendinous findings, the su- praspinatus tendon was the most frequently involved, showing echographic pattern alteration in 36.36% of cases. Tendinosis was the most prevalent finding, present in at least one tendon in 50% of the studied shoulders. The incidence of partial-thickness tendon tears was similar to the incidence reported for non- athlete individuals (13%), always present in individuals above 40 years of age. CONCLUSION: Swimmers do not seem to present a higher incidence of tendon tears or degeneration when compared with the general population. Individuals’ age is the most relevant determining factor, as far as rotator cuff lesions are con- cerned, no matter these individuals practice or not activities involving an overload of the shoulder joint. Keywords: Impingement syndrome; Rotator cuff; Swimmers; Ultrasonography.
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ROTATOR CUFF TEARS and SHOULDER IMPINGEMENT: A TALE of TWO DIAGNOSTIC TEST ACCURACY REVIEWS

ROTATOR CUFF TEARS and SHOULDER IMPINGEMENT: A TALE of TWO DIAGNOSTIC TEST ACCURACY REVIEWS

The main finding of the review is that MRI, MRA, and ultrasonography have good and similar diagnostic accuracy for the detection of full- thickness tears in the population studied.[1] Nonetheless, as quantified in the review, some full thickness tears will be missed, and some people will be offered unnecessary surgery should full-thickness tears be the main indicator. The less-evidenced findings for any rotator cuff tear (combined results for full- and partial thickness tears) are worth spelling out: "In a population of 100 people with shoulder pain suspected of having a rotator cuff tear and for whom surgery is being considered, if the
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Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

The reproducibility of the data was also assessed in this study to prevent errors during the measurement of posterior shoulder tightness and external and internal rotation strength. We observed excellent intra-evaluators reliability. Therefore, the evaluators (2 and 3) involved in posterior shoulder tightness measured the dominant shoulder tightness of 5 athletes (average ± SD age, 20.1 ± 1.2 years old; height 172.8 ± 5.1 cm; body mass, 72.1 ± 4.8 kg) twice. All athletes were evaluated in agreement with the process described above with a one-week interval between the two evaluations. The results indicated excellent intra-evaluator reliability, with intraclass correlation coeficients (ICC) of 0.98.
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Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

The initial literature search retrieved 126 relevant articles (duplicates were discarded). Seventy-seven articles were excluded for not investigating the topic after carefully screening the titles. Then, the abstracts were reviewed, and 40 articles were excluded (10 laboratory or animal studies, 25 reviews, 4 system reviews and meta-analyses, and 1 case report), which left 9 studies for further full publication review. Two studies were excluded for level III or IV evidence [27,28]. Therefore, 7 studies matched the selection criteria and were suitable for this meta-analysis [29,30,31,32,33,34,35], with 6 being prospective randomized control trials and 1 being a prospective cohort study. The flow- diagram is shown in Figure 1. A total of 379 patients (185 for PRP application and 194 for control) were enrolled in the studies. The key characteristics of the included studies are summarized in Table 1. All the studies involved patients with reparable full- thickness rotator cuff tears and who were followed for at least 12 months. Among the included studies, the Constant scale, ASES scale, UCLA scale, SST scale, and radiological (MRI) assessment were matched in 3 studies. A review of the data extraction revealed 100% agreement between the 2 reviewers.
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Rev. Bras. Anestesiol.  vol.62 número1 en v62n1a13

Rev. Bras. Anestesiol. vol.62 número1 en v62n1a13

One of most frequent shoulder pathologies with SSNB in- dication is adhesive capsulitis, which is a painful syndrome characterized by limitation of both active and passive move- ments of this articulation in all directions, and no mechanical block can explain it. Therefore, glenohumeral blocked luxation and arthrosis appear as an important differential diagnosis. The etiology is idiopathic and clinical picture is characterized by severe pain at rest and articular rigidity, as capsule of the shoulder is retractile and reduced in its normal volume. As sensitivity of the latter is given by branches from suprasca- pular nerve, the employment of SSNB in therapeutics of this disease is justified 11,15,18,25 .
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Rev. bras. ortop.  vol.51 número1

Rev. bras. ortop. vol.51 número1

not good or excellent at the first evaluation and those who could not be contacted for the reevaluation were excluded. With these criteria, out of the initial group of 61 patients, 53 who had been classified as having good or excellent results were included in the present study. Among these, it was only possible to reevaluate 35. The sample loss (18 patients; 33%) was composed of 15 patients who could not be located, two deaths and one patient who refused to take part in the inves- tigation (Table 1).

