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Sample records for chronic rotator cuff

  1. Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis.

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    Riley, G P; Harrall, R. L.; Constant, C R; Chard, M D; Cawston, T E; Hazleman, B L

    1994-01-01

    OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons (supraspinatus and subscapularis tendons, n = 53) were obtained during open should...

  2. Biceps tendinitis in chronic rotator cuff tears: a histologic perspective.

    Science.gov (United States)

    Singaraju, Vamsi M; Kang, Richard W; Yanke, Adam B; McNickle, Allison G; Lewis, Paul B; Wang, Vincent M; Williams, James M; Chubinskaya, Susan; Romeo, Anthony A; Cole, Brian J

    2008-01-01

    Patients with chronic rotator cuff tears frequently have anterior shoulder pain attributed to the long head of the biceps brachii (LHBB) tendon. In this study, tenodesis or tenotomy samples and cadaveric controls were assessed by use of immunohistochemical and histologic methods to quantify inflammation, vascularity, and neuronal plasticity. Patients had moderate pain and positive results on at least 1 clinical test of shoulder function. The number of axons in the distal LHBB was significantly less in patients with biceps tendinitis. Calcitonin gene-related peptide and substance P immunostaining was predominantly within nerve roots and blood vessels. A moderate correlation (R = 0.5) was identified between LHBB vascularity and pain scores. On the basis of these results, we conclude that, in the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity.

  3. Rotator cuff exercises

    Science.gov (United States)

    ... to these tendons may result in: Rotator cuff tendinitis, which is irritation and swelling of these tendons ... Brien MJ, Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, ...

  4. Use of small intestine submucosa in a rat model of acute and chronic rotator cuff tear.

    Science.gov (United States)

    Perry, Stephanie M; Gupta, Rishi R; Van Kleunen, Jonathan; Ramsey, Matthew L; Soslowsky, Louis J; Glaser, David L

    2007-01-01

    Augmentation materials for rotator cuff tears, such as small intestine submucosa (SIS), have been used with the goal of improving outcome. Knowledge is limited on the use of SIS in animal models of acute and chronic rotator cuff tears. We hypothesized that the use of SIS in the surgical management of full thickness supraspinatus tears would improve histologic and biomechanical properties. Results show temporal improvements in several histologic parameters. Both acute and chronic injuries repaired with SIS have similar and increased mechanical properties respectively, compared to those repaired without SIS. In general, acute repairs with SIS were comparable to acute repairs without SIS. In chronic repairs, the use of SIS significantly reduced the cross sectional area of the healing tendon and increased the modulus. These results provide information on the use of SIS for rotator cuff repairs.

  5. Relationship of rotator cuff tendon pathology with obesity, chronic diseases and steroid use

    OpenAIRE

    Ayse Umul; Hakan Demirtas; Ahmet Orhan Celik; Mustafa Kara; Omer Yilmaz; Bumin Degirmenci; Hasan Ali Eksili; Hikmet Orhan

    2016-01-01

    Purpose: To investigate the possible relationship between rotator cuff tendon pathologies detected with magnetic resonance imaging and obesity and chronic diseases. Materials and Methods: Two hundred and sixty seven patients, who underwent shoulder MRI between 2014 January and October 2014 for pain and limitation of motion in the shoulder, were reviewed retrospectively. Tendon pathology was detected in 153 patients and they were included in the study. Tendon pathologies were examined by t...

  6. Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis.

    OpenAIRE

    Riley, G P; Harrall, R. L.; Constant, C R; Chard, M D; Cawston, T E; Hazleman, B L

    1994-01-01

    OBJECTIVES--To analyse the collagen composition of normal adult human supraspinatus tendon and to compare with: (1) a flexor tendon (the common biceps tendon) which is rarely involved in any degenerative pathology; (2) degenerate tendons from patients with chronic rotator cuff tendinitis. METHODS--Total collagen content, collagen solubility and collagen type were investigated by hydroxyproline analysis, acetic acid and pepsin digestion, cyanogen bromide peptide analysis, SDS-PAGE and Western ...

  7. Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

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    Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

    2013-11-01

    Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports.

  8. Rotator Cuff Injuries.

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    Connors, G. Patrick

    Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

  9. Relationship of rotator cuff tendon pathology with obesity, chronic diseases and steroid use

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    Ayse Umul

    2016-12-01

    Conclusion: In our study, statistically significant correlation was observed between the supraspinatus tendon pathology with increasing age and increasing BMI. Aging process can not be changed, however prevention of obesity may provide a positive contribution to the conservation of the rotator cuff tendon pathology. [Cukurova Med J 2016; 41(4.000: 648-652

  10. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial

    NARCIS (Netherlands)

    Kolk, A. van der; Yang, K.G.; Tamminga, R.; Hoeven, H. van der

    2013-01-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were

  11. Ultrasonography of the Rotator Cuff

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    Yoon, Yong Cheol [Samsung Medica Center, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

    2006-09-15

    The ultrasonography (US) is an important modality in evaluating shoulder disease. It is accurate in diagnosing the various shoulder diseases including tendinosis, calcific tendinitis, and subacromial bursitis as well as rotator cuff tears. This article presents a pictorial review of US anatomy of the shoulder, the technical aspects of shoulder US, major types of shoulder pathology, and interventional procedure under US guidance

  12. Retraction pattern of delaminated rotator cuff tears: dual-layer rotator cuff repair

    OpenAIRE

    Cha, Sang-Won; Lee, Choon-Key; Sugaya, Hiroyuki; Kim, Taegyun; Lee, Su-Chan

    2016-01-01

    Background There has been no report to date regarding retraction patterns of delaminated rotator cuff tears. The purpose of this study was to evaluate the incidence and tearing patterns of delamination and repair integrity after the dual-layer repair of delaminated cuff tears. Methods/design A consecutive series of 64 patients with posterosuperior rotator cuff tears underwent arthroscopic rotator cuff repair from August 2011 to September 2012. Among the patients, 53 who received either dual-l...

  13. Rotator cuff tear: A detailed update

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    Vivek Pandey

    2015-01-01

    Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

  14. Metalloproteases and rotator cuff disease.

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    Del Buono, Angelo; Oliva, Francesco; Longo, Umile Giuseppe; Rodeo, Scott A; Orchard, John; Denaro, Vincenzo; Maffulli, Nicola

    2012-02-01

    The molecular changes occurring in rotator cuff tears are still unknown, but much attention has been paid to better understand the role of matrix metalloproteinases (MMP) in the development of tendinopathy. These are potent enzymes that, once activated, can completely degrade all components of the connective tissue, modify the extracellular matrix (ECM), and mediatethe development of painful tendinopathy and tendon rupture. To control the local activity of activated proteinases, the same cells produce tissue inhibitors of metalloproteinases (TIMP) that bind to the enzymes and prevent degradation. The balance between the activities of MMPs and TIMPs regulates tendon remodeling, whereas an imbalance produces a collagen dis-regulation and disturbances intendons. ADAMs (a disintegrin and metalloproteinase) are cell membrane-linked enzymes with proteolytic and cell signaling functions. ADAMTSs (ADAM with thrombospondin motifs) are secreted into the circulation, and constitute a heterogenous family of proteases with both anabolic and catabolic functions. Biologic modulation of endogenous MMP activity to basal levels may reduce pathologic tissue degradation and favorably influence healing after rotator cuff repair. Further studies are needed to better define the mechanism of action, and whether these new strategies are safe and effective in larger models.

  15. Intense focused ultrasound stimulation of the rotator cuff: evaluation of the source of pain in rotator cuff tears and tendinopathy.

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    Gellhorn, Alfred C; Gillenwater, Cody; Mourad, Pierre D

    2015-09-01

    The objective of this preliminary study was to evaluate the ability of individual 0.1-s long pulses of intense focused ultrasound (iFU) emitted with a carrier frequency of 2 MHz to evoke diagnostic sensations when applied to patients whose shoulders have rotator cuff tears or tendinopathy. Patients were adults with painful shoulders and clinical and imaging findings consistent with rotator cuff disease. iFU stimulation of the shoulder was performed using B-mode ultrasound coupled with a focused ultrasound transducer that allowed image-guided delivery of precisely localized pulses of energy to different anatomic areas around the rotator cuff. The main outcome measure was iFU spatial average-temporal average intensity (I_SATA), and location required to elicit sensation. In control patients, iFU produced no sensation throughout the range of stimulation intensities (≤2000 W/cm(2) I_SATA). In patients with rotator cuff disease, iFU was able to induce sensation in the tendons of the rotator cuff, the subacromial bursa, and the subchondral bone in patients with chronic shoulder pain and rotator cuff disease, with an average ± standard deviation intensity equaling 680 ± 281 W/cm(2) I_SATA. This result suggests a primary role for these tissues in the pathogenesis of shoulder pain related to rotator cuff tendinopathy.

  16. Diagnostic imaging of shoulder rotator cuff lesions

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    Nogueira-Barbosa Marcello Henrique; Volpon José Batista; Elias Jr Jorge; Muccillo Gerson

    2002-01-01

    Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US) and magnetic resonance imaging (MRI). Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensi...

  17. Rotator cuff rehabilitation: current theories and practice.

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    Osborne, Jeffrey D; Gowda, Ashok L; Wiater, Brett; Wiater, J Michael

    2016-01-01

    A fully functioning, painless shoulder joint is essential to maintain a healthy, normal quality of life. Disease of the rotator cuff tendons (RCTs) is a common issue that affects the population, increasing with age, and can lead to significant disability and social and health costs. RCT injuries can affect younger, healthy patients and the elderly alike, and may be the result of trauma or occur as a result of chronic degeneration. They can be acutely painful, limited to certain activities or completely asymptomatic and incidental findings. A wide variety of treatment options exists ranging from conservative local and systemic pain modalities, to surgical fixation. Regardless of management ultimately chosen, physiotherapy of the RCT, rotator cuff muscles and surrounding shoulder girdle plays an essential role in proper treatment. Length of treatment, types of therapy and timing may vary if therapy is definitive care or part of a postoperative protocol. Allowing time for adequate RCT healing must always be considered when implementing ROM and strengthening after surgery. With current rehabilitation methods, patients with all spectrums of RCT pathology can improve their function, pain and quality of life. This manuscript reviews current theories and practice involving rehabilitation for RCT injuries.

  18. Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear

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    Su, Wei Ren; Jou, I Ming [National Cheng Kung University Hospital, Tainan (China); Lin, Cheng Li [Show-Chwan Memorial Hospital, Changhua (China); Chih, Wei Hsing [Chia-Yi Christian Hospital, Chiayi (China)

    2012-01-15

    Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

  19. Rotator cuff tears: clinical, radiographic, and US findings.

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    Moosikasuwan, Josh B; Miller, Theodore T; Burke, Brian J

    2005-01-01

    Rotator cuff tears are a common cause of shoulder pain. Clinical and radiographic findings can suggest the presence of a rotator cuff tear. The most sensitive clinical findings are impingement and the "arc of pain" sign. Radiographic findings are usually normal in the acute setting, although the "active abduction" view may show decreased acromiohumeral distance. In more chronic cases, an outlet view may show decreased opacity and decreased size of the supraspinatus muscle due to atrophy. In late cases, the humeral head may become subluxated superiorly, and secondary degenerative arthritis of the glenohumeral joint may ensue. Ultrasonography (US), with over 90% sensitivity and specificity, can help confirm the diagnosis in clinically or radiographically equivocal cases. US can also reveal the presence of other abnormalities that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis.

  20. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.

    Science.gov (United States)

    Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

    2013-11-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ≤ 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment.

  1. Role of metalloproteinases in rotator cuff tear.

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    Garofalo, Raffaele; Cesari, Eugenio; Vinci, Enzo; Castagna, Alessandro

    2011-09-01

    The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPS) in the pathophysiology of rotator cuff tears has not been established yet. Recent advances empathize about the role of MMPs and TIMPS in extracellular matrix (ECM) remodeling and degradation in rotator cuff tears pathogenesis and healing after surgical repair. An increase in MMPs synthesis and the resulting MMPs mediated alterations in the ECM of tendons have been implicated in the etiopathogenesis of tendinopathy, and there is an increase in the expression of MMPs and a decrease in TIMP messenger ribonucleic acid expression in tenocytes from degenerative or ruptured tendons. Importantly, MMPs are amenable to inhibition by cheap, safe, and widely available drugs such as the tetracycline antibiotics and bisphosphonates. A better understanding of relationship and activity of these molecules could provide better strategies to optimize outcomes of rotator cuff therapy.

  2. Diagnostic imaging of shoulder rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Nogueira-Barbosa Marcello Henrique

    2002-01-01

    Full Text Available Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US and magnetic resonance imaging (MRI. Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001. We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

  3. Biological strategies to enhance rotator cuff healing.

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    Longo, Umile Giuseppe; Rizzello, Giacomo; Berton, Alessandra; Maltese, Ludovica; Fumo, Caterina; Khan, Wasim S; Denaro, Vincenzo

    2013-11-01

    Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair. Growth factors are delivered to the repair site using tissue-engineered scaffolding, coated sutures, or dissolved in a fibrin sealant. Platelet-rich plasma is an autologous concentration of platelets and contains an high density of growth factors. There is some evidence that platelet-rich plasma may improve pain and recovery of function in a short time period, but it does not improve healing rates in rotator cuff. Thus the routine use of platelet-rich plasma in rotator cuff repair is not recommended. The addition of mesenchymal stem cells to scaffolds can lead to the production of a better quality healing tissue. Gene therapy is a gene transfer from a cell into another, in order to over-express the gene required. In this way, cultures of stem cells can over-express growth factors. Better understanding of the mechanisms of physiological tendon healing can promote the correct use of these new biological therapies for a better healing tissue.

  4. Regenerative Medicine in Rotator Cuff Injuries

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    Pietro Randelli

    2014-01-01

    Full Text Available Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs. Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.

  5. Composition of Muscle Fiber Types in Rat Rotator Cuff Muscles.

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    Rui, Yongjun; Pan, Feng; Mi, Jingyi

    2016-10-01

    The rat is a suitable model to study human rotator cuff pathology owing to the similarities in morphological anatomy structure. However, few studies have reported the composition muscle fiber types of rotator cuff muscles in the rat. In this study, the myosin heavy chain (MyHC) isoforms were stained by immunofluorescence to show the muscle fiber types composition and distribution in rotator cuff muscles of the rat. It was found that rotator cuff muscles in the rat were of mixed fiber type composition. The majority of rotator cuff fibers labeled positively for MyHCII. Moreover, the rat rotator cuff muscles contained hybrid fibers. So, compared with human rotator cuff muscles composed partly of slow-twitch fibers, the majority of fast-twitch fibers in rat rotator cuff muscles should be considered when the rat model study focus on the pathological process of rotator cuff muscles after injury. Gaining greater insight into muscle fiber types in rotator cuff muscles of the rat may contribute to elucidate the mechanism of pathological change in rotator cuff muscles-related diseases. Anat Rec, 299:1397-1401, 2016. © 2016 Wiley Periodicals, Inc.

  6. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

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    Paulo Moraes Agnollitto

    2016-02-01

    Full Text Available Abstract 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.

  7. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear*

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    Agnollitto, Paulo Moraes; Chu, Marcio Wen King; Lorenzato, Mario Muller; Zatiti, Salomão Chade Assan; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    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. PMID:26929462

  8. Muscle progenitor cell regenerative capacity in the torn rotator cuff.

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    Meyer, Gretchen A; Farris, Ashley L; Sato, Eugene; Gibbons, Michael; Lane, John G; Ward, Samuel R; Engler, Adam J

    2015-03-01

    Chronic rotator cuff (RC) tears affect a large portion of the population and result in substantial upper extremity impairment, shoulder weakness, pain, and limited range of motion. Regardless of surgical or conservative treatment, persistent atrophic muscle changes limit functional restoration and may contribute to surgical failure. We hypothesized that deficits in the skeletal muscle progenitor (SMP) cell pool could contribute to poor muscle recovery following tendon repair. Biopsies were obtained from patients undergoing arthroscopic RC surgery. The SMP population was quantified, isolated, and assayed in culture for its ability to proliferate and fuse in vitro and in vivo. The SMP population was larger in muscles from cuffs with partial tears compared with no tears or full thickness tears. However, SMPs from muscles in the partial tear group also exhibited reduced proliferative ability. Cells from all cuff states were able to fuse robustly in culture and engraft when injected into injured mouse muscle, suggesting that when given the correct signals, SMPs are capable of contributing to muscle hypertrophy and regeneration regardless of tear severity. The fact that this does not appear to happen in vivo helps focus future therapeutic targets for promoting muscle recovery following rotator cuff repairs and may help improve clinical outcomes.

