جستجوی مقالات مرتبط با کلیدواژه "rotator cuff" در نشریات گروه "پزشکی"

Return to the Emergency Department (ED) within 90-days following arthroscopic shoulder surgery represents a potential source of increased healthcare expenditures. Understanding the risk factors could bring about interventions aimed at reducing its prevalence.  A retrospective review of all shoulder arthroscopies undertaken at a single academic institution from February 2016 through November 2023 was performed. Patient demographics and surgical data, including age, diagnosis of mental health disorder, history of prior ipsi- and/or contralateral shoulder arthroscopy, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), operative time and nature of the surgical procedure was collected. Patient visits to the ED within 12 months prior to surgery were recorded. Regression analysis was utilized to determine the independent predictors for 90-day postoperative ED return.  There were 584 total cases included in this study, of which 303 (52%) were women. The median age of the cohort was 57 years (IQR 51,62). There were 60 (10.3%) patients who experienced at least one unplanned 90-day ED return visit. A diagnosis of mental health disorder (OR 2.67, 95% CI 1.50-4.75, P=0.001), an ED visit within 3 months of surgery (OR 2.63, 95% CI 1.28-5.40, P=0.009), an ED visit between 3-6 months of surgery (OR 2.79, 95% CI 1.41-5.54, P=0.003), and an ED visit between 6-12 months of surgery (OR 1.98, 95% CI 1.07-3.66, P=0.029) was significantly associated with a 90-day unplanned postoperative ED visit. Finally, having >3 preoperative ED visits was significantly associated with a 90-day postoperative ED visit (OR 9.41, 95% CI 3.68-24.06, P<0.001).  Patients with a history of mental health disorder and those with a visit to the ED within 12 months prior to the planned shoulder arthroscopy should be counseled preoperatively regarding appropriate direct contact with the treating surgical team following discharge to minimize postoperative 90-day ED visits. Level of evidence: III

To compare Ultra Sonography (USG) with Magnetic Resonance Image (MRI) in evaluation of lesions causing impairment of mobility of the shoulder joint.

Method and Materials: 

This study was a cross-sectional observational study. Sonographic examination of shoulder was done using a linear high-frequency probe (7.5-15 MHz) on Siemens machine and MRI evaluation was performed on 3T Siemens Skyra machine. Data was analyzed using standard statistical methods and results were compared with Arthroscopy where possible. According inclusion criteria the patients of all age groups presenting with symptoms of shoulder pain or restricted movement referred from department of orthopaedics were studied.

Fifty patients were included in the study. Sensitivity and specificity of USG in comparison with MRI for diagnosing supraspinatus, subscapularis, infraspinatus and long head of biceps tendon pathologies in our study were 95.4% and 100%, 66.6% and 100%, 60% and 100%, 80% and 100% respectively. Sensitivity and specificity of USG for detecting AC joint arthropathy were 88.2% and 100% respectively in our study. The Sensitivity and specificity of USG were 82.7% and 100% respectively in detecting Subacromial Subdeltoid bursitis (SASD) bursitis, which were similar to as in other studies in literature.

This study revealed that USG has a good sensitivity, specificity and diagnostic accuracy in diagnosing rotator cuff tendon tears and tendinosis as well as for diagnosis of Acromioclavicular (AC) joint arthroplasty. Moreover, it is a non-invasive technique, readily available and cost effective. MRI is best modality for diagnosing labro-ligamentous pathologies at the shoulder.

Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the “gold standard” between vertebral level and goniometer-based measurements. Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright. Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = - 0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = - 0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%). A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.        Level of evidence: III

 Tendinitis is a prevalent musculoskeletal disorder affecting the shoulder joint. Low-power lasers have been demonstrated to have beneficial effects, such as pain reduction and increased range of motion, in treating shoulder tendinitis.

 The aim of this study was to examine the impact of high-power lasers on improving the clinical symptoms of individuals with rotator cuff tendinopathy.

 This study was a randomized, single-blind clinical trial involving 41 patients who were divided into 2 groups: The intervention group (21 participants) and the control group (20 participants). Both groups received the same physiotherapy treatment. However, the intervention group additionally received high-power laser treatment. Before and after the treatment, all patients completed the Visual Analog Scale (VAS) to assess pain intensity and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire to evaluate shoulder functional activity. Shoulder range of motion was measured using a goniometer.

 The average scores of both the VAS and DASH questionnaires showed a significant decrease after treatment in both the high-power laser and control groups (P = 0.001). However, the decrease in the intervention group was greater than that in the control group, and this difference was also statistically significant (P = 0.001). Following treatment, both groups exhibited a statistically significant reduction in the painful range of motion of the shoulder joint (P = 0.002). However, the difference between the 2 groups in this regard was not significant (P = 0.20).