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Arthroscopic-Assisted Repair in Full-Thickness Rotator Cuff Ruptures: Functional and  Radiologic Results of Five-Year Follow-Up

Arthroscopic-Assisted Repair in Full-Thickness Rotator Cuff Ruptures: Functional and Radiologic Results of Five-Year Follow-Up

Açık rotator manşet tamirinden sonra en sık görülen komplikasyon %13-68 arasında değişen oranlarda tekrarlayan yırtık oluşmasıdır [17]. Har- ryman ve ark. tamir ettikleri rotator manşetlerin %20’sinde tekrarlayan yırtık saptamışlar ve izlem sırasında belirlenen lezyon tipinin ameliyat sırasın- da gözlenenden daha önemli olduğu ve doku kali- tesinin fonksiyonel sonucu etkilediği bildirilmiştir [18]. Gazielly ve ark. 100 hastaya rotator manşet ta- miri uygulamışlar ve %24 olguda tekrarlayan yırtık saptamışlar [19]. Knudsen ve ark. ise 31 hastanın %32’sinde ameliyat sonrası tekrarlayan yırtık sap- tamışlar ve tendon bütünlüğü ile hastaların fonk- siyonel sonuçları arasında anlamlı bir ilişki tespit edememişler [20]. Gerber ve ark. tekrarlayan yırtık saptanan 20 hastada hastaların ameliyat öncesine göre durumlarında iyileşme olduğunu, tekrarlayan yırtığın ilk yırtıktan küçük olduğunu ve hastaların yırtık olmasına rağmen ağrılarının ameliyat öncesi- ne göre azaldığını ve hastaların fonksiyonel sonuç- larında artma olduğunu tespit etmişler [21]. Castag- na ve ark. [22], Jost ve ark. [23] ve Hanusch ve ark. [24] tekrarlayan yırtıkların cerrahi başarızıslık anla- mına gelmediği ve tekrarlayan yırtıkların ilk yırtı- ğa oranla boyutunun daha küçük olduğu olgularda fonksiyonel sonuçların anlamlı olarak düzeldiğini bildirmişlerdir. Bu yazarların sonuçlarının bizim sonuçlarımızla uyumlu olup bizim çalışmamızdaki hastaların 5 yıllık takipleri sonucunda %22,2’sinde tekrarlayan yırtık tespit edilmiştir.
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Long head of biceps: from anatomy to treatment

Long head of biceps: from anatomy to treatment

The determination of treatment is very dependent on the associated and concomitant diseases, since the pathology of isolated LHB is uncommon. The choice of treatment is not easier because of the lack of clini- cal studies that support accurate and clear guidelines. It is uniformly accepted the need for well-designed studies to firstly clarify the role of LHB in the kine- matics of the shoulder and in the other hand to help the choice of the best method of treatment for each disease process.

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Rev. bras. ortop.  vol.50 número1

Rev. bras. ortop. vol.50 número1

Objectives: To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series) and compare this with function in patients without recurrence (control group); and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm. Methods: This was a retrospective evaluation of patients who underwent arthroscopic revi- sion of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair.
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Rev. bras. ortop.  vol.50 número1

Rev. bras. ortop. vol.50 número1

study, we used evaluations on lumbar and femoral T measure- ments, which indirectly assess patients’ bone mineral density. From these results, the patients were stratified into three groups: normal, osteopenic and osteoporotic. The statistical analysis showed that the patients in the group with densit- ometric values within the range for osteoporosis presented worse clinical results on the UCLA scale than did those with densitometric values with the range of normality (p = 0.027). This was the main outcome from our study, given that we did not find any other studies in the literature that had cor- related the results from arthroscopic suturing of large and extensive rotator cuff injuries with the patients’ bone mineral density.
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MRI EVALUATION IN SUSPECTED CASES OF ROTATOR CUFF/ LABRAL TEARS ON LOW FIELD MRI SYSTEM

MRI EVALUATION IN SUSPECTED CASES OF ROTATOR CUFF/ LABRAL TEARS ON LOW FIELD MRI SYSTEM

There is no debate that high-field MR images are of superior diagnostic value compared to low-field images. Low-field MRI scanners, however, besides being available at a low cost, have open design, which is better tolerated by claustrophobic and pediatric patients. In the present setup, this helps in alleviating the anxiety in population of rural area thus facilitating patients co-operation in the study.

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O ombro em uma linha de produção: estudo clínico e ultrassonográfico

O ombro em uma linha de produção: estudo clínico e ultrassonográfico

patient sitting in front of the examiner, and the shoulder in neutral position, the biceps tendon is assessed longitudinally and crosswise. Then, with the maximum external rotation, the subscapular tendon is examined. The following structure is the supraspinatus tendon, with the shoulder in hyperextension, adduction and internal rotation to place the tendon anteriorly. And finally, with the shoulder in neutral position, the structures of the back are analyzed, the infraspinatus and glenoid labrum. The equipment used was an Aloka model SSD900 with a 7.5 MHz linear transducer. No more than thirty days elapsed between the clinical and ultrasound evaluations.
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Surgical Treatment of Rotator Cuff Tears After 65 Years

Surgical Treatment of Rotator Cuff Tears After 65 Years

There is a need to conduct more studies on the current subject, to support the data concluded from this systematic review. To achieve a consistent indication for the surgical repair of rotator cuff tears over 65 years old, a randomized control study comparing two groups with RCT: one surgically repaired versus another with no repair, must be performed. As the population continues to age, with progressively more active individuals, a standardized treatment for RCT in patients in the age range over 65 years old is paramount. Based on current literature, rotator cuff repair in patients older than 65 years imparts favorable improvement in clinical outcome scores and overall patient satisfaction.
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A Canine Non-Weight-Bearing Model with Radial Neurectomy for Rotator Cuff Repair.