  9. Characterization of tendon cell cultures of the human rotator cuff.

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    Pauly, S; Klatte, F; Strobel, C; Schmidmaier, G; Greiner, S; Scheibel, M; Wildemann, B

    2010-07-26

    Rotator cuff tears are common soft tissue injuries of the musculoskeletal system that heal by formation of repair tissue and may lead to high retear rates and joint dysfunction. In particular, tissue from chronic, large tendon tears is of such degenerative nature that it may be prone to retear after surgical repair. Besides several biomechanical approaches, biologically based strategies such as application of growth factors may be promising for increasing cell activity and production of extracellular tendon matrix at the tendon-to-bone unit. As a precondition for subsequent experimental growth factor application, the aim of the present study was to establish and characterize a human rotator cuff tendon cell culture. Long head biceps (LHB)- and supraspinatus muscle (SSP)- tendon samples from donor patients undergoing shoulder surgery were cultivated and examined at the RNA level for expression of collagen type-I, -II and -III, biglycan, decorin, tenascin-C, aggrecan, osteocalcin, tenomodulin and scleraxis (by Real-time PCR). Finally, results were compared to chondrocytes and osteoblasts as control cells. An expression pattern was found which may reflect a human rotator cuff tenocyte-like cell culture. Both SSP and LHB tenocyte-like cells differed from chondrocyte cell cultures in terms of reduced expression of collagen type-II (ptendon matrix and osteofibroblastic integration at the tendon-bone unit following tendon repair.

  10. [Rotator cuff tear of the hip].

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    Jeanneret, Luc; Kurmann, Patric T; van Linthoudt, Daniel

    2008-05-14

    We report the observations of two women with a recurrent periarthritis of the hip complicated by a spontaneous rupture of the tendons of the gluteus medius and minimus. These patients usually complain from an acute lateral hip pain and show a Trendelenburg gait. When the rupture is complete, clinical evaluation reveals a drop of the pelvis on the non-stance side and resisted rotation starting from the extreme external rotation position is weak. MRI plays a key role in the diagnosis and the evaluation of a possible surgical repair. Hip rotator-cuff rupture is probably insufficiently diagnosed by ignorance. Nonetheless, optimized handling could relieve the pain of most these patients and improve the disability of some of them.

  11. Characterization of tendon cell cultures of the human rotator cuff

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    S Pauly

    2010-07-01

    Full Text Available tator cuff tears are common soft tissue injuries of the musculoskeletal system that heal by formation of repair tissue and may lead to high retear rates and joint dysfunction. In particular, tissue from chronic, large tendon tears is of such degenerative nature that it may be prone to retear after surgical repair. Besides several biomechanical approaches, biologically based strategies such as application of growth factors may be promising for increasing cell activity and production of extracellular tendon matrix at the tendon-to-bone unit. As a precondition for subsequent experimental growth factor application, the aim of the present study was to establish and characterize a human rotator cuff tendon cell culture.Long head biceps (LHB- and supraspinatus muscle (SSP- tendon samples from donor patients undergoing shoulder surgery were cultivated and examined at the RNA level for expression of collagen type-I, -II and -III, biglycan, decorin, tenascin-C, aggrecan, osteocalcin, tenomodulin and scleraxis (by Real-time PCR. Finally, results were compared to chondrocytes and osteoblasts as control cells.An expression pattern was found which may reflect a human rotator cuff tenocyte-like cell culture. Both SSP and LHB tenocyte-like cells differed from chondrocyte cell cultures in terms of reduced expression of collagen type-II (p≤0.05 and decorin while higher levels of collagen type-I were seen (p≤0.05. With respect to osteoblasts, tenocyte-like cells expressed lower levels of osteocalcin (p≤0.05 as well as tenascin C, biglycan and collagen type-III. Expression of scleraxis, tenomodulin and aggrecan was similar between all cell types.This study represents a characterization of tenocyte-like cells from the human rotator cuff as close as possible. It helps analyzing their biological properties and allows further studies to improve production of tendon matrix and osteofibroblastic integration at the tendon-bone unit following tendon repair.

  12. Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised, double-blind, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Harris Anthony

    2007-08-01

    Full Text Available Abstract Background Chronic rotator cuff pathology (CRCP is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness. Methods/Design This randomised, double-blind, placebo-controlled trial will involve 200 participants with CRCP recruited from medical practices, outpatient departments and the community via print and radio media. Participants will be randomly allocated to a physiotherapy or placebo group using concealed allocation stratified by treating physiotherapist. Both groups will receive 10 sessions of individual standardised treatment over 10 weeks from one of 10 project physiotherapists. For the following 12 weeks, the physiotherapy group will continue a home exercise program and the placebo group will receive no treatment. The physiotherapy program will comprise shoulder joint and spinal mobilisation, soft tissue massage, postural taping, and home exercises for scapular control, posture and rotator cuff strengthening. The placebo group will receive inactive ultrasound and gentle application of an inert gel over the shoulder region. Blinded assessment will be conducted at baseline and at 10 weeks and 22 weeks after randomisation. The primary outcome measures are self reported questionnaires including the shoulder pain and disability index (SPADI, average pain on an 11-point numeric rating scale and participant perceived global rating of change. Secondary measures include Medical Outcomes Study 36-item short form (SF-36, Assessment of Quality of Life index, numeric rating scales for shoulder pain and stiffness, participant perceived rating of change for pain, strength and stiffness, and manual muscle testing for shoulder strength using a handheld dynamometer. To evaluate cost-effectiveness, participants will record the use of all health

  13. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

    Science.gov (United States)

    Seitz, Amee L; McClure, Philip W; Finucane, Sheryl; Boardman, N Douglas; Michener, Lori A

    2011-01-01

    The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes.

  14. Patch-Augmented Rotator Cuff Repair and Superior Capsule Reconstruction

    Science.gov (United States)

    Petri, M.; Greenspoon, J.A.; Moulton, S.G.; Millett, P.J.

    2016-01-01

    Background: Massive rotator cuff tears in active patients with minimal glenohumeral arthritis remain a particular challenge for the treating surgeon. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: For patients with irreparable rotator cuff tears, a reverse shoulder arthroplasty or a tendon transfer are often performed. However, both procedures have rather high complication rates and debatable long-term results, particularly in younger patients. Therefore, patch-augmented rotator cuff repair or superior capsule reconstruction (SCR) have been recently developed as arthroscopically applicable treatment options, with promising biomechanical and early clinical results. Conclusion: For younger patients with irreparable rotator cuff tears wishing to avoid tendon transfers or reverse total shoulder arthroplasty, both patch-augmentation and SCR represent treatment options that may delay the need for more invasive surgery.

  15. Improved apparatus for predictive diagnosis of rotator cuff disease

    Science.gov (United States)

    Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

    2014-03-01

    Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

  16. Biceps Lesion Associated With Rotator Cuff Tears

    Science.gov (United States)

    Jeong, Ho Yeon; Kim, Jung Youn; Cho, Nam Su; Rhee, Yong Girl

    2016-01-01

    Background: Various tenodesis methods are being used for long head of the biceps tendon lesions. However, there is no consensus on the most appropriate surgical method. Hypothesis: There are significant differences in incidence of cosmetic deformity and persistent bicipital pain between open subpectoral and arthroscopic intracuff tenodesis groups. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 72 patients who underwent biceps tenodesis and rotator cuff repair between January 2009 and May 2014 and who were followed for at least 1 year. Open subpectoral tenodesis was performed in 39 patients (group A), and arthroscopic intracuff tenodesis was performed in 33 patients (group B). Results: In group A, the mean visual analog scale (VAS) score for pain during motion and mean University of California, Los Angeles (UCLA) and Constant scores significantly improved from 4.6, 18.6, and 64.5 preoperatively to 1.9, 30.5, and 86.5 at last follow-up, respectively (P Popeye deformity was noted in 2 (5.2%) patients from group A and 5 (15.6%) patients from group B (P = .231). Additionally, persistent bicipital tenderness was noted in 1 (2.6%) patient from group A and 8 (24.2%) patients from group B (P = .012). Conclusion: Both open subpectoral tenodesis and arthroscopic intracuff tenodesis show good clinical outcomes for long head of the biceps tendon lesions. However, open subpectoral tenodesis may be more appropriate, considering the low incidence of Popeye deformity and tenderness. PMID:27231699

  17. Rotator cuff injury: fat suppression MR image

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yoon; Suh, Jin Suck; Park, Chang Yun; Lee, Yeon Hee [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo [Inje University College of Medicine, Busan (Korea, Republic of)

    1994-04-15

    We performed the study prospectively to evaluate the advantage of fat suppression MR in the diagnosis of rotator cuff injury. Ten symptomatic patients were studied with both conventional T2WI and FST2WI using chemical shift technique. Each image was analyzed for the assessment of injuries, conspicuity of the lesion, the presence of effusion in subacromical bursae and joint space, and presence of humeral head injury. Arthroscopy was done in 4 patients following MRI. We could made presumptive diagnoses on FSMR as identical as on conventional MR in six cases(1 normal, 2 tendinitis, 2 partial thickness tear, 1 full thickness tear), two of them were confirmed by arthroscopic procedures. Two cases of partial thickness tear proved by arthroscopy were detected on FST2WI, whereas they were considered tendinitis on conventional T2WI. There were another 2 cases who showed tendinitis on FSMR, but normal on conventional T2WI. They, however, were not confirmed by either arthroscopy or surgical procedure. We found the FSMR were superior to conventional T2WI in the conspicuity of lesions and detection of joint effusion and abnormalities on the humeral head. We think FSMR of the shoulder could have significant diagnostic advantages over the conventional spin-echo MR imaging.

  18. Progression from calcifying tendinitis to rotator cuff tear.

    Science.gov (United States)

    Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke

    2003-02-01

    This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed.

  19. Progression from calcifying tendinitis to rotator cuff tear

    Energy Technology Data Exchange (ETDEWEB)

    Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke [Department of Orthopaedic Surgery, Medical Center of Kurume University, 155-1 Kokubu-machi, Kurume City, Fukuoka 839-0862 (Japan)

    2003-02-01

    This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

  20. Postoperative Rehabilitation After Rotator Cuff Repair

    Science.gov (United States)

    Mollison, Scott; Shin, Jason J.; Glogau, Alexander; Beavis, R. Cole

    2017-01-01

    Background: Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion. Hypothesis/Purpose: The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013. Results: The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey. Conclusion: There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later

  1. Pain, Disability and Sleep Quality in Patients With Rotator Cuff Tendinopathy and Concurrent Myofascial Pain

    Directory of Open Access Journals (Sweden)

    Morteza Nakhaei Amroodi

    2016-05-01

    Full Text Available Background Rotator cuff tendinopathy and concurrent myofascial pain may result in sleep disturbances, poor quality of life, and social dysfunction along with chronic annoying pain and progressive physical disability. Objectives The present study aimed to assess severity of pain, physical disability, and sleep quality in patients with rotator cuff tendinopathy and concurrent myofascial pain. Patients and Methods This case-control study was conducted on 30 consecutive patients with rotator cuff tendinopathy without tear (impingement syndrome and concurrent myofascial pain referred to the shoulder clinic in Shafa-Yahyaian Hospital during year 2014 (January to April. Eighteen gender and age-matched healthy individuals without any history of rotator cuff tendinopathy were included as controls. Along with baseline assessment, for determining the level of arm, shoulder and hand disability, the quick disabilities of the arm, shoulder and hand questionnaire was also used. Sleep quality was assessed by the pittsburgh sleep quality index (PSQI. Results Compared to healthy individuals, the mean shoulder disability score was significantly higher in the patient group (P = 0.001. Also, regarding sleep quality, the mean score was significantly higher in the patient group when compared with healthy subjects (P = 0.002. Conclusions Patients with rotator cuff tendinopathy concurrent with myofascial pain experienced low level of sleep quality along with severe pain and physical disability. In order to improve clinical outcome of these patients, improving physical function and sleep quality in these patients is necessary.

  2. Arthroscopic Removal and Rotator Cuff Repair Without Acromioplasty for the Treatment of Symptomatic Calcifying Tendinitis of the Supraspinatus Tendon

    OpenAIRE

    2015-01-01

    Background: Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. Although most patients respond well to conservative treatment, some eventually require surgical treatment. Purpose: To evaluate the clinical outcome with arthroscopic removal of calcific deposit and rotator cuff repair without acromioplasty for the treatment of calcific tendinitis of the supraspinatus tendon. Study Design: Case series; Level of ev...

  3. COMPARISON OF ASTYM THERAPY AND KINESIOTAPING FOR ROTATOR CUFF TENDINOPATHY IN DIABETIC PATIENTS: RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Azza Atya

    2017-09-01

    Full Text Available Background: Rotator cuff tendinopathy is a significant problem among diabetics that frequently restricts patient’s activity in terms of pain and disability. The purpose of this study was to compare between the effect of Astym therapy and kinesiotaping in treating diabetic patients with chronic rotator cuff tendinopathy. Methods: 56 diabetic patients diagnosed with chronic rotator cuff tendinopathy were randomly assigned into Astym therapy group (n=28 or kinesiotaping group (n= 28. All patients received conventional program in addition to Astym treatment or Kinesiotaping for 24 sessions (2times/week. Patients were assessed at baseline and at the end of corresponding intervention with visual analogy scale (VAS for pain intensity, shoulder disability questioner (SDQ for shoulder disability, and electrogoniometer for shoulder range of motion. Results: For the 56 study participants (21 males and 35 females; mean age=41.9±6.9 years there were significant differences in all measuring outcomes in both group when compared to baseline measurements (p 0.05. Conclusion: kinesiotaping appears to be more effective than Astym therapy in reducing pain for diabetic patients with chronic rotator cuff tendinopathy.

  4. Risk factors for the development of rotator cuff disease

    Directory of Open Access Journals (Sweden)

    Northover J

    2007-01-01

    Full Text Available We have undertaken a case control study of 300 patients to ascertain some of the etiological variables in the development of rotator cuff disease. Materials and Methods: The results of 300 questionnaires of two groups of 150 people were compared. The first group with symptoms of impingement and ultrasound appearances of rotator cuff pathology (mean age 59.0, range 24-86 were compared to a second group of asymptomatic controls (mean age 60.6, range 35-90. Results: Activities that increase the risk of developing rotator cuff pathology include occupations that involve manual (odds ratio 3.81 and/or overhead work (3.83, weight training (2.32 and swimming (1.98. Patient factors that increase the risk include diabetes (3.34 and general osteoarthritis (2.39.

  5. Calcifying tendinitis of the rotator cuff with cortical bone erosion.

    Science.gov (United States)

    Chan, Roxanne; Kim, David H; Millett, Peter J; Weissman, Barbara N

    2004-10-01

    Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.

  6. Calcifying tendinitis of the rotator cuff with cortical bone erosion

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Roxanne; Kim, David H.; Millett, Peter J. [Harvard Medical School, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Weissman, Barbara N. [Harvard Medical School, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Department of Radiology, Musculoskeletal Division, Boston (United States)

    2004-10-01

    Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed. (orig.)

  7. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy.

    Science.gov (United States)

    Greis, Ari C; Derrington, Stephen M; McAuliffe, Matthew

    2015-04-01

    Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients.

  8. Effect of rotator cuff dysfunction on the initial mechanical stability of cementless glenoid components

    OpenAIRE

    2009-01-01

    textabstractThe functional outcome of shoulder replacement is related to the condition of the rotator cuff. Rotator cuff disease is a common problem in candidates for total shoulder arthroplasty; this study relates the functional status of the rotator cuff to the initial stability of a cementless glenoid implant. A 3D finite element model of a complete scapula was used to quantify the effect of a dysfunctional rotator cuff in terms of bone-implant interface micromotions when the implant is ph...

  9. Surgical treatment of the impingement syndrome and of the rotator cuff tears: personal experience in 134 cases

    Directory of Open Access Journals (Sweden)

    A. Rioda

    2011-09-01

    Full Text Available The time-course covered by the original definition of scapulo-humeral periarthritis suggested by Duplay through the more recent term of subacromial impingement syndrome coined by Neer, follows the identification of the pathogenetic mechanisms leading to chronic subacromial impingement and degenerative tears of the rotator cuff. The Authors recall the functional-anatomic development evolution of the shoulder and the disequilibrium between the depressor and the elevator muscles which may promote the chronic friction against the acromion. However, the actual pathogenesis of the impingement still remains controversial. We evaluated 134 patients (81F, 53M, mean age 56.4 years with chronic subacromial impingement syndrome. In 92 cases (69% non traumatic tears of the rotator cuff were also present as confirmed by ultrasonography in 94 cases, CT in18 cases and magnetic resonance in 102 cases. The different tear patterns of the rotator cuff were classified as suggested by Ellman (L shaped, L reverse, triangular, trapezoidal and massive with retraction and clinical results were analysed following Sahlstrand clinical criteria and Costant numerical scale. According to the anatomical damage, patients were divided into those with impingement without severe cuff tendinopathy (42 cases, those with rotator cuff tears without loss of motion of the shoulder (32 cases and those with cuff tears and loss of active motion (60 cases. The different surgical techniques and rehabilitation procedures after surgery are also reported. After a mean follow-up of 1.3 years (range 8 months - 2 years, good or excellent results were obtained in 91% of the patients without rotator cuff tears, in 87% of the patients with tears but without loss of motion and in 75% of the cases with loss of active motion. Our data demonstrate that in the majority of patients with chronic impingement syndrome and rotator cuff tears, surgical treatment shows high success rates. When surgery is

  10. Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

    2016-01-01

    Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears.

  11. Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

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    Kim, Eui Jong; Ryu, Kyung Nam; Lee, Sun Wha; Lim, Jae Hoon; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Chenona (Korea, Republic of)

    1992-11-15

    Twenty-six patients with chief complaint of shoulder pain who underwent both ultrasonographic examination and arthrography of the shoulder were analyzed. Ten out of 12 cases with clinical impression of frozen shoulder, showed normal findings on the ultrasonographic examination of the shoulder. Among these ten cases, nine cases showed adhesive capsulitis and one case showed rotator cuff tear on arthrography. Among six cases with the clinical impression of rotator cuff tear, five cases showed rotator cuff tear and one case showed combined calcific tendinitis and adhesive capsulitis on ultrasonographic examination. In arthrography, four cases of rotator cuff tear, one case of calcific tendinitis and biceps tendinitis and one case of normal finding were diagnosed. For the remaining eight cases in the ultrasonographic examination, normal finding or biceps tendinitis were found and for the remaining of the cases in arthrography adhesive capsulitis were found. With the above results, we recommend that the shoulder ultrasonography as the first line diagnostic modality for a patient with chief complaint of shoulder pain.

  12. [Sources of error in sonographic diagnosis of the rotator cuff].

    Science.gov (United States)

    Casser, H R; Sulimma, H; Straub, A; Paus, R

    1991-12-01

    Sonography of the shoulder joint has developed into an established examination technique in the diagnosis of periarticular lesions of the shoulder. Sonographic diagnosis of the rotator cuff in particular contains a multitude of possible errors, which are gone into by this study by means of 149 clinically, radiologically and sonographically examined shoulder patients with an average age of 50.5 years. Besides errors made by wrong examination technique such of the transducer as incorrect adjustment of the equipment, insufficient contact of the transducer with the skin and unsuitable choice of the examination plane, there are sources of errors in the interpretation of the sonogram caused by lack of knowledge about physically caused artifacts and sonoanatomical qualities of the shoulder joint. Calcification inside the rotator cuff and the so-called "sonographic inhomogeneity of the rotator cuff" are numbered among the sources of error particular to the shoulder joint. Most errors in sonographic diagnosis of the rotator cuff can be avoided by careful examination of both shoulder joints with an exactly tuned ultrasound device, taking into account the sonoanatomical and ultrasonic qualities. Radiological examination of the affected shoulder joint cannot be replaced by ultrasound.

  13. Muscle Gene Expression Patterns in Human Rotator Cuff Pathology

    Science.gov (United States)

    Choo, Alexander; McCarthy, Meagan; Pichika, Rajeswari; Sato, Eugene J.; Lieber, Richard L.; Schenk, Simon; Lane, John G.; Ward, Samuel R.

    2014-01-01

    Background: Rotator cuff pathology is a common source of shoulder pain with variable etiology and pathoanatomical characteristics. Pathological processes of fatty infiltration, muscle atrophy, and fibrosis have all been invoked as causes for poor outcomes after rotator cuff tear repair. The aims of this study were to measure the expression of key genes associated with adipogenesis, myogenesis, and fibrosis in human rotator cuff muscle after injury and to compare the expression among groups of patients with varied severities of rotator cuff pathology. Methods: Biopsies of the supraspinatus muscle were obtained arthroscopically from twenty-seven patients in the following operative groups: bursitis (n = 10), tendinopathy (n = 7), full-thickness rotator cuff tear (n = 8), and massive rotator cuff tear (n = 2). Quantitative polymerase chain reaction (qPCR) was performed to characterize gene expression pathways involved in myogenesis, adipogenesis, and fibrosis. Results: Patients with a massive tear demonstrated downregulation of the fibrogenic, adipogenic, and myogenic genes, indicating that the muscle was not in a state of active change and may have difficulty responding to stimuli. Patients with a full-thickness tear showed upregulation of fibrotic and adipogenic genes; at the tissue level, these correspond to the pathologies most detrimental to outcomes of surgical repair. Patients with bursitis or tendinopathy still expressed myogenic genes, indicating that the muscle may be attempting to accommodate the mechanical deficiencies induced by the tendon tear. Conclusions: Gene expression in human rotator cuff muscles varied according to tendon injury severity. Patients with bursitis and tendinopathy appeared to be expressing pro-myogenic genes, whereas patients with a full-thickness tear were expressing genes associated with fatty atrophy and fibrosis. In contrast, patients with a massive tear appeared to have downregulation of all gene programs except inhibition of

  14. The 50 Most Cited Articles in Rotator Cuff Repair Research.

    Science.gov (United States)

    Kraeutler, Matthew J; Freedman, Kevin B; MacLeod, Robert A; Schrock, John B; Tjoumakaris, Fotios P; McCarty, Eric C

    2016-11-01

    Analysis of the number of citations within a given specialty provides information on the classic publications of that specialty. The goals of this study were to identify the 50 most cited articles on rotator cuff repair and to analyze various characteristics of these articles. The ISI Web of Science (Thomson Reuters, Philadelphia, Pennsylvania) was used to conduct a search for the term rotator cuff repair. The 50 most cited articles were retrieved, and the following objective characteristics of each article were recorded: number of times cited, citation density, journal, country of origin, and language. The following subjective characteristics of each article were also recorded: article type (clinical vs basic science), article subtype, and level of evidence for clinical articles. Of the 50 most cited articles on rotator cuff repair, the number of citations ranged from 138 to 677 (mean, 232±133 citations) and citation density ranged from 3.8 to 53.5 citations per year (mean, 16.9±9.2 citations per year). The articles were published between 1974 and 2011, with most of the articles published in the 2000s (29 articles), followed by the 1990s (16 articles). The articles originated from 8 countries, with the United States accounting for 30 articles (60%). Overall, 66% of the articles were clinical and 34% were basic science. The most common article subtype was the clinical case series (48%). Of the 33 clinical articles, 24 (73%) were level IV. Among the 50 most cited articles on rotator cuff repair, the case series was the most common article subtype, showing the effect that publication of preliminary outcomes and new surgical techniques has had on surgeons performing rotator cuff repair. [Orthopedics. 2016; 39(6):e1045-e1051.].

  15. Platelet-rich plasma for rotator cuff repair.

    Science.gov (United States)

    Barber, F Alan

    2013-12-01

    Rotator cuff tears are a common cause of shoulder pain and disability. Because they combine both traumatic and degenerative elements, the surgical repair can be challenging. Even after surgical intervention, tendon residual defects or "retears" often develop. Risk factors for tendon "retears" include patient age, number of tendons involved, tear size, and smoking. Platelet-rich plasma (PRP) is a supraphysiological concentration of platelets, which may be able to positively augment rotator cuff tendon healing. Not all PRPs are the same and those containing higher leukocyte levels may be detrimental to tendon healing. Thrombin activation triggers an immediate release of growth factors from the PRP and may actually inhibit some parts of the healing response. As yet, the clinical data does not conclusively prove a benefit from PRP, but discernment is required in evaluating the published results. As different PRPs may act differently and the results may be dose dependent requiring more PRP to achieve a beneficial threshold. How success is measured (clinical outcomes vs. intact cuff tendons) and how long the patients are followed are also critical items. Currently, the PRP fibrin matrix version holds the greatest promise for improving clinical success after rotator cuff tendon repair.

  16. Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

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    Brody A Flanagin

    2016-01-01

    Full Text Available Purpose: Arthroscopic transosseous (TO rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student′s t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001. Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%, good in 8 (7.3%, fair in 3 (2.8%, and poor in 3 (2.8%. There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of "injury" preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique

  17. Arthroscopic rotator cuff repair in elite rugby players

    Directory of Open Access Journals (Sweden)

    Tambe Amol

    2009-01-01

    Full Text Available Background: Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. Aims: We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Materials and Methods: Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans. Results: There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360° labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6-31 months post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed. Conclusion: We conclude that full-thickness rotator cuff tears in the contact athlete can

  18. Partial rotator cuff injury in athletes: bursal or articular?

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    Cassiano Diniz Carvalho

    2015-08-01

    Full Text Available ABSTRACTA painful shoulder is a very common complaint among athletes, especially in the case of those in sports involving throwing. Partial lesions of the rotator cuff may be very painful and cause significant functional limitation to athletes' sports practice. The incidence of partial lesions of the cuff is variable (13-37%. It is difficult to make the clinical and radiological diagnosis, and this condition should be borne in mind in the cases of all athletes who present symptoms of rotator cuff syndrome, including in patients who are diagnosed only with tendinopathy. OBJECTIVE: To evaluate the epidemiological behavior of partial lesions of the rotator cuff in both amateur and professional athletes in different types of sports. METHODS: We evaluated 720 medical files on athletes attended at the shoulder service of the Discipline of Sports Medicine at the Sports Traumatology Center, Federal University of São Paulo. The majority of them were men (65%. Among all the patients, 83 of them were diagnosed with partial lesions of the rotator cuff, by means of ultrasonography or magnetic resonance, or in some cases using both. We applied the binomial test to compare the proportions found. RESULT: It was observed that intra-articular lesions predominated (67.6% and that these occurred more frequently in athletes in sports involving throwing (66%. Bursal lesions occurred in 32.4% of the athletes, predominantly in those who did muscle building (75%. CONCLUSION: Intra-articular lesions are more frequent than bursal lesions and they occur predominantly in athletes in sports involving throwing, while bursal lesions were more prevalent in athletes who did muscle building.

  19. Vitamin D and the immunomodulation of rotator cuff injury

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    Dougherty KA

    2016-06-01

    Full Text Available Kaitlin A Dougherty,1 Matthew F Dilisio,2 Devendra K Agrawal1 1Department of Clinical & Translational Science, 2Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, USA Abstract: Tendon-to-bone healing after rotator cuff repair surgery has a failure rate of 20%–94%. There has been a recent interest to determine the factors that act as determinants between successful and unsuccessful rotator cuff repair. Vitamin D level in patients is one of the factors that have been linked to bone and muscle proliferation and healing, and it may have an effect on tendon-to-bone healing. The purpose of this article is to critically review relevant published research that relates to the effect of vitamin D on rotator cuff tears and subsequent healing. A review of the literature was conducted to identify all studies that investigate the relationship between vitamin D and tendon healing, in addition to its mechanism of action. The data were then analyzed in order to summarize what is currently known about vitamin D, rotator cuff pathology, and tendon-to-bone healing. The activated metabolite of vitamin D, 1α,25-dihydroxyvitamin D3, affects osteoblast proliferation and differentiation. Likewise, vitamin D plays a significant role in the tendon-to-bone healing process by increasing the bone mineral density and strengthening the skeletal muscles. The 1α,25-dihydroxyvitamin D3 binds to vitamin D receptors on myocytes to stimulate growth and proliferation. The form of vitamin D produced by the liver, calcifediol, is a key initiator of the myocyte healing process by moving phosphate into myocytes, which improves function and metabolism. Investigation into the effect of vitamin D on tendons has been sparse, but limited studies have been promising. Matrix metalloproteinases play an active role in remodeling the extracellular matrix (ECM of tendons, particularly deleterious remodeling of the collagen fibers. Also, the levels of

  20. Biologically based strategies to augment rotator cuff tears

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    M Schaer

    2012-01-01

    Full Text Available Lesions of the rotator cuff (RC are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords "tendon," "rotator cuff," "augmentation," "growth factor," "platelet-rich fibrin," and "platelet-rich plasma" for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

  1. Effects of lidocaine on torn rotator cuff tendons.

    Science.gov (United States)

    Honda, Hirokazu; Gotoh, Masafumi; Kanazawa, Tomonoshin; Nakamura, Hidehiro; Ohta, Keisuke; Nakamura, Kei-Ichiro; Shiba, Naoto

    2016-09-01

    We determined lidocaine's action on torn rotator cuff tendons in vitro and in vivo. For in vitro experiments, cell proliferation and viability assays were performed using tenocytes derived from human torn rotator cuff tendons. For in vivo experiments, acute rotator cuff tears were made on the supraspinatus tendons in the rats' bilateral shoulders; before closure, lidocaine was injected into the shoulder and saline into the contralateral shoulder (control). After sacrifice, the specimens underwent biomechanical testing or histological analysis at 24 h and at 2, 4, and 8 weeks after surgery. The extent of collagen organization and apoptosis were semi-quantitatively evaluated using collagen picrosirius red staining. Apoptosis was examined using TUNEL staining and electron microscopy. Cell proliferation decreased dose-dependently. After exposure to 0.1% lidocaine for 24 h, cell viability decreased. Two and 4 weeks after surgery, the ultimate load to failure decreased more in the lidocaine group than in the control group, with significantly reduced stiffness in the lidocaine group 2 weeks after surgery. Collagen organization significantly decreased in the lidocaine group by 4 weeks after surgery but returned to baseline at 8 weeks. TUNEL staining detected numerous apoptotic tenocytes at the torn tendon edge exposed to lidocaine 24 h after surgery; electron microscopy confirmed the condensed cell nuclei. These changes were not observed in controls. Lidocaine caused cytotoxicity to tenocytes under both conditions, decreased biomechanical properties, and induced apoptosis and delay of collagen organization in this model. Subacromial lidocaine injections in patients with rotator cuff tears should be performed carefully. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1620-1627, 2016.

  2. Augmentation of Rotator Cuff Repair With Soft Tissue Scaffolds

    OpenAIRE

    2015-01-01

    Background Tears of the rotator cuff are one of the most common tendon disorders. Treatment often includes surgical repair, but the rate of failure to gain or maintain healing has been reported to be as high as 94%. This has been substantially attributed to the inadequate capacity of tendon to heal once damaged, particularly to bone at the enthesis. A number of strategies have been developed to improve tendon-bone healing, tendon-tendon healing, and tendon regeneration. Scaffolds have receive...

  3. Evaluation of Internet Information About Rotator Cuff Repair.

    Science.gov (United States)

    Lawson, Kevin A; Codella, Stephen; Ciccotti, Michael G; Kane, Patrick W; Duncan, Ian C; Cohen, Steven B

    2016-01-01

    The content and quality of Internet websites are not governed or regulated. Therefore, patients who consult the Internet may receive outdated or incorrect medical information. Researchers have analyzed the quality of web information about various orthopedic surgeries, but no such analysis has been performed on websites covering rotator cuff repair. We conducted a study to evaluate and analyze rotator cuff repair information available to the general public through the Internet; to assess changes in the quality of information over time; to determine if sites sponsored by academic institutions offered higher-quality information; and to assess whether the readability of the material varied according to DISCERN scores. Two Internet searches were conducted, in 2011 and 2014. The 3 most commonly used search engines were used to search for rotator cuff repair. The first 50 websites from each search engine were evaluated for authorship and content. The DISCERN instrument was used to analyze the quality of each website's health information. The 2011 search revealed 21% of websites were associated with an academic institution, 38% were authored by a hospital or physician group, and 11.5% were industry-sponsored. The 2014 search revealed a similar distribution of contributors. The highest DISCERN scores were given to academic institution websites (51.6) and public education websites (49). There was no correlation between readability and DISCERN scores. Websites associated with academic institutions produced the highest-quality medical information. Over the past few years, authorship and content have changed little with respect to Internet information about rotator cuff repair.

  4. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment.

    Science.gov (United States)

    Jacobs, Ruben; Debeer, Philippe

    2006-06-01

    In this study, we assessed the functional results after arthroscopic excision of rotator cuff calcifications. Sixty-one shoulders in 57 patients with chronic calcifying tendinitis of the rotator cuff were treated with arthroscopic excision, subacromial bursa debridement and shaving. In patients with fraying or roughness of the coracoacromial ligament, an acromioplasty was also performed. Patients were evaluated after a mean follow-up of 15 months. The modified Constant score and DASH score significantly improved from 33.4 to 66.8 and from 49.7 to 17.3 respectively. Performing an acromioplasty did not influence the final outcome. Frozen shoulder was a frequent complication (18%) without significant effect on the final DASH or Constant score. The presence of residual calcifications after arthroscopic needling did not influence the final outcome. We therefore believe that the presence of residual calcifications can be accepted if this is deemed necessary to preserve the integrity of the tendon.

  5. Anterior superior instability with rotator cuff tearing: SLAC lesion.

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    Savoie, F H; Field, L D; Atchinson, S

    2001-07-01

    Anterosuperior instability of the shoulder may occur from a variety of pathologic lesions. We describe a specific entity, the SLAC (superior labrum, anterior cuff) lesion that involves an association of anterior-superior labral tear with a partial supraspinatus tear. We retrospectively isolated a group of 40 patients with this lesion. The presenting complaints, physical examination findings, surgical findings, and results were isolated. Overhead activities were the most common etiology; load and shift instability testing and whipple rotator cuff testing were the most common physical examination findings. Surgical repair was successful in 37 of the 40 patients. The SLAC lesion is a definable clinical entity with predictable history, examination, surgical pathology, and satisfactory results from surgery.

  6. Biceps tendon sheath effusion as a diagnostic clue to rotator cuff pathology.

    Science.gov (United States)

    Yadav, Pankaj K; Shah, Bhavin; Shende, Amol; Rajesh, S

    2014-02-01

    The objective of this study was to evaluate the role of biceps tendon sheath effusion detected on ultrasound as a diagnostic clue to rotator cuff pathology. Despite being the most common cause of shoulder pain in adults early sonographic changes of rotator cuff tendinopathy are easy to miss. A total of 31 patients out of whom 27 had unilateral shoulder pain and 4 had bilateral complaints under- went ultrasonographic examination of shoulder joint using high frequency linear array transducer. Any fluid surrounding the long head of biceps tendon was noted followed by a careful search for any associated sonographic abnormality involving the rotator cuff. Eighteen out of the 35 had presence of fluid in their biceps tendon sheath. Twelve had presence of both biceps tendon sheath effusion and rotator cuff pathologies. Among 17 patients, who had no fluid in their biceps tendon sheath, only 2 had rotator cuff involvement whereas rest 15 had neither biceps tendon sheath fluid nor rotator cuff pathologies. A significant association was found between presence of fluid in long head of biceps tendon sheath and rotator cuff pathologies. Thus the most common finding observed in association with the presence of fluid around the long head of biceps tendon sheath in this study was tendinosis of rotator cuff. On ultrasonography simple presence of fluid around the long head of biceps tendon sheath demands careful examination of rotator cuff.

  7. Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview.

    Science.gov (United States)

    Littlewood, Chris

    2012-11-01

    It is now over a decade since the features defining a contractile dysfunction of the shoulder were first reported. Since this time, some progress has been made to better understand this mechanical syndrome. In response to these developments, this narrative review will explore current understanding in relation to pathology, diagnosis, treatment, and prognosis of this syndrome with reference to literature specifically relating to contractile dysfunction but also literature relating to rotator cuff tendinopathy where necessary. The review not only identifies the strengths of the mechanical diagnosis and therapy approach with reference to a contractile dysfunction of the shoulder but also identifies where further progress needs to be made.

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

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    Vishnumurthy H. Y

    2016-09-01

    Full Text Available INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS Thirty patients clinically suspected to have rotator cuff tear who underwent ultrasonography and arthroscopy of shoulder were included in the study. Duration of study was for two years. All ultrasonography examinations were conducted in ultrasound machine using GE Voluson 730 PRO high frequency (10-12 MHz linear array transducer done by two experienced radiologists. Arthroscopies were done by two experienced shoulder arthroscopic surgeons. RESULTS Age of the patients with rotator cuff tears ranged from 40 to 80 years. 57% were females and 43% were males among the patients who had rotator cuff tears. 71.43% of the rotator cuff tears were found in the dominant arm. 64.28% of patients with rotator cuff tear had given history of fall or trauma to the corresponding shoulder within 6 months prior to presentation. 39.28% of patients who had rotator cuff tears were known diabetics. Supraspinatus tendon was the most commonly affected tendon, followed by infraspinatus and subscapularis tendons. For overall detection of rotator cuff tears, ultrasonography in comparison with the arthroscopy has sensitivity and specificity of 92.85% and 100%. For detection of full thickness rotator cuff tear, its sensitivity and specificity was 94.73% and 100% and for partial thickness rotator cuff tears 76.92% and 100%. Ultrasonography has 100% sensitivity and specificity for detection of supraspinatus full thickness tear. For supraspinatus partial thickness tear, sensitivity and specificity was 88

  9. Predicting rotator cuff tears using data mining and Bayesian likelihood ratios.

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    Hsueh-Yi Lu

    Full Text Available OBJECTIVES: Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. METHODS: In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree and a statistical method (logistic regression to classify the rotator cuff diagnosis into "tear" and "no tear" groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. RESULTS: Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear. CONCLUSIONS: Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears.

  10. Gene expression analysis in calcific tendinopathy of the rotator cuff

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    F Oliva

    2011-06-01

    Full Text Available We evaluated the expression of several genes involved in tissue remodelling and bone development in patients with calcific tendinopathy of the rotator cuff. Biopsies from calcified and non-calcified areas were obtained from 10 patients (8 women and 2 men; average age: 55 years; range: 40-68 with calcific tendinopathy of the rotator cuff. To evaluate the expression of selected genes, RNA extraction, cDNA synthesis and quantitative polymerase chain reaction (PCR were performed. A significantly increased expression of tissue transglutaminase (tTG2 and its substrate, osteopontin, was detected in the calcific areas compared to the levels observed in the normal tissue from the same subject with calcific tendinopathy, whereas a modest increase was observed for catepsin K. There was also a significant decrease in mRNA expression of Bone Morphogenetic Protein (BMP4 and BMP6 in the calcific area. BMP-2, collagen V and vascular endothelial growth factor (VEGF did not show significant differences. Collagen X and matrix metalloproteinase (MMP-9 were not detectable. A variation in expression of these genes could be characteristic of this form tendinopathy, since an increased level of these genes has not been detected in other forms of tendon lesions.

  11. From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts.

    NARCIS (Netherlands)

    Rutten, M.J.C.M.; Jager, G.J.; Blickman, J.G.

    2006-01-01

    High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a d

  12. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears : a randomized controlled trial

    NARCIS (Netherlands)

    Lambers Heerspink, Okke; van Raay, Jos J. A. M.; Koorevaar, Rinco C. T.; van Eerden, Pepijn J. M.; Westerbeek, Robin E.; van 't Riet, Esther; van den Akker-Scheek, Inge; Diercks, Ronald L.

    2015-01-01

    Background: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tea

  13. From the RSNA refresher courses - US of the rotator cuff : Pitfalls, limitations, and artifacts

    NARCIS (Netherlands)

    Rutten, Matthieu J. C. M.; Jager, Gerrit J.; Blickman, Johan G.

    2006-01-01

    High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a d

  14. Editorial Commentary: Arthroscopic Rotator Cuff Repair--Infection Rate After Rotator Cuff Repair With Arthroscopic, Open, and Mini-open Techniques.

    Science.gov (United States)

    Brand, Jefferson C

    2016-03-01

    In "Risk Factors for Infection After Rotator Cuff Repair," B. G. Vopat et al. report a lower rate of postoperative infection with an arthroscopic rotator cuff repair than with an open or mini-open approach. Although there were only 14 infections (infection rate of 0.77%), the reason for the preponderance of male patients, 13 of the 14 infections, needs further research to determine effective preventive strategies.

  15. Arthroscopic suprascapular neurotomy for the painful irreparable rotator cuff tear

    Science.gov (United States)

    Mclaughlin-Symon, Iain; Heasley, Richard; Morgan, Barnes; Ravenscroft, Matt

    2014-01-01

    Background Massive irreparable rotator cuff tears are becoming increasingly difficult to manage. Methods Patients were considered for treatment if they had a painful shoulder in the presence of a compensated cuff tear. All patients had radiological evidence of a massive irreparable cuff tear and underwent suprascapular neurotomy, arthroscopically. Results There were 15 males and 25 females with a mean age of 74 years (range 59 years to 88 years). The mean pre-operative Oxford Shoulder Score (OSS) in all patients was 17.7, with a mean pre-operative visual analogue score (VAS) of 8.0. The mean post-operative OSS was 30.8 [27.42–34.18 = confidence interval (CI) 95%] with a mean VAS of 3.6 (2.64–4.56 CI 95%) at the 3-month (short-term) period (n = 32). The medium-term (1-year) OSS and VAS had improved to 33.6 (32.27–34.93 = CI 95%) and 3.7 (0–8.39 CI 95%) respectively (n = 26). The difference pre- and postoperatively at 12 months was statistically significant (p < 0.001). Patients who underwent biceps tenotomy at the time of surgery had a less significant improvement in their VAS and OSS. Conclusions Suprascapular neurotomy can afford medium-term benefit in over two-thirds of the patients who would otherwise have undergone reverse polarity shoulder replacements. We consider that this is a reproducible technique. PMID:27582962

  16. NMR of the rotator cuff. An update; MRT der Rotatorenmanschette. Ein Update

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich; Maehringer-Kunz, Aline [Universitaetsmedizin Mainz (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2016-03-15

    The rotator cuff consists of the tendons of the supscapularis, supraspinatus, infraspinatus and teres minor muscles. This group of muscles performs multiple functions and is often stressed during various activities. This explains, why rotator cuff disease is common and the most often cause of shoulder pain and dysfunction in adults. MR imaging still is the most important imaging modality in assessment of rotator cuff disease. It enables the radiologist to make an accurate diagnosis, the basis for an appropriate management. In this article, current concepts with regard to anatomy and imaging diagnosis will be reviewed. The discussion of the complex anatomy is followed by normal and pathologic MR imaging appearances of the rotator cuff including tendinopathy and tearing, and concluding with a review of the postoperative cuff.

  17. Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy

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    Suad Trebinjac

    2015-12-01

    Full Text Available Introduction: The objective of this study was to assess a long-term clinical effect of Prolotherapy on chronic symptomatic rotator cuff tendinopathy.Methods: We conducted a retrospective, uncontrolled study in the outpatient setting with 12 months follow-up. Adults diagnosed clinically and radiologically with rotator cuff tendinopathy that has been persisting for a minimum of six months were included. Patients received 15% extra-articular and 25% intra-articular hyperosmolar dextrose injections, repeated at weeks 5, 9, 13, 17 and 21. Primary outcome measure was validated Shoulder Pain and Disability Index (SPADI. Secondary outcome measure was validated visual pain analogue scale (VAS 0-10. The third outcome measures were patient’s satisfaction with Prolotherapy and adverse reactions after injections.Results: Twenty-one patients, 14 male and 7 female were treated with 6 sessions of hyperosmolar dextrose Prolotherapy repeated every 4 weeks. Average SPADI before starting the treatment was 73.995 ± 13.6, while 12 months after completed treatment was 20.84 ± 26.03 (P< 0.0001. Average VAS score before starting the treatment was 8.14 ± 1.2, while 12 months after completed treatment was 2.29 ± 2.8 (P<0.0001. Out of 21 patients, 18 (85.71% would recommend Prolotherapy to other people with the similar condition, and no one participant reported any side effect that was not resolved within one week after the treatment.Conclusion: Hyperosmolar dextrose Prolotherapy may result in significant reduction of pain and disability index in adult patients with chronic rotator cuff tendinopathy, without eliciting long-lasting side effects. Results of this pilot study need to be validated in prospective controlled randomized trials.

  18. Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities

    Science.gov (United States)

    Carvalho, Cassiano Diniz; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Ejnisman, Benno

    2016-01-01

    ABSTRACT Objective To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Methods Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. Results There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Conclusion Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities. PMID:28076600

  19. Calcific tendonitis of the rotator cuff: an unusual case.

    Science.gov (United States)

    Mitsui, Yasuhiro; Gotoh, Masafumi; Tanesue, Ryo; Shirachi, Isao; Shibata, Hideaki; Nakama, Kenjiro; Okawa, Takahiro; Higuchi, Fujio; Nagata, Kensei

    2012-01-01

    Few case reports have described the surgical treatment of calcifying tendonitis of the subscapularis tendon. We present a case of symptomatic diffuse calcifying tendonitis involving the subscapularis and infraspinatus insertions that was difficult to detect arthroscopically. The patient was treated with arthroscopic incision of the tendinous insertions thorough removal of the calcific deposits and subsequent repair using a suture-anchor technique. Two years after the surgical procedure, the patient was completely pain-free and attained full range of motion. Radiographic evaluation performed 2 years after the procedure revealed no calcific deposits. We conclude that the combination of incision of the subscapularis and infraspinatus insertions, complete removal of the calcific deposits, and subsequent suture-anchor repair in an all-arthroscopic manner can lead to an excellent clinical outcome without compromising the functional integrity of the rotator cuff tendons.

  20. Calcific Tendonitis of the Rotator Cuff: An Unusual Case

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    Yasuhiro Mitsui

    2012-01-01

    Full Text Available Few case reports have described the surgical treatment of calcifying tendonitis of the subscapularis tendon. We present a case of symptomatic diffuse calcifying tendonitis involving the subscapularis and infraspinatus insertions that was difficult to detect arthroscopically. The patient was treated with arthroscopic incision of the tendinous insertions thorough removal of the calcific deposits and subsequent repair using a suture-anchor technique. Two years after the surgical procedure, the patient was completely pain-free and attained full range of motion. Radiographic evaluation performed 2 years after the procedure revealed no calcific deposits. We conclude that the combination of incision of the subscapularis and infraspinatus insertions, complete removal of the calcific deposits, and subsequent suture-anchor repair in an all-arthroscopic manner can lead to an excellent clinical outcome without compromising the functional integrity of the rotator cuff tendons.

  1. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology

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    Breda H. Eubank

    2016-05-01

    Full Text Available Abstract Background Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1 to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2 to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm. Methods A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark “agree” or “disagree” beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting. Results In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic. Conclusion This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

  2. The influence of rotator cuff pathology on functional outcome in total shoulder replacement

    Directory of Open Access Journals (Sweden)

    Nathanael Ahearn

    2013-01-01

    Conclusions: TSR is an efficacious treatment option for patients with primary glenohumeral osteoarthritis in the medium term, even in the presence of rotator cuff tendonopathy or partial tearing. Minor changes within the cuff do not significantly affect functional outcome following TSR.

  3. Exercise Therapy for Total Tear of Rotator Cuff: A Case Report

    OpenAIRE

    Nejati, Parisa; Akbari, Faramarz

    2013-01-01

    Background Shoulder pain is one of the most common problems in ages older than 60 years of age. Rotator cuff pathology is the most common etiology of shoulder pain. Most of rotator cuff pathologies are treated conservatively in old ages and exercise therapy is not an accepted intervention for management of rotator cuff tear yet. Case presentation The case was a man of 53 years age with shoulder pain who had total tear of supraspinatus tendon and biceps tendinitis in the right shoulder. He had...

  4. The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair.

    Science.gov (United States)

    Vopat, Bryan G; Murali, Jothi; Gowda, Ashok L; Kaback, Lee; Blaine, Theodore

    2014-04-22

    Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthroscopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author's practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS) technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (Ptechnique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

  5. The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair

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    Bryan G. Vopat

    2014-05-01

    Full Text Available Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthro- scopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001. This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

  6. Reliability of diagnostic tests in rotator cuff muscle pathology

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    R. Sadenbergh

    2006-02-01

    Full Text Available Background: Several tests to assist it in the diagnoses of rota-tor cuff impairment have been described in the literature but controversystill exists as to the accuracy of these tests. A study was therefore conducted to determine the reliability of the rotator cuff muscle tests (empty can, full can, lift off and external rotation as a diagnostic tool.Methodology: Fifty three patients experiencing shoulder pain were assessedusing manual muscle tests (empty can; full can; lift off and external rotationtests. Both pain and weakness were recorded using numerical scales adapted from tests performed by Itoi et al, (1999. These results were compared to ultrasonic diagnoses made by a surgeon. Informed consent was obtained and anonymity was ensured for all participants.Results: A test was false positive when ultrasonic diagnosis indicated no tear in the muscle (although oedema or calcification may have been present, but the manual muscle test was positive regarding pain and weakness. A test on the other hand was false negative when the ultrasonic diagnosis indicated a muscle tear but the manual muscle tests indicated no pain or muscle weakness. Reliability was tested using sensitivity and specificity tests. The sensitivity of all four tests was high (80%, but the specificity was low (20% to 40%, implying that a large number of false positive diagnoses can be made. The major contributors to the false positive results were sub-acromial sub-deltoid bursitis and a decreased acromio-humeral space. When considering pain alone for a positive result the correlation increased a  little, however, taking both pain and muscle weakness into account, the correlation increased even more.Conclusion: The manual muscle tests were not as reliable as expected, but concurrent pathologies may be the main factor influencing the results of the tests. The combination of muscle strength and pain could be recommendedas criteria for a positive test. The empty can and full can

  7. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: A population-based study

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    Jula Antti

    2010-07-01

    Full Text Available Abstract Background Shoulder pain is a common health problem. The purpose of this study was to assess the associations of lifestyle factors, metabolic factors and carotid intima-media thickness with shoulder pain and chronic (> 3 months rotator cuff tendinitis. Methods In this cross-sectional study, the target population consisted of subjects aged 30 years or older participating in a national Finnish Health Survey during 2000-2001. Of the 7,977 eligible subjects, 6,237 (78.2% participated in a structured interview and clinical examination. Chronic rotator cuff tendinitis was diagnosed clinically. Weight-related factors, C-reactive protein and carotid intima-media thickness were measured. Results The prevalence of shoulder joint pain during the preceding 30 days was 16% and that of chronic rotator cuff tendinitis 2.8%. Smoking, waist circumference and waist-to-hip ratio were related to an increased prevalence of shoulder pain in both genders. Metabolic syndrome, type 2 diabetes mellitus and carotid intima-media thickness were associated with shoulder pain in men, whereas high level of C-reactive protein was associated with shoulder pain in women. Increased waist circumference and type 1 diabetes mellitus were associated with chronic rotator cuff tendinitis in men. Conclusions Our findings showed associations of abdominal obesity, some other metabolic factors and carotid intima-media thickness with shoulder pain. Disturbed glucose metabolism and atherosclerosis may be underlying mechanisms, although not fully supported by the findings of this study. Prospective studies are needed to further investigate the role of lifestyle and metabolic factors in shoulder disorders.

  8. Tissue Engineering for Rotator Cuff Repair: An Evidence-Based Systematic Review

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    Nicola Maffulli

    2012-01-01

    Full Text Available The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month followup. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup.

  9. Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model?

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    Yi Lu

    2015-01-01

    Conclusions: Nonsteroidal anti-inflammatory drugs can delay tendon healing in the early stage after rotator cuff repair. Compared with nonselective COX inhibitors, selective COX-2 inhibitors significantly impact tendon healing.

  10. A Simplified Approach for Arthroscopic Repair of Rotator Cuff Tear with Dermal Patch Augmentation

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    Anthony C. Levenda

    2015-01-01

    Full Text Available Here, we describe an arthroscopic method specifically developed to augment rotator cuff repair using a flexible acellular dermal patch (ADP. In this method, an apparently complex technique is simplified by utilizing specific steps to augment a rotator cuff repair. In this method, using a revised arthroscopic technique, rotator cuff repair was performed. This technique allowed easy passage of the graft, excellent visualization, minimal soft tissue trauma, and full four-corner fixation of an ADP. Twelve patients underwent rotator cuff repair with augmentation using the combination of this method and ADP. Due to the technique and biomechanical characteristics of the material, the repairs have been stable and with high patient satisfaction.

  11. Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study

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    Schibany, N. E-mail: nadja.schibany@univie.ac.at; Zehetgruber, H.; Kainberger, F.; Wurnig, C.; Ba-Ssalamah, A.; Herneth, A.M.; Lang, T.; Gruber, D.; Breitenseher, M.J

    2004-09-01

    Objective: To determine the prevalence and clinical impact of rotator cuff tears in asymptomatic volunteers. Materials and Methods: Sonographic examinations of the shoulder of 212 asymptomatic individuals between 18 and 85 years old were performed by a single experienced operator. The prevalence and location of complete rotator cuff tears were evaluated. The clinical assessment was based on the Constant Score. Magnetic resonance imaging (MRI) of the shoulder was obtained in those patients where US showed rotator cuff pathology. Results: Ultrasound showed a complete rupture of the supraspinatus tendon in 6% of 212 patients from 56 to 83 years of age (mean: 67 years). MRI confirmed a complete rupture of the supraspinatus tendon in 90%. All patients reported no functional deficits, although strength was significantly lower in the patient group with complete supraspinatus tendon tear (P<0.01). Conclusion: There is a higher prevalence in older individuals of rotator cuff tendon tears that cause no pain or decrease in activities of daily living.

  12. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases.

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    Christine Tempelaere

    Full Text Available MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases.Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI.The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear and without tears (tendinopathy (p = 0.012. The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm than in normals (3.4mm (p = 0.02. The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm and supraspinatus tear (9.3 mm shoulders compared to normals (3.5mm and tendinopathy (4.8mm shoulders (p = 0.05.The Dynamic MRI enabled a novel measure; 'Looseness', i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.

  13. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

    Science.gov (United States)

    Tempelaere, Christine; Pierrart, Jérome; Lefèvre-Colau, Marie-Martine; Vuillemin, Valérie; Cuénod, Charles-André; Hansen, Ulrich; Mir, Olivier; Skalli, Wafa; Gregory, Thomas

    2016-01-01

    Background MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases. Methods Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI. Results The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05). Conclusion The Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position. PMID:27434235

  14. Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

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    Zbojniewicz, Andrew M.; Emery, Kathleen H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Maeder, Matthew E. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Lenox Hill Hospital, Department of Radiology, New York, NY (United States); Salisbury, Shelia R. [University of Cincinnati College of Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2014-06-15

    Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

  15. MR imaging of delamination tears of the rotator cuff tendons

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    Walz, Daniel M.; Chen, Steven [North Shore University Hospital, Department of Radiology, Manhasset, NY (United States); Miller, Theodore T. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Hofman, Josh [Long Island Jewish Medical Center, New Hyde Park, NY (United States)

    2007-05-15

    The objective was to describe the imaging appearances and location of delamination tears of the rotator cuff tendons on non-contrast conventional MR imaging. This study was reviewed and approved by our Institutional Review Board. The reports of 548 consecutive MR examinations of the shoulder were reviewed, looking for mention or description of delamination tears of the rotator cuff. The images of the identified cases were then reviewed by two radiologists to confirm the findings. Correlation with surgical and arthroscopic information was then performed. Delamination tears were defined as horizontal retraction of either the bursal or articular surface of the tendon, manifest as thickening of the torn retracted edge, and/or interstitial splitting of the tendon, manifest as fluid-like high signal intensity on fat-suppressed T2-weighted oblique coronal images. Fourteen cases of delamination tears were identified in 13 patients. Ten of the cases involved the supraspinatus tendon, all with articular surface involvement. Nine of these supraspinatus cases were isolated tears and one occurred as part of a full thickness tear. All 10 of these supraspinatus cases showed medial retraction of the articular surface of the tendon, with thickening of the retracted edge, and 5 of the 10 had a demonstrable horizontal cleft in the interstitium. Four cases involved the subscapularis tendon, with articular surface disruption in three and pure interstitial delamination in one. Medial subluxation of the tendon of the long head of the biceps was present in all four cases. No delamination tears occurred on the bursal surface. Only three of the 14 shoulders underwent surgical repair with one confirmation of supraspinatus delamination, one confirmation of a subscapularis tear that had become a full thickness tear 10 months after initial imaging and another interstitial subscapularis delamination that was not identified arthroscopically. Delamination tears occur most often in the

  16. Efficacy of surgery for rotator cuff tendinopathy: a systematic review.

    Science.gov (United States)

    Toliopoulos, Panagiota; Desmeules, François; Boudreault, Jennifer; Roy, Jean-Sébastien; Frémont, Pierre; MacDermid, Joy C; Dionne, Clermont E

    2014-01-01

    The objective of this study is to review randomized controlled trials evaluating the efficacy of surgery for the treatment of rotator cuff (RC) tendinopathy. Studies up to August 2013 were located in the PubMed, Embase, CINAHL, and PEDro databases using relevant keywords. Studies were included if: (1) participants had rotator cuff tendinopathy, (2) the trials were conducted on an adult population (≥18 years old), (3) at least one of the interventions studied was a surgical procedure, (4) study design was a randomized controlled trial (RCT), and (5) the article was written in English or French. Characteristics of the included studies were extracted using a standardized form. Two independent raters reviewed the methodological quality of the studies using the Risk of Bias Assessment tool developed by the Cochrane Collaboration Group. Differences were resolved by consensus. Fifteen trials met our inclusion criteria. After consensus, the mean methodological quality for all studies was 58.9 ± 10.8 %. In three out of four RCTs of moderate or low methodological quality, no significant difference in treatment effectiveness was observed between open or arthroscopic acromioplasty compared to exercises in the treatment of RC tendinopathy. Based on two studies of low or moderate methodological quality, no difference in treatment effectiveness was observed between arthroscopic and open acromioplasty. Two other RCTs of low to moderate quality, however, found that arthroscopic acromioplasty yielded better results in the short-term for shoulder range of motion in flexion but that both procedures were comparable in the long-term. One additional study favored open acromioplasty over arthroscopic acromioplasty for the treatment of RC tendinopathy. Based on low- to moderate-quality evidence, acromioplasty, be it open or arthroscopic, is no more effective than exercises for the treatment of RC tendinopathy. Low-grade evidence also suggests that arthroscopic acromioplasty may

  17. Difference between early versus delayed postoperative physical rehabilitation protocol following arthroscopic rotator cuff repair

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    Samar M Fawzy

    2016-01-01

    Conclusion Significant improvement in pain, ROM, and function after arthroscopic rotator cuff repair was seen at 1 year postoperatively, regardless of early or delayed postoperative rehabilitation protocols. However, early motion increases pain scores and may increase the possibility of rotator cuff retear but with early regain of ROM. A delayed rehabilitation protocol with immobilization for 6 weeks would be better for tendon healing without risk for retear or joint stiffness and easily convalescence with less postoperative pain.

  18. The effect of unloading on gene expression of healthy and injured rotator cuffs

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    Killian, ML; Lim, CT; Thomopoulos, S; Charlton, N; Kim, HM; Galatz, LM

    2013-01-01

    Little is known about the effects of muscle and tendon unloading on the molecular response of the rotator cuff. Tendon unloading following rupture of one of the rotator cuff tendons can induce alterations in muscle physiology and tendon structure, which can subsequently affect reparability and healing potential. The goals of the current study were to determine the effect of mechanical unloading on gene expression and morphology of (1) healthy supraspinatus tendons and muscles, and (2) suprasp...

  19. Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study

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    Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo

    2009-01-01

    We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P  0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

  20. Rotator cuff injuries and factors associated with reoperation

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    Alexandre Litchina Carvalho

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the prevalence of rotator cuff tears and describe the profile of reoperated patients, causes of repeated tendon tears, tear evolution and range of times between surgical procedures. METHOD: This was a cross-sectional study involving 604 surgical procedures performed at two regional referral hospitals between January 2006 and December 2012. After approval by the ethics committee, data describing the patients' epidemiological profile were gathered at a single time, using Cofield's classification to measure the extent of the tears, all of which underwent arthroscopic surgery. The data were entered into Epi Info 3.5.3 and were analyzed using SPSS version 18.0. RESULTS: Among the 604 surgical procedures, females were affected in more cases (351; 58.1%. When the dominant limb was the right limb, it was affected in 90% of the cases (p < 0.05. The supraspinatus tendon was affected in 574 cases (95% and the tears were of medium size in 300 cases (49.7%. Eighteen reoperations were performed (2.98% and the upper right limb was the most affected (66.6%. The cause was non-traumatic in 12 patients. The repeated tears were mostly smaller (44%, and the length of time between the two surgical procedures ranged from 6 to 298 weeks. CONCLUSION: Female gender, smaller extent in the second procedure and non-traumatic cause were found in most of the cases analyzed.

  1. Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review

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    David M Levy

    2016-01-01

    Full Text Available Rotator cuff tears have been reported to be uncommon following total shoulder arthroplasty (TSA. Postoperative rotator cuff tears can lead to pain, proximal humeral migration, and glenoid component loosening. The purpose of this paper was to evaluate the incidence of post-TSA rotator cuff tears or dysfunction in osteoarthritic patients. A systematic review of multiple databases was performed using preferred reporting items for systematic reviews and meta-analyses guidelines. Levels I-IV evidence clinical studies of patients with primary osteoarthritis with a minimum 2-year follow-up were included. Fifteen studies with 1259 patients (1338 shoulders were selected. Student′s t-tests were used with a significant alpha value of 0.05. All patients demonstrated significant improvements in motion and validated clinical outcome scores (P < 0.001. Radiographic humeral head migration was the most commonly reported data point for extrapolation of rotator cuff integrity. After 6.6 ± 3.1 years, 29.9 ± 20.7% of shoulders demonstrated superior humeral head migration and 17.9 ± 14.3% migrated a distance more than 25% of the head. This was associated with an 11.3 ± 7.9% incidence of postoperative superior cuff tears. The incidence of radiographic anterior humeral head migration was 11.9 ± 15.9%, corresponding to a 3.0 ± 13.6% rate of subscapularis tears. We found an overall 1.2 ± 4.5% rate of reoperation for cuff injury. Nearly all studies reported indirect markers of rotator cuff dysfunction, such as radiographic humeral head migration and clinical exam findings. This systematic review suggests that rotator cuff dysfunction following TSA may be more common than previously reported. IV, systematic review of Levels I-IV studies.

  2. Revision Rotator Cuff Reconstruction for Large Tears With Retraction: A Novel Technique Using Autogenous Tendon and Autologous Marrow.

    Science.gov (United States)

    Skoff, Hillel D

    2015-07-01

    Revision rotator cuff reconstruction for large tears with retraction results in a high rate of recurrent cuff tearing. To try to obtain more consistent results, I conducted a study of a technique that addresses the potential factors involved. Ten patients (7 men, 3 women) were enrolled. Mean age was 58 years. Mean follow-up was 24 months. Mean time between primary and revision cuff surgery was 36 months. The cardinal inclusion criterion was a symptomatic, full-thickness rotator cuff tear with at least 3 cm of retraction in a shoulder that previously underwent rotator cuff repair. Ultrasound was used for postoperative radiographic assessment of cuff integrity. Validated Constant, American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) shoulder scoring systems were used. Surgical technique included mini-open incision, adequate débridement and mobilization of remaining cuff, reconstitution of cuff defect with autogenous biceps tendon incubated in concentrated autologous bone marrow, and sewing under zero tissue tension. Constant, ASES, and UCLA scores improved significantly (standard error at .001). Ultrasound revealed 0% incidence of full-thickness rotator cuff retearing. In patients with large recurrent retracted rotator cuff tears the technique presented in the current study consistently yields satisfactory clinical results and promotes rotator cuff tissue healing without full-thickness retearing.

  3. Disability and satisfaction after Rotator Cuff decompression or repair: a sex and gender analysis

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    Davis Aileen M

    2011-04-01

    Full Text Available Abstract Background Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors and gender (non-biological factors with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC index, the American Shoulder & Elbow Surgeons (ASES assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment. Results and Discussion One hundred and seventy patients entered into the study (85 men and 85 women. One hundred and sixty patients (94% completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength. Conclusions The results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health

  4. Rotator cuff tears noncontrast MRI compared to MR arthrography

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    Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Department of Radiology, Chungang University Hospital, Seoul (Korea, Republic of); Yoo, Jae Chul [Sungkyunkwan University, School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2015-12-15

    To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

  5. Torn human rotator cuff tendons have reduced collagen thermal properties on differential scanning calorimetry.

    Science.gov (United States)

    Chaudhury, Salma; Holland, Christopher; Porter, David; Tirlapur, Uday K; Vollrath, Fritz; Carr, Andrew J

    2011-12-01

    The cause of the high failure rates often observed following rotator cuff tendon repairs, particularly massive tears, is not fully understood. Collagen structural changes have been shown to alter tendon thermal and mechanical properties. This study aimed to form a quantitative rather than qualitative assessment, of whether differences in collagen structure and integrity existed between small biopsies of normal, small, and massive rotator cuff tears using differential scanning calorimetry. Thermal properties were measured for 28 human biopsies taken intra-operatively from normal, small, and massive rotator cuff tendon tears in this powered study. Denaturation temperatures are represented by T(onset) (°C) and T(peak) (°C). The T(onset) is proposed to represent water-amide hydrogen bond breakage and resulting protein backbone mobility. T(peak) reportedly corresponds to the temperature at which the majority of proteins fall out of solution. Denaturation enthalpy (ΔH) should correlate with the amount of triple helical structure that is denatured. Fluorescence and confocal microscopy allowed quantitative validation. Small and massive rotator cuff tears had significantly higher T(onset), T(peak), and ΔH compared to controls. Polarized light microscopy of torn tendons confirmed greater collagen structural disruption compared to controls. These novel findings suggest greater quantifiable collagen structural disruption in rotator cuff tears, compared to controls. This study offers insight into possible mechanisms for the reduced strength of torn tendons and may explain why repaired tendons fail to heal.

  6. Morphological changes of roof of subacromial bursa in patients with rotator cuff tear

    Institute of Scientific and Technical Information of China (English)

    ZHU Jin-yu 朱锦宇; ZHU Qing-sheng 朱庆生; Takashi Hashimoto; Katsuya Nobuhara

    2004-01-01

    Objective: To investigate the morphological changes of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear. Methods: In the experimental group, the roof of SAB was obtained from 30 cases of rotator cuff tear both at the tear site and a site 2.5-3.0 cm distal to the tear site during rotator cuff repair. In the control group, the roof of SAB was obtained from the exposed site of recurrently dislocated shoulder or fractured humeral shaft of 8 cases.The specimens were stained with hematoxylin and eosin and observed under a transmission electron microscope. The cell number was quantitated through counting the bluestained nucleus in SAB with a computer image analysis system.Results: The number of cells increased significantly in the roof of SAB in the experimental group compared with that of the control group. However, no difference of the bursal reaction was found among the type of rotator cuff tear, the bursa thickness and the presence of fluid in the bursa. The great majority of cells were type B cells observed under the transmission electron microscope.Conclusions: The increase in cell number in the roof of SAB in the experimental group is a reactive increase rather than an inflammatory process and the involvement of SAB is not limited in extent. The change of the roof of SAB is a secondary reaction to the rotator cuff tear.

  7. Outcome of surgical treatment and the prognostic factors in full-thickness rotator cuff tear

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    M.R. Giti

    2006-07-01

    Full Text Available Background: Rotator cuff tendon tear injury is one of the most frequently seen orthopaedic conditions, and surgical repair of rotator cuff tears is a common procedure. The purpose of the present study was to determine the results of full-thickness rotator cuff repair and to look for predictors of outcomes. Methods: we studied 27 patients (17 men and 10 women with a mean age of 57.7 years who underwent open rotator cuff repair surgery for full-thickness tear between 2001 and 2005 at the Imam Khomeini Hospital and were subsequently followed-up for 6 and 12 months after surgery. The shoulder function was assessed by Constant classification and factors potentially associated with outcomes were Results: The mean of preoperative Constant score (CS was 45.8 ± 14.1 after 12 months, 6 patients (22.2% had good results and 21 patients (77.8% had excellent result according to CS. Pain relief was generally satisfactory. Using multiple regression analysis, treatment was significantly correlated preoperative CS and acromio-humeral interval (AHI however, no correlation was found between the result of the treatment and pretreatment atrophy, tear size, acromial morphology, preoperative symptom duration and age. Conclusion: In this study, a standard rotator cuff repair technique reduced pain severity and was associated with good results, however larger studies are necessary to define the long-term outcome of this procedure.

  8. Long-term outcome and structural integrity following open repair of massive rotator cuff tears

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    Christoph Bartl

    2012-01-01

    Full Text Available Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST and a pain visual analog scale (VAS. At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05. Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did

  9. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

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    Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

    2014-06-28

    Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.

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

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    Hio Teng Leong

    Full Text Available Although excessive tension of the upper trapezius (UT is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1 to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2 to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002, regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001. When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008 and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002 was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001. Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy.

  11. Calcifying tendinitis of the rotator cuff with focal umeral osteolysis. Imaging features

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    V. V. Mascarenhas

    2015-10-01

    Full Text Available Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. The authors report two cases of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.

  12. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment.

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    Merolla, Giovanni; Singh, Sanjay; Paladini, Paolo; Porcellini, Giuseppe

    2016-03-01

    Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.

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

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    Leong, Hio Teng; Hug, François; Fu, Siu Ngor

    2016-01-01

    Although excessive tension of the upper trapezius (UT) is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1) to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2) to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years) participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002), regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001). When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008) and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002) was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001). Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy.

  14. Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age.

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    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

    2010-12-01

    We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group: median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years). The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but different in age. After careful arthroscopic evaluation of the full-thickness rotator cuff tear, rotator cuff repair and biceps tenotomy were performed in all patients. Pre- and post-operatively, each patient was evaluated for range of motion, shoulder score (UCLA), and SF-36 self-administered questionnaire. Comparing pre- versus post-operative status at a minimum 24 months follow-up, forward elevation, internal and external rotation, modified UCLA rating system scores, and SF-36 scores improved significantly in both groups, with no significant difference between the groups. At the last follow-up, strength improved significantly in both groups, with non-significant intergroup difference. The Popeye sign was detected in 13/28 (46%) of the patients in the over 65 group and in 11/28 (39%) in the under 65 group (χ = 0.29) with non-significant difference between the two groups. In selected active patients older than 65, arthroscopic rotator cuff repair associated with biceps tenotomy (when necessary) can yield clinical and related quality of life outcomes similar to those of patients younger than 65 years.

  15. A mixed methods study to evaluate the clinical and cost-effectiveness of a self-managed exercise programme versus usual physiotherapy for chronic rotator cuff disorders: protocol for the SELF study

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    Littlewood Chris

    2012-04-01

    Full Text Available Abstract Background Shoulder pain is the third most common reason for consultation with a physiotherapist and up to 26% of the general population might be expected to experience an episode at any one time. Disorders of the shoulder muscles and tendons (rotator cuff are thought to be the commonest cause of this pain. The long-term outcome is frequently poor despite treatment. This means that many patients are exposed to more invasive treatment, e.g. surgery, and/or long-term pain and disability. Patients with this disorder typically receive a course of physiotherapy which might include a range of treatments. Specifically the value of exercise against gravity or resistance (loaded exercise in the treatment of tendon disorders is promising but appears to be under-used. Loaded exercise in other areas of the body has been favourably evaluated but further investigation is needed to evaluate the impact of these exercises in the shoulder and particularly the role of home based or supervised exercise versus usual treatment requiring clinic attendance. Methods/Design A single-centre pragmatic unblinded parallel group randomised controlled trial will evaluate the effectiveness of a self-managed loaded exercise programme versus usual clinic based physiotherapy. A total of 210 study participants with a primary complaint of shoulder pain suggestive of a rotator cuff disorder will be recruited from NHS physiotherapy waiting lists and allocated to receive a programme of self-managed exercise or usual physiotherapy using a process of block randomisation with sealed opaque envelopes. Baseline assessment for shoulder pain, function and quality of life will be undertaken with the Shoulder Pain & Disability Index, the Patient Specific Functional Scale and the SF-36. Follow-up evaluations will be completed at 3, 6 and 12 months by postal questionnaire. Both interventions will be delivered by NHS Physiotherapist’s. An economic analysis will be conducted from an

  16. Effect of methylprednisolone use on the rotator cuff in rats: biomechanical and histological study

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    Gustavo Vinícius Ghellioni

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the influence of treatment with different doses of methylprednisolone on the mechanical resistance and possible histological alterations of the rotator cuff tendon in rats.METHODS: Male Wistar rats were divided randomly into four treatment groups: sham, vehicle or 0.6 mg/kg or 6.0 mg/kg of methylprednisolone. Changes to mechanical resistance (in N and histological parameters (fibrillar appearance, presence of collagen, edema and vascular proliferation of the rotator cuff tendon were evaluated. The analyses were conducted after administration of one treatment (24 h afterwards, two treatments (7 days afterward or three treatments (14 days afterwards, into the subacromial space.RESULTS: Seven and fourteen days after the treatments were started, it was found that in a dose-dependent manner, methylprednisolone reduced the mechanical resistance of the rotator cuff tendon (p < 0.05 in relation to the vehicle group. Modifications to the histological parameters were observed on the 7th and 14th days after the first infiltration, especially regarding the presence of collagen and vascular proliferation, for the dose of 0.6 mg/kg of methylprednisolone, and also regarding the presence of collagen, edema and vascular proliferation for the dose of 6.0 mg/kg of corticoid.CONCLUSION: The results obtained demonstrated a relationship between methylprednisolone use through infiltration into the subacromial space and reduction of the mechanical resistance of and histological modifications to the rotator cuff tendon in rats.

  17. Rotator cuff degeneration in the rheumatoid shoulder : 'the issue is soft tissue'

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    Sande, Michiel Adrianus Josephus van de

    2008-01-01

    We hypothesized that shoulder pain, caused by rheumatoid arthritis (RA), can lead to disuse of the affected shoulder joint. In addition to the structural changes caused by rotator cuff tears, tendonitis or synovitis disuse may play an important role in the aetiology of fatty degeneration (FD) of the

  18. RC-QOL score for rotator cuff pathology: adaptation to Italian.

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    Papalia, Rocco; Osti, Leonardo; Leonardi, Francesco; Denaro, Vincenzo; Maffulli, Nicola

    2010-10-01

    We translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The RC-QOL questionnaire was then administered to 22 subjects (range 45-74 years) with a diagnosis of rotator cuff tears. For test-retest evaluation, the 22 patients were asked to complete the questionnaire at first examination, and 30 min following the end of this examination. The intraclass correlation coefficient for the 22 patients was 0.94 (95% CI = 0.85-0.98), indicating a high reliability. There were no significant differences between the scores immediately after the consultation and 30 min later. The Italian and the English versions of the RC-QOL questionnaire evaluate the same aspects of clinical severity in patients with rotator cuff tears.

  19. Ultrasound: Can it replace MRI in the evaluation of the rotator cuff tears?

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    Samira Saraya

    2016-03-01

    Conclusion: Ultrasound and MRI are comparable in both sensitivity and specificity. Since US is less expensive and more available, it could be considered as the screening method when rotator cuff integrity is the main question, if well-trained radiologists and high resolution equipments are available.

  20. Calcific tendinitis of the rotator cuff as a cause of drooping shoulder

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    Prato, N.; Banderali, A. [Department of Radiology, San Carlo Hospital, Piazzale Gianasso, 16158 Genoa (Italy); Neumaier, C.E. [Department of Radiology, National Cancer Institute, Viale Benedetto XV 10, 16132 Genoa (Italy); Dahmane, M.; Martinoli, C.; Derchi, L.E. [Department of Radiology, University of Genoa, Viale Benedetto XV 10, 16132 Genoa (Italy)

    2003-02-01

    We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed. (orig.)

  1. IMAGING OF ROTATOR CUFF PATHOLOGY- IS ULTRASOUND AS GOOD AS MRI

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    Vinot

    2015-12-01

    Full Text Available Aim of this study is to compare the diagnostic accuracy of ultrasound versus MRI in detecting rotator cuff pathology. Rotator cuff pathology involves group of disorder, which progresses from bursitis to tendinitis to partial tear and full thickenss tear. The most commonly affected tendon is the supraspinatus tendon. In our prospective study of 35 patients as initial ultrasound was followed by MRI sensitivity, specificity and accuracy for diagnosis of full thickness tear of supraspinatus when USG was compared to MRI was 100%, whereas sensitivity, specificity and accuracy of diagnosing partial thickness tear using ultrasound compared to MRI are 100%, 78% and 84%. There is no significant p value difference on comparing ultrasound with MRI on detecting tears. Ultrasound and MRI showed almost similar diagnostic accuracy in associated findings like tendon retraction, muscle atrophy, bursal effusion. Ultrasound also has additional value of dynamic evaluation, which is useful in evaluating subacromial and subcoracoid impingement. Modality choice for the evaluation of rotator cuff pathology should be based on several factors like availability, patient preference and clinical information being sought. The high resolution sonography is an attractive screening modality for rotator cuff in patients presenting with painful shoulder. A well performed ultrasound examination in most cases obviates the need for more invasive diagnostic tests like arthrography and cumbersome and expensive MRI examinations.

  2. Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency

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    RANDELLI, PIETRO; RANDELLI, FILIPPO; COMPAGNONI, RICCARDO; CABITZA, PAOLO; RAGONE, VINCENZA; PULICI, LUCA; BANFI, GIUSEPPE

    2015-01-01

    Purpose the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. Methods a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. Results nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. Conclusions RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. Level of evidence level IV, systematic review of level I–IV studies. PMID:26151037

  3. The rotator cuff: from bench to bedside. Developments in tissue engineering, surgical techniques and pathogenetic factors

    NARCIS (Netherlands)

    Longo, U.G.

    2012-01-01

    This thesis originates from the difficulties in the management of patients with rotator cuff tears. Since tendon healing rate is relatively slow compared with other connective tissues, we reviewed the available literature on tissue engineered biological augmentation for tendon healing, including gro

  4. Molecular mechanism of fatty degeneration in rotator cuff muscle with tendon rupture.

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    Itoigawa, Yoshiaki; Kishimoto, Koshi N; Sano, Hirotaka; Kaneko, Kazuo; Itoi, Eiji

    2011-06-01

    Fatty degeneration often occurs in rotator cuff muscle with tendon rupture. However, the molecular mechanism underlying this change has not been fully clarified yet. We investigated the gene expression of Wnt10b and adipogenic marker gene, PPARγ and C/EBPα in C2C12 myogenic cell line under inhibition of Wnt10b by adipogenic induction medium, isobutylmethylxanthine, dexamethasone, and insulin (MDI). The role of Wnt-signal was confirmed by adding Lithium chloride (LiCl), which mimics Wnt signaling to the cultured cell with MDI. We also assessed the expression profiles of same genes in the rat rotator cuff tear model in vivo. MDI induced Oil red-O staining positive adipocytes and upregulated PPARγ and C/EBPα expression. LiCl inhibited adipogenic induction of MDI. Rotator cuff muscle with tendon rupture showed positive staining for Oil red-O. Real-time polymerase chain reaction analyses revealed decreased expression of Wnt10b followed by increased PPARγ and C/EBPα gene expression in the supraspinatus muscle. Fatty degeneration and its molecular events were remarkably seen in the distal one-third of the detached supraspinatus muscle versus control. Wnt signaling may regulate adipogenic differentiation both in the myoblasts in vitro and the muscle in vivo. Our results indicate that the reduction of Wnt10b in muscle with a rotator cuff tear is a key signal in fatty degeneration of the muscle.

  5. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

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    Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

    2007-02-15

    We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

  6. Comparison of self-report and interview administration methods based on the Brazilian versions of the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire in patients with rotator cuff disorders

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    Andréa Diniz Lopes

    2009-02-01

    Full Text Available OBJECTIVE: The purpose of the present study was to compare self-report and interview administration methods using the Western Ontario Rotator Cuff Index (WORC and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH in patients with rotator cuff disorders. METHODS: Thirty male and female patients over 18 years of age with rotator cuff disorders (tendinopathy or rotator cuff tear and Brazilian Portuguese as their primary language were recruited for assessment via administration of the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire. A randomization method was used to determine whether the questionnaires would be self-reported (n=15 or administered by an interviewer (n=15. Pearson correlation coefficients were used to evaluate the correlation between the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire in each group. The t-test was used to determine whether the difference in mean questionnaire scores and administration time was statistically significant. For statistical analysis, the level of significance was set at 5%. RESULTS: The mean subject age was 55.07 years, ranging from 27 to 74 years. Most patients had a diagnosis of tendinopathy (n=21. With regard to level of schooling, the majority (n=26 of subjects had completed a college degree or higher. The mean questionnaire scores and administration times did not significantly differ between the two groups (p>0.05. There were statistically significant correlations (p<0.05 between Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire, and strong correlations were found between the questionnaires in both groups. CONCLUSION: There are no differences between the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire administration methods with regard to administration time or correlations between the

  7. Systematics of injuries of the rotator cuff and biceps tendon; Systematik der Verletzungen von Rotatorenmanschette und Bizepssehne

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    Breitenseher, M.J. [Landesklinikum Horn, Institut fuer Radiologie und interventionelle Radiologie, Horn (Austria); Pones, M.; Breitenseher, J.B. [Medizinische Universitaet Wien, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria)

    2015-03-01

    Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically. These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury. Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns. (orig.) [German] Bei der Verletzung von Rotatorenmanschette und Bizepssehne koennen verschiedene Muster klinisch und radiologisch erkannt werden. Diese Muster sind das Impingementsyndrom mit einem zusaetzlichen Trauma, das isolierte Trauma und die Verletzung der Rotatorenmanschette im Rahmen einer Schulterluxation. Darueber hinaus ist die Beurteilung des Ausmasses einer Verletzung von zentraler klinischer Relevanz. Die MRT kann die Differenzierung dieser Muster bestmoeglich durchfuehren. (orig.)

  8. "Bursal reactions" in rotator cuff tearing, the impingement syndrome, and calcifying tendinitis.

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    Ishii, H; Brunet, J A; Welsh, R P; Uhthoff, H K

    1997-01-01

    Subacromial bursal specimens from 63 patients undergoing surgery for rotator cuff tearing (n = 43), the impingement syndrome (n = 14), and calcifying tendinitis n = 6) were studied to characterize the reactions that develop at the tendinopathy "lesional" sites. Intensity of the bursal reactions and production of type III collagen vary considerably, with the highest incidence of both seen in patients with rotator cuff tears. The intensity of bursal reactions correlated with the degree of formation of perivascular new collagen and type III collagen expression. In 22 of the 63 patients the bursal reaction distant to the tendon lesion was also studied. It was minimal and did not correlate to the lesional bursal findings. A strong correlation, however, existed between surgical appearance and histologic grading. The term "localized bursal reaction" as opposed to bursitis more correctly describes bursal involvement. Resection of bursal tissues should be limited to the lesional tissue that interferes with subacromial motion.

  9. Anatomical total shoulder replacement with rotator cuff repair for osteoarthritis of the shoulder.

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    Simone, J P; Streubel, P H; Sperling, J W; Schleck, C D; Cofield, R H; Athwal, G S

    2014-02-01

    We assessed the clinical results, radiographic outcomes and complications of patients undergoing total shoulder replacement (TSR) for osteoarthritis with concurrent repair of a full-thickness rotator cuff tear. Between 1996 and 2010, 45 of 932 patients (4.8%) undergoing TSR for osteoarthritis underwent rotator cuff repair. The final study group comprised 33 patients with a mean follow-up of 4.7 years (3 months to 13 years). Tears were classified into small (10), medium (14), large (9) or massive (0). On a scale of 1 to 5, pain decreased from a mean of 4.7 to 1.7 (p = shoulders during anatomical TSR, but reverse replacement should be considered for older, less active patients with larger tears.

  10. A pilot trial to study the effectiveness of an exercise programme in the treatment of rotator cuff tendinopathy

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    STASINOPOULOS DIMITRIOS

    2014-10-01

    Full Text Available The aim of this pilot trial was to study the effectiveness of an exercise programme in the treatment of chronic rotator cuff tendinopathy. Patients were allocated to two groups by sequential allocation. the patients in group a (n=10 received an exercise programme consisted of slow progressive isotonic, including eccentric, strengthening exercises and static stretching exercises. The exercise programme was given daily (apart from weekends for 4 weeks. The patients in the group B (placebo group, n=10 received placebo tablets (unmarked vitamin C twice daily for four weeks. Patients’ pain was evaluated using a visual analogue scale (VaS at the end of the four-week course of treatment (week 4 and three months after the end of treatment (week 16. Differences between groups were determined using the independent t test. The difference within groups between baseline and end of treatment was analysed with a paired t test. At the end of treatment there was a decline in visual analogue scale of about 7 units in the exercise programme group compared with baseline (p0.0005, independent t test in favour of the exercise programme group. Although the pain reduced in patients with shoulder tendinopathy at the end of the treatment using an exercise programme, future controlled studies are needed to establish the effectiveness of an exercise programme in the treatment of rotator cuff tendinopthy.

  11. Septic arthritis and arthropathy of the rotator cuff: remember this association

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    Danilo Sobreira

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: To describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures. METHODOLOGy: Eight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females. Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years. The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity. RESULTS: All seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients' satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case. CONCLUSION: Surgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected.

  12. Comparison of rotator cuff muscle architecture between humans and other selected vertebrate species.

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    Mathewson, Margie A; Kwan, Alan; Eng, Carolyn M; Lieber, Richard L; Ward, Samuel R

    2014-01-15

    In this study, we compare rotator cuff muscle architecture of typically used animal models with that of humans and quantify the scaling relationships of these muscles across mammals. The four muscles that correspond to the human rotator cuff - supraspinatus, infraspinatus, subscapularis and teres minor - of 10 commonly studied animals were excised and subjected to a series of comparative measurements. When body mass among animals was regressed against physiological cross-sectional area, muscle mass and normalized fiber length, the confidence intervals suggested geometric scaling but did not exclude other scaling relationships. Based on the architectural difference index (ADI), a combined measure of fiber length-to-moment arm ratio, fiber length-to-muscle length ratio and the fraction of the total rotator cuff physiological cross-sectional area contributed by each muscle, chimpanzees were found to be the most similar to humans (ADI=2.15), followed closely by capuchins (ADI=2.16). Interestingly, of the eight non-primates studied, smaller mammals such as mice, rats and dogs were more similar to humans in architectural parameters compared with larger mammals such as sheep, pigs or cows. The force production versus velocity trade-off (indicated by fiber length-to-moment arm ratio) and the excursion ability (indicated by fiber length-to-muscle length ratio) of humans were also most similar to those of primates, followed by the small mammals. Overall, primates provide the best architectural representation of human muscle architecture. However, based on the muscle architectural parameters of non-primates, smaller rather than larger mammals may be better models for studying muscles related to the human rotator cuff.

  13. The accurate assessment and physiotherapeutic treatment of rotator cuff myofascial Pain Syndrome: A case report

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    B. B. Barker

    2011-02-01

    Full Text Available Management  of  patients  with  rotator  cuff  myofascial  pain syndrome varies  and  successful  intervention  is  dependent  on accurate assessment. The aim of this case report is to show the importance of accurate assessment  and  clinical  reasoning  in  the  physiotherapeutic management  of a  patient  suffering  from  ante-cubital  and  anterior shoulder  pain.  The  patient was  referred  for  physiotherapy  after proving refractory  to  treatment  with  non-steroidal anti-inflammatory medication. The physiotherapist diagnosed a rotator cuff myofascial pain syndrome and treatment proceeded on that basis. Treatment consisted of twitch-obtaining dry needling, myofascial release and exercise therapy.  The result was a change in the harryman rotator cuff functional Assessment Scale score from 22/52 to 43/52 over eight treatments. Strength was regained and subjective pain report on the visual rating scale was improved to 1/10. The case study highlights the importance of accurate assessment and consideration of alternative myofascial sources for pain even in circumstances which initially seem trauma related. Precise diagnosis of the cause - in this case rotator cuff myofascial pain syndrome – will result in effective treatment being administered.

  14. Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff.

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    Kim,Eugene

    2006-08-01

    Full Text Available The purpose of this study was to investigate the validity of the supraspinatus test as a screening test for detecting torn rotator cuff and to determine what its valuable positive signs were. Both the empty-can test and full-can test were performed on 200 shoulders diagnosed by magnetic resonance imaging (MRI-and in some cases, surgical findings-to have full-thickness or partial-thickness torn rotator cuff s, or no tear in the rotator cuff . During the maneuver, the presence of pain or weakness or both pain and weakness were recorded as positive signs, and the distribution of these signs were analyzed according to the degree of tear. The predictive values were calculated in 2 ways by considering (1 only full-thickness tears as tears and (2 both full- and partial-thickness tears as tears. The 2 tests and the 2 ways of considering partial-thickness tears were compared. Pain and weakness were severity-dependent, and the empty-can test had a higher incidence of pain. The sensitivities of the 2 supraspinatus tests in all positive signs were higher when including partial-thickness tears in the tear group ; however, their specificities were higher when excluding partial-thickness tears. Both pain and weakness were interpretive for the supraspinatus test, and both tests were sensitive to full- and partial- thickness tears and specific for full-thickness tears.

  15. Rotator cuff injuries: current perspectives and trends for treatment and rehabilitation

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    Fabio Antonio Vieira

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To map out the approaches used by Brazilian orthopedists in treating complete tears of the rotator cuff. METHODS: A multiple-choice questionnaire was handed out to 232 orthopedists at the 45th Brazilian Congress of Orthopedics and Traumatology. Of these, 207 were returned but five were incomplete and were excluded. Thus, 202 questionnaires were used. RESULTS: Among the orthopedists who answered the questionnaires, around 60% were from the southeastern region and 46% were shoulder and elbow surgeons. There was a significant association ( p < 0.05 between length of experience and number of rotator cuff repairs performed per year. There was also a significant association ( p < 0.05 between shoulder specialty and the following variables: arthroscopic technique, use of anchors in a single-row configuration, mean time taken for an indication for surgery to be made in cases of traumatic and degenerative lesions, use of a specific protocol for postsurgical rehabilitation, return to sport and indication of irreparable injuries. CONCLUSIONS: Brazilian shoulder surgeons have well-established approaches toward treating rotator cuff injuries. Most of these approaches differ significantly from those of other specialties. This shows the importance of placing value on training in preparing shoulder specialists in this country.

  16. Rabbit supraspinatus motor endplates are unaffected by a rotator cuff tear.

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    Gayton, J Christopher; Rubino, L Joseph; Rich, Mark M; Stouffer, Mark H; Wang, Qingbo; Boivin, Gregory P

    2013-01-01

    Rotator cuff tears are a major cause of morbidity. Following rotator cuff tears, muscle atrophy and fatty infiltration begin in the tissue, limiting repair potential and leading to a higher re-tear rate and a worse functional outcome. We evaluated whether fatty degeneration resulting from a complete supraspinatus tear with retraction is associated with an injury to the suprascapular nerve. Four skeletally mature New Zealand white rabbits were randomized to receive an index procedure on either their right or left shoulder with the opposite shoulder serving as a control. At the index procedure, the supraspinatus tendon was transected at its insertion and allowed to retract. At 3 months, the rabbits were euthanized, and both supraspinatus muscles were harvested. The specimens were then examined with confocal microscopy and histology. Atrophy was grossly visible in all four test muscles, and fatty infiltration was confirmed with osmium tetroxide staining. In all four rabbits, the degree of denervation (p = 0.71) and partial denervation (p = 0.91) was not significantly different between control and experimental muscle. Rotator cuff tear does not affect the motor endplate or innervation status of the supraspinatus. Fatty infiltration occurs independent of denervation of the supraspinatus.

  17. Platelets and plasma stimulate sheep rotator cuff tendon tenocytes when cultured in an extracellular matrix scaffold.

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    Kelly, Brian A; Proffen, Benedikt L; Haslauer, Carla M; Murray, Martha M

    2016-04-01

    The addition of platelet-rich plasma (PRP) to rotator cuff repair has not translated into improved outcomes after surgery. However, recent work stimulating ligament healing has demonstrated improved outcomes when PRP or whole blood is combined with an extracellular matrix carrier. The objective of this study was to evaluate the effect of three components of blood (plasma, platelets, and macrophages) on the in vitro activity of ovine rotator cuff cells cultured in an extracellular matrix environment. Tenocytes were obtained from six ovine infraspinatus tendons and cultured over 14 days in an extracellular matrix scaffold with the following additives: (1) plasma (PPP), (2) plasma and platelets (PAP), (3) plasma and macrophages (PPPM), (4) plasma, platelets and macrophages (PAPM), (5) phosphate buffered saline (PBS), and (6) PBS with macrophages (PBSM). Assays measuring cellular metabolism (AlamarBlue), proliferation (Quantitative DNA assay), synthesis of collagen and cytokines (SIRCOL, TNF-α and IL-10 ELISA, and MMP assay), and collagen gene expression (qPCR) were performed over the duration of the experiment, as well as histology at the conclusion. Plasma was found to stimulate cell attachment and spreading on the scaffold, as well as cellular proliferation. Platelets also stimulated cell proliferation, cellular metabolism, transition of cells to a myofibroblast phenotype, and contraction of the scaffolds. The addition of macrophages did not have any significant effect on the sheep rotator cuff cells in vitro. In vivo studies are needed to determine whether these changes in cellular function will translate into improved tendon healing.

  18. Localization and expression of osteopontin in the rotator cuff tendons in patients with calcifying tendinitis.

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    Takeuchi, E; Sugamoto, K; Nakase, T; Miyamoto, T; Kaneko, M; Tomita, T; Myoui, A; Ochi, T; Yoshikawa, H

    2001-06-01

    Calcifying tendinitis of rotator cuff tendons is a common and painful condition caused by ectopic calcification in humans. To examine the involvement of osteopontin (OPN), a potent regulator of calcium deposition on connective tissues, localization and expression of OPN protein and messenger (m)RNA were investigated in human tissue samples of calcified rotator cuff tendons. Immunohistochemistry demonstrated that OPN was localized in cells surrounding the calcified area. OPN was localized in two distinct cell types, i.e., fibroblast-like cells negative for CD68 and tartrate-resistant acid phosphatase (TRAP) and multinucleated macrophages positive for CD68 and TRAP. In situ hybridization revealed that the mRNA expression of OPN in these cells coincided with the immunohistochemistry results, and these results were supported by reverse transcriptase polymerase chain reaction analysis using human OPN-specific oligonucleotides. Cells located away from the calcified area did not express OPN. The present findings indicate the involvement of OPN in the process of calcification of rotator cuff tendons and suggest that OPN plays a role in such painful disorders through the actions of at least two cell types.

  19. Electromyographic study of rotator cuff muscle activity during full and empty can tests

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    Yoshihiro Kai

    2015-01-01

    Full Text Available The empty can (EC and full can (FC tests are used as diagnostic tools for patients with rotator cuff disease. However, recently concerns have been raised that these tests do not selectively activate the muscle. Therefore, the purpose of this study was to evaluate the rotator cuff muscle activation levels during the EC and FC tests in various positions using electromyography. Twelve healthy, right-handed men without shoulder complaints (mean age: 26.1 years, range: 23–35 years were included. The tests were performed isometrically with the shoulder elevated at 45° and 90° in the sagittal, scapular, and coronal planes, either in the thumb-up (FC test or thumb-down (EC test positions. During these positions, the electromyographic signal was recorded simultaneously from the four shoulder muscles using a combination of surface and intramuscular fine-wire electrodes. The average activation of the supraspinatus and subscapularis was greater during the EC test than during the FC test and in the scapular and coronal planes than in the sagittal plane at 90°. For the infraspinatus, there were no significant differences in any positions between the two tests. Thus, the rotator cuff muscles are influenced by arm position and the elevation plane during the EC and FC tests.

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

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    Xiaoxi Ji

    Full Text Available The major concern of using a large animal model to study rotator cuff repair is the high rate of repair retears. The purpose of this study was to test a non-weight-bearing (NWB canine model for rotator cuff repair research.First, in the in vitro study, 18 shoulders were randomized to 3 groups. 1 Full-width transections repaired with modified Mason-Allen sutures using 3-0 polyglactin suture, 2 Group 1 repaired using number 2 (#2 polyester braid and long-chain polyethylene suture, and 3 Partial-width transections leaving the superior 2 mm infraspinatus tendon intact without repair. In the in vivo study of 6 dogs, the infraspinatus tendon was partially transected as the same as the in vitro group 3. A radial neurectomy was performed to prevent weight bearing. The operated limb was slung in a custom-made jacket for 6 weeks.In the in vitro study, mean ultimate tensile load and stiffness in Group 2 were significantly higher than Group 1 and 3 (p<0.05. In the in vivo study, gross inspection and histology showed that the preserved superior 2-mm portion of the infraspinatus tendon remained intact with normal structure.Based on the biomechanical and histological findings, this canine NWB model may be an appropriate and useful model for studies of rotator cuff repair.

  1. Effectiveness of shock wave therapy as an alternative to the rotator cuff injury treatment

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    Roberto Joaquín Del Gordo-D´Amato

    2016-02-01

    Full Text Available Rotator cuff injuries are reason for consultation frequent in elderly patients. Most of the time there are no background traumatic acute generating progressive limitations in activities of daily living (ADLS. The objective of this study is to show results in tendonitis of the rotator cuff, in patients treated with extracorporeal shock wave therapy (ESWT. It is a prospective descriptive observational study which presents clinical and functional outcomes in patients with described lesion, treated with ESWT with poor response to conventional treatments and clinical pictures of longstanding through implementing visual analog scale (VAS of pain and evaluation of range of motion. The greater presence of lesion is present in women 63.6%. Mostly affected shoulder was right in a 63.6%. Found significant changes in VAS pre and post treatment with averages of 7.9 and 0.5 respectively and different statistical p < 0.001. We were conclude that the ESWT is an effective method in the treatment of the tendonitis of the rotator cuff with relief from pain and return to functional levels.

  2. Low-term results from non-conventional partial arthroplasty for treating rotator cuff arthroplasthy

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    Antônio Carlos Tenor Júnior

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the evolution of the functional results from CTA(rhemiarthroplasty for surgically treating degenerative arthroplathy of the rotator cuff, with a mean follow-up of 5.4 years.METHODS: Eighteen patients who underwent CTA(r partial arthroplasty to treat degenerative arthroplathy of the rotator cuff between April 2007 and June 2009 were reevaluated, with minimum and mean follow-ups of 4.6 years and 5.4 years, respectively. Pre and postoperative parameters for functionality and patient satisfaction were used (functional scale of the University of California in Los Angeles, UCLA. All the patients underwent prior conservative treatment for 6 months and underwent surgical treatment because of the absence of satisfactory results. Patients were excluded if they presented any of the following: previous shoulder surgery; pseudoparalysis; insufficiency of the coracoacromial arch (type 2 B in Seebauer's classification; neurological lesions; or insufficiency of the deltoid muscle and the subscapularis muscle.RESULTS: With a mean follow-up of 5.4 years, 14 patients considered that they were satisfied with the surgery (78%; the mean range of joint motion for active elevation improved from 55.8° before the operation to 82.0° after the operation; the mean external rotation improved from 18.9° before the operation to 27.3° after the operation; and the mean medial rotation remained at the level of the third lumbar vertebra. The mean UCLA score after the mean follow-up of 5.4 years was 23.94 and this was an improvement in comparison with the preoperative mean and the mean 1 year after the operation.CONCLUSION: The functional results from CTA(r hemiarthroplasty for treating rotator cuff arthroplasty in selected patients remained satisfactory after a mean follow-up of 5.4 years.

  3. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

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    Godinho, Glaydson Gomes; Freitas, José Márcio Alves; de Oliveira França, Flávio; Santos, Flávio Márcio Lago; de Simoni, Leandro Furtado; Godinho, Pedro Couto

    2016-01-01

    Objective To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. Methods Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. Results The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). Conclusion The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation. PMID:27069884

  4. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

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    Glaydson Gomes Godinho

    2016-04-01

    Full Text Available OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A or greater than or equal to 3.0 cm (group B. All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743. Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416. CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation.

  5. Functional evaluation of arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis,

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    Alberto Naoki Miyazaki

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the functional result from arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis, defined as incapacity to actively raise the arm above 90◦ , while complete passive elevation was possible.METHODS: we reevaluated 38 patients with a mean follow-up of 51 months (minimum of 24. We analyzed the pseudoparalysis reversion rate and the functional result obtained.RESULTS: according to the assessment criteria of the University of California in Los Angeles (UCLA, 31 (82% patients had good and excellent results, two (5% had fair results and five (13% had poor results. The mean active elevation went from 39◦ before the operation to 139◦ after the operation (p < 0.05; the mean active lateral rotation went from 30◦ to 48◦ (p < 0.05 and the mean active medial rotation went from level L3 to T12 (p < 0.05.CONCLUSION: arthroscopic repair of rotator cuff injuries produced good and excellent results in 82% of the cases and a statistically significant improvement of active range of motion, with reversion of the pseudoparalysis in 97.4% of the cases. It is therefore a good treatment option.

  6. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

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    Raza Syed A

    2009-12-01

    Full Text Available Abstract Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved

  7. Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence

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    Abdul-Wahab, Taiceer A.; Betancourt, Jean P.; Hassan, Fadi; Thani, Saeed Al.; Choueiri, Hened; Jain, Nitin B.; Malanga, Gerard A.; Murrell, William D.; Prasad, Anil; Verborgt, Olivier

    2016-01-01

    Summary Background rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Methods a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 – 1 December 2014), search terms: ‘rotator cuff tear’, ‘natural history’, ‘atraumatic’, ‘injection’, ‘physiotherapy’ or ‘physical therapy’, ‘injection’, ‘corticosteroid’, ‘PRP‘, ‘MSC’, risk of conservative treatment’, and ‘surgical indication’. Results eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88–44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome. Conclusions complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy. PMID:27331030

  8. Icariin Promotes Tendon-Bone Healing during Repair of Rotator Cuff Tears: A Biomechanical and Histological Study

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    Ye, Chenyi; Zhang, Wei; Wang, Shengdong; Jiang, Shuai; Yu, Yuanbin; Chen, Erman; Xue, Deting; Chen, Jianzhong; He, Rongxin

    2016-01-01

    To investigate whether the systematic administration of icariin (ICA) promotes tendon-bone healing after rotator cuff reconstruction in vivo, a total of 64 male Sprague Dawley rats were used in a rotator cuff injury model and underwent rotator cuff reconstruction (bone tunnel suture fixation). Rats from the ICA group (n = 32) were gavage-fed daily with ICA at 0.125 mg/g, while rats in the control group (n = 32) received saline only. Micro-computed tomography, biomechanical tests, serum ELISA (calcium; Ca, alkaline phosphatase; AP, osteocalcin; OCN) and histological examinations (Safranin O and Fast Green staining, type I, II and III collagen (Col1, Col2, and Col3), CD31, and vascular endothelial growth factor (VEGF)) were analyzed two and four weeks after surgery. In the ICA group, the serum levels of AP and OCN were higher than in the control group. More Col1-, Col2-, CD31-, and VEGF-positive cells, together with a greater degree of osteogenesis, were detected in the ICA group compared with the control group. During mechanical testing, the ICA group showed a significantly higher ultimate failure load than the control group at both two and four weeks. Our results indicate that the systematic administration of ICA could promote angiogenesis and tendon-bone healing after rotator cuff reconstruction, with superior mechanical strength compared with the controls. Treatment for rotator cuff injury using systematically-administered ICA could be a promising strategy. PMID:27792147

  9. Towards predictive diagnosis and management of rotator cuff disease: using curvelet transform for edge detection and segmentation of tissue

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    Pai Raikar, Vipul; Kwartowitz, David M.

    2016-04-01

    Degradation and injury of the rotator cuff is one of the most common diseases of the shoulder among the general population. In orthopedic injuries, rotator cuff disease is only second to back pain in terms of overall reduced quality of life for patients. Clinically, this disease is managed via pain and activity assessment and diagnostic imaging using ultrasound and MRI. Ultrasound has been shown to have good accuracy for identification and measurement of rotator cuff tears. In our previous work, we have developed novel, real-time techniques to biomechanically assess the condition of the rotator cuff based on Musculoskeletal Ultrasound. Of the rotator cuff tissues, supraspinatus is the first that sees degradation and is the most commonly affected. In our work, one of the challenges lies in effectively segmenting and characterizing the supraspinatus. We are exploring the possibility of using curvelet transform for improving techniques to segment tissue in ultrasound. Curvelets have been shown to give optimal multi-scale representation of edges in images. They are designed to represent edges and singularities along curves in images which makes them an attractive proposition for use in ultrasound segmentation. In this work, we present a novel approach to the possibility of using curvelet transforms for automatic edge and feature extraction for the supraspinatus.

  10. Are shoulder surgeons any good at diagnosing rotator cuff tears using ultrasound?: A comparative analysis of surgeon vs radiologist

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    Jeyam Muthu

    2008-01-01

    Full Text Available High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US. All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92% and the radiologist (94%. The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 85% for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.

  11. Study of the porcine dermal collagen repair patch in morpho-functional recovery of the rotator cuff after minimum follow-up of 2.5 years.

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    Giannotti, Stefano; Ghilardi, Marco; Dell'osso, Giacomo; Magistrelli, Luca; Bugelli, Giulia; Di Rollo, Frederica; Ricci, Giulia; Calabrese, Rosanna; Siciliano, Gabriele; Guido, Giulio

    2014-03-01

    Tendon augmentation grafts have the potential to facilitate the repair of massive or otherwise unrepairable rotator cuff tears. In our clinic, between 2009 and 2013, 25 patients underwent surgery to treat massive symptomatic rotator cuff tears with porcine dermal collagen patch. This study is a clinical and instrumental assessment of 9 patients with the longest follow-up. These patients were evaluated with Constant score, the American Shoulder and Elbow Surgeons Evaluation Form, ultrasound imaging, magnetic resonance imaging, and electromyography. The clinical evaluations have shown good outcomes. The magnetic resonance imaging results were comparable with those of the ultrasound scan. In all cases, we found covering of humeral head, centering of the humeral head, maintenance of the tropism of the supraspinatus, no appearance of fatty degeneration, no worse in cases with fatty degeneration. With the electromyographic examination a complete functional recovery was observed with the possibility of performing maximal contraction against resistance in all cases. We believe that porcine dermal collagen is effective as an augmentation graft in the treatment of chronic extensive rotator cuff tears, providing excellent pain relief with an improvement in active ranges of motion and strength.

  12. Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears

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    Justus Gille

    2009-09-01

    Full Text Available The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI and the Constant and Simple (CS shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3 to 72.3 (±7.8 at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p0.05. Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.

  13. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff

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    Vandevenne, Jan E. [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium); Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Mahachie John, Jestinah M. [University of Hasselt, Centre for Statistics, Diepenbeek (Belgium); Gelin, Geert [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium)

    2009-07-15

    The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography to diagnose rotator cuff tears. Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS (acquisition time of 5 min) sequences in the axial and paracoronal plane on a 1.0-T MR unit. Two radiologists scored rotator cuff tendons on VIBE and T1-FS images separately as normal, small/large partial thickness and full thickness tears with or without geyser sign. T1-FS sequences were considered the gold standard. Surgical correlation was available in a small sample. Sensitivity, specificity, and positive and negative predictive values of VIBE were greater than 92% for large articular-sided partial thickness and full thickness tears. For detecting fraying and articular-sided small partial thickness tears, these parameters were 55%, 94%, 94%, and 57%, respectively. The simple kappa value was 0.76, and the weighted kappa value was 0.86 for agreement between T1-FS and VIBE scores. All large partial and full thickness tears at surgery were correctly diagnosed using VIBE or T1-FS MR images. Fast MR arthrography of the shoulder joint using VIBE sequences showed good concordance with the classically used T1-FS sequences for the appearance of the rotator cuff, in particular for large articular-sided partial thickness tears and for full thickness tears. Due to its very short acquisition time, VIBE may be especially useful when performing MR arthrography in claustrophobic patients or patients with a painful shoulder. (orig.)

  14. Long Head of the Biceps Pathology Combined with Rotator Cuff Tears

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    Konstantinos Ditsios

    2012-01-01

    Full Text Available The long head of the biceps tendon (LHBT is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies.

  15. [Rotator cuff diseases in occupational medicine between occupational diseases and accidents: medical-legal considerations].

    Science.gov (United States)

    Spigno, F; Galli, R; Casali, C; Lagattolla, N; De Lucchi, M

    2010-01-01

    The authors have gone through the complaints concerning all the cases of shoulder accidents at work filed by the Genoa office of the Italian Workers' National compensation Agency (INAIL) during the two years' period 2006-2007, reviewing in particular those somehow affecting rotator components