 The combination of high-power laser treatment with conventional physiotherapy appears to have enhanced therapeutic effects. The laser's anti-inflammatory mechanism may have contributed to accelerated pain reduction and improved joint function. However, further studies are necessary to confirm this hypothesis.

 Otalgia is a very common symptom induced by a wide variety of diseases. Depending on the location of the pathology, otalgia is categorized into primary and secondary types. In primary otalgia, the main source of the pain is located within the ear. On the contrary, secondary or referred otalgia is defined as a disorder which the underlying pathology is outside of the ear complex giving rise to the sensation of pain in the ear. Multiple etiologies have been reported to produce secondary otalgia including temporomandibular joint dysfunctions, cervical spine pathologies, laryngitis, pharyngitis and tonsillitis.

  In this study, we present a 57-year-old man with referred otalgia, associated to rotator cuff tendon tear and acromioclavicular joint osteoarthritis, which is uncommon and atypical.

Shoulder pathologies like rotator cuff tendon tear and acromioclavicular joint osteoarthritis can be considered as a possible but rare cause of referred otalgia

 High power laser therapy (HPLT) seems to be a new modality to possibly manage rotator cuff tendinitis.The purpose of this study was to investigate the effects of HPLT on clinical and sonographic findings in people with chronic rotator cuff tendinitis.

 Thirty-two people suffering from rotator cuff tendinitis participated in this study. The patients  were  randomly assigned to the control group (n=16) that received routine physiotherapy including Transcutaneous electrical nerve stimulation (TENS), ultrasound, hot pack, exercise consisting range of motion, pendulum, strengthening, and stability exercises, or the treatment group (n=16) that received routine physiotherapy and HPLT in the painful area of the shoulder (12 sessions) Clinical and functional findings including pain, shoulder range of motion, shoulder disability, and sub-acromial liquid were measured using the visual analog scale, goniometry, questionnaire, and sonography, respectively before and after treatment.

 Pain, active and passive range of motion, shoulder disability and sub-acromial fluid accumulation were significantly different in both groups and improved, but no difference was reported in the thickness of the rotator cuff tendon, especially the supraspinatus tendon. The improvement was more significant (pain reduction and sub-acromial liquid, increase in range of motion and level of function) in the treatment group than in the control group (P <0.05).

 HPLT combined with the routine physiotherapy improve the clinical as well as sonography findings including supraspinatus tendon thickness and accumulation of sub-acromial fluid in people with rotator cuff tendinitis compared with those in the control group.

Repair of massive rotator cuff tears remains a challenging process with mixed success. There is agrowing interest in the use of patches to augment the repair construct and the potential to enhance the strength,healing, and associated clinical outcomes. Such patches may be synthetic, xenograft, or autograft/allograft, and avariety of techniques have been tried to biologically enhance their integration and performance. The materials used arerapidly advancing, as is our understanding of their effects on rotator cuff tissue. This article aims to evaluate what wecurrently know about patch augmentation through a comprehensive review of the available literature.

We explore the results of existing clinical trials for each graft type, new manufacturing methods, noveltechniques for biological enhancement, and the histological and biomechanical impact of patch augmentation.

There are promising results in short-term studies, which suggest that patch augmentation has greatpotential to improve the success rate. In particular, this appears to be true for human dermal allograft, while porcinedermal grafts and some synthetic grafts have also had promising results.

However, there remains a need for high-quality, prospective clinical trials directly comparing each type ofgraft and the effect that they have on the clinical and radiological outcomes of rotator cuff repair. 

 The clinical outcomes of rotator cuff repair (RCR) surgeries vary because each method has its own advantages and limitations.

 This study aimed to compare the short-term outcomes of arthroscopic RCR (ARCR) and mini-open RCR (MRCR).

 In this study, we included 49 patients with a diagnosis of full rotator cuff tear who had undergone ARCR and MRCR at Poursina Hospital of Rasht and Akhtar Hospital of Tehran from 20 March 2017 to 20 March 2020. The patients were divided into ARCR (n = 24) and MRCR (n = 25) groups. The two surgical procedures were compared with each other before surgery and three and six months after surgery in terms of shoulder function based on UCLA, disability based on QUICKDASH, range of motion (ROM), and pain based on Visual Analogue Scale (VAS). Data were analyzed by chi-square, independent t-test, and repeated measures analysis of variance (ANOVA).

 There were no differences between the groups in terms of demographic details. The mean duration of surgery was significantly higher in the ARCR group compared to MRCR group (125.5 vs. 70.42 minutes). The short-term outcomes in the two groups on three measurement occasions showed a significant improvement in shoulder function, disability, and ROM in both groups along with a reduction in pain severity (P < 0.05); however, there was no significant difference between the two groups on any of the three occasions (P > 0.05).

 Shoulder function, disability, ROM, and pain were not different between the two groups, but duration of surgery was less in MRCR group. Therefore, under the same conditions, MRCR is a better choice than ARCR due to its short duration of surgery.

Nonunion and pseudoarthrosis formation following scapular spine fracture is a rare condition and is limited only to case reports. Some authors reported its association with rotator cuff impingement. Standard treatment is not defined well as the condition is rare.

Case Report:

Our patient was a 61-year-old man with painful nonunion in addition to cuff impingement. Surgical treatment by open reduction, internal fixation with reconstruction plate and tension band wiring, along with bone grafting led to fracture union, as well as complete resolution of the rotator cuff tendinopathy.

Surgical fixation seems to be the best choice in treating scapular spine pseudoarthrosis. The first attempt should be the best, so we took an aggressive approach by the use of plating, tension band wiring, and bone grafting altogether.

The pectoralis minor muscle originates from third to fifth ribs of the chest wall and inserts at the medial side of the coracoid process of Scapula. It contributes to the abduction of the scapulothoracic joint and downward movement of the shoulder. The anomalous insertion of pectoralis minor beyond the coracoid process is known since the 19th century.

Aim of the study:

 To report the curious case of anomalous insertion of pectoralis minor at greater tuberosity via rotator interval.

The Case Report: 

A unilateral anomalous insertion of pectoralis minor muscle was found on the right side during routine dissection of the upper limb in a sixty-year male cadaver. The anomalous attachment was present beyond the coracoid process which extended, underneath of coracoacromial ligament. After cutting the coracoacromial ligament, the tendon was located in the rotator interval, which was followed to its final insertion at greater tuberosity along with the tendon of Supraspinatus muscle. Three types of variations of anomalous tendon insertion were known based on the classification of Le Double. In this case, type IIIM of Le Double classification was found in which muscle belly (not tendon) crossed the coracoid process and attached at greater tuberosity. The muscle was separated from coracoid process by very thin bursa.

The pectoralis minor tendon may be found in the rotator interval, and surgeons should be careful during rotator cuff repairs.

To identify the effect of imagery exercises on activity of the shoulder muscles.

A sample of 23 healthy participants (17 females and 6 males), with no history of shoulder injury, participated in the present study. Surface bipolar electrodes were applied over the supraspinatus, infraspinatus, posterior deltoid, middle deltoid, anterior deltoid, and pectoralis major. Participants performed six imagery exercises: flexion, extension, abduction, adduction, external rotation, and internal rotation. Root mean square of myoelectric activity of shoulder muscles was calculated for statistical analysis. The RMS during rest was used as an offset and also to normalize the activity of each muscle during imagery exercises.

Performing the imagery exercises resulted in significant activation of the shoulder muscles (P < 0.01). In the case of the supraspinatus muscle, significant difference (P< 0.05) was found among exercise types but no significant value was seen for infraspinatus muscle. In flexion, abduction, adduction, and internal rotation imagery exercises, the correlation observed between muscles activation was significant (P<0.01).

Supraspinatus highly activated in exercises including elevation of the arm. Activation of infraspinatus in all exercises suggest its important stability role in glenohumeral joint.

Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the typeof the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, thecurrent study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patientssuffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear incomparison with magnetic resonance imaging (MRI). This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. Anultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modalityof choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR)guidelines were used to design the protocols and implement imaging measures. Based on the reference standard ofMRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotatorcuff disorders were calculated. A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years wereenrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The mostcommonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear(n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound wasobserved in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity wasfound in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%). Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partialand full-thickness rotator cuff tears and rule out the rotator cuff pathologies.Level of evidence: I

The study investigated the effects of isokinetic versus isotonic training among adolescent state‑level weightlifters in terms of total leukocytes, total lymphocytes, and its subsets following 24 sessions of training program and a month following training program cessation. Nineteen adolescent state‑level weightlifters were assigned into isokinetic or isotonic groups. All participants were recruited from a pool of weightlifters with standardized training program provided by their coach. Series of immunological tests were carried out before the commencement, immediately upon the completion, and a month after the cessation of the additional training program to evaluate total leukocytes and lymphocytes count. The results revealed a significant time and group interaction and main effects of time on mean total leukocytes (P < 0.05). Mean total leukocytes count at posttest decreased in both groups. In isotonic group, it was further decreased following 1 month of training cessation (P < 0.05) but not in the isokinetic group. However, the decrement was not high and the values were in the normal range. No significant time and group interaction was observed in total lymphocytes and its subsets count. Eight weeks of isokinetic and isotonic additional training with emphasis on shoulder joint only affect mean total leukocytes count in state‑level adolescent weightlifters

The shoulder complex, because of its relatively extensive freedom of motion, offers a great variety of testing positions and articular planes for strength examination. Despite this, reliability of results are not clearly addressed. A novel pulley electromechanical dynamometer (FED) (functional electronic dynamometer) could be an alternative in strength assessment, however, the relative and absolute reliability have not been reported in the literature.
To report the results of shoulder internal (IR) and rotators (ER) peak torque reliability in two assessment positions by FED in asymptomatic subjects.
Fifty-two healthy college students were included and tested twice within a two week period. In a supine position, the subjects randomly performed four isometric strength tests (i.e. IR at 40°, IR at 90°, ER at 40°, and ER at 90° of shoulder abduction).
The intra-class correlation coefficients (ICC) for relative reliability at 90° were 0.96 (0.94 - 0.98) for IR and 0.94 (0.90 - 0.96) for ER. ICC at 40° were 0.89 (0.80 - 0.94) for IR and 0.97 (0.94 - 0.98) for ER. Absolute reliability expressed as standard error of measurement compared to the mean (SEM%) and 95% confidence interval (CI) of minimal detectable change percentage (MDC%) at 90° were 8.8% (-20.8, 28.4%) and 11.4% (-28.0, 35.2%) for ER. MDC% at 40° were 12.6% (-35.5, 34.8%) for IR and 18.1% (-28.1, 35, 2%) for ER.
Isometric strength testing protocol using FED showed an excellent reproducibility and can be safely used in clinical settings to monitor the strength changes in a group of individuals or in a single individual.

Degenerative changes and inflammation in the rotator cuff (RC) are the most important causes of shoulder pain. The aim of the present study was to determine the effectiveness of platelet-rich plasma (PRP) in patients with chronic RC tendinopathy.

This study was an open-label study performed at Kashani Hospital between April 2012 and June 2014. Patients with a <1 cm partial tearing of the bursal side of RC with no or little response to conservative management were included. PRP injection was done using ultrasonography guide via posterior subacromial approach. Demographic data were obtained in all patient before the study, and shoulder function was evaluated using Constant shoulder score (CSS) before and 3 months after PRP injection.

A total number of 17 patients were enrolled. The mean of CSS before and after intervention was 37.05 ± 11.03 and 61.76 ± 14.75, respectively (P < 0.001). There was no statistically significant correlation between the pain score before the study and the improvement in CSS (P = 0.45, r = 0.03). Significant relation was observed between the individuals’ age and improvement of CSS (P = 0.02, r = −0.49). There was no significant difference in CSS improvement between genders (P = 0.23).

Single injection of PRP is effective to reduce pain and improve range of motion in patients with bursal side partial tearing of RC who failed to respond to conservative treatments.

Professional sports injuries are usually all dealt with at one single operation to return the player to the sport after appropriate rehabilitation. We questioned the assumption that rotator cuff tears must be repaired concurrently with instability syndromes, and aimed to allow a professional rugby league player to achieve career goals by NOT correcting all pathology at one surgery..
A professional rugby league player presented with acute shoulder instability on a setting of a chronic full thickness rotator cuff tear. We performed an “in season” arthroscopic stabilization on an elite rugby league player, leaving a previously diagnosed large full thickness rotator cuff tear untreated. This allowed aggressive rehabilitation and return to contact competition at 12 weeks post-surgery. The player achieved a long held career goal of winning a premiership ring before undertaking rotator cuff repair at the end of the season. Latest follow up at seven years (still at elite level) demonstrated an asymptomatic shoulder..
The assumption that all pathology found at surgical exploration requires correction to play at elite level is not universally correct. We postulate that whilst rotator cuff deficiency has severe long-term sequelae, it is shoulder instability alone that prevents high level contact sports participation. Career goal management is an important part of managing elite level athletes. We have demonstrated that by careful management of the specific pathology preventing participation can allow elite athletes to achieve career goals without compromising long-term health..

Context: There are many studies in the literature looking into factors affecting outcomes in rotator cuff surgery. The aetiology of rotator cuff deficiency is often multi-factorial and there are many facets towards successful management in this often debilitating condition.
Evidence Acquisition: We performed a literature search of MEDLINE and Embase databases using the terms large rotator cuff tears, fatty infiltration rotator cuff, rotator cuff atrophy, rotator cuff augmentation, rotator cuff tendon transfers, allografts rotator cuff repair, xenograft rotator cuff repair and synthetic grafts rotator cuff repair.
In this article, we focus particularly on the aetiology, pathology and prognosis of large tears, fatty infiltration and muscle atrophy of the rotator cuff. An overview of the various treatment strategies and current/future concepts are also discussed in managing patients with these types of rotator cuff deficiencies.
Large tears, fatty infiltration and muscle atrophy of the cuff are challenging. An in-depth understanding of these elements may prove vital for the practising orthopedician in determining the right course of management. Techniques in strengthening the repair construct using augmentation play an important role in the treatment of this condition.