A Canine Non-Weight-Bearing Model with Radial Neurectomy for Rotator Cuff Repair.

It should be recognized that the major limitation of this study was to use a partial laceration without repair to test the feasibility of this NWB model indirectly, instead of establishing a full laceration with repair in vivo model. Although the strength of the intact portion of the tendon in the partial laceration model was weaker than the full laceration repaired with #2 suture in vitro model, it should be cautioned there are differences in biomechanical and biological response between in vivo and in vitro model, and also between full and partial laceration mod- els as well. This major limitation was because the dogs used in this study were primarily assigned for the other study that used NWB model, and the IACUC requested that the surgical procedure would be as simple as possible to minimize operative time and trauma. Therefore we designed this partial transection without repair with a small incision and quick procedure in vivo, and then using an in vitro model to study the mechanical strength of this partial tran- section compared to the repairs of a full transection model. However, the current study pro- vided an indirect support for the feasibility of this novel NWB animal model for rotator cuff repair related research. We plan to move forward to verify the usefulness of the NWB model in a full laceration and repair model in the future. Second, partial weight-bearing and full weight- bearing models were not created, so we cannot compare the failure rate, ultimate tensile load, and stiffness of those models with the current NWB model. Third, a laceration was created at the tendon substance in this study, rather than one at tendon-to-bone insertion, which would introduce a clinically relevant scenario. However, the purpose of this study was to investigate if the strength of a 2-mm tendon bundle of the IS tendon could be tolerant a vivo force applied to the IS tendon without rupture, rather than the healing characteristics.
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Rev. bras. ortop.  vol.47 número6 en v47n6a11

Rev. bras. ortop. vol.47 número6 en v47n6a11

Objective: To compare the functional results among patients undergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff injuries, with a minimum two-year follow-up. Method: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenode- sis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, ope- rated side, lesion size using the Gartsman classification, pre and postoperative range of motion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using
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Rev. bras. ortop.  vol.52 número5

Rev. bras. ortop. vol.52 número5

Complications, other than rupture of the rotator cuff, were observed in nine patients (29%). The most common compli- cations were shoulder stiffness in four patients (13%), loss of humeral head reduction greater than 10 degrees of the head- shaft angle in three cases (9%), joint protrusion of the proximal screws in three patients (9%), and osteonecrosis in two cases (6%). In no case did the nail remain in an inadequate posi- tion, that is, above the greater tubercle. Of the four patients with transfixing rupture of the rotator cuff, two had other complications, with 43.5 ± 6.4 points on the Constant-Murley score at 12 months. The two cases with isolated rupture of the cuff had 80.5 ± 0.7 points. The rotator cuff rupture rate (par- tial or complete) in patients with some complication was 33%, with no statistically significant difference when compared to cases without other complications (p = 0.535). Six patients (19%) underwent reoperations.
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The Effectiveness of Land and Water Based Resistance Training on Shoulder Rotator Cuff Strength and Balance of Youth Swimmers

The Effectiveness of Land and Water Based Resistance Training on Shoulder Rotator Cuff Strength and Balance of Youth Swimmers

Also regarding the IR strength values, we found significant differences with large effect sizes between groups in the assessments in both protocols and shoulders. In fact, the WG significantly increased the IR strength values comparing to the LG. If we consider that the aquatic training was similar for both groups and that the maturational levels are were identical, we cannot find an obvious explanation for the fact that the WG raised IR strength to a higher level compared to the LG. One can assume that probably the LG, having higher ER training effects, might have changed in some way the “normal” pattern of neuromuscular function and consequently the intramuscular coordination, compared to the WG. However, complementary studies should be carried out to clarify this situation, namely recording shoulder rotators electromyography activity before and after compensatory strength training.
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Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy.

Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy.

To address the first aim of this study, repeated measures of ANOVAs were used to deter- mine between-group difference in UT shear modulus at different arm positions (within subject factors: arm position; between-subject factor: group). This was repeated for each task (i.e. pas- sive and active task). When significant interactions were found, independent t-test for compar- isons of means for each dependent measure were used and post-hoc analysis was performed using Bonferroni tests to compare the differences between the groups (adjusted p values are reported). To address the second aim, receiver operating characteristic (ROC) curves analyses were used to determine a cut-off point of UT shear modulus for both the passive and the active tasks that had significant group difference. Youden’s index (J) was computed from the sensitiv- ity and specificity values (J = Sensitivity + Specificity– 1). The highest index represented the best overall sensitivity and specificity and defined as the cut-off point for identification of sub- jects with and without rotator cuff tendinopathy [5]. The area under the curve (AUC), the cut- off scores together with the sensitivity and specificity values were reported. The statistical anal- yses were performed using SPSS Version 23 for Windows (SPSS Inc, Chicago, IL.) The level of significance for all tests was set at 0.05.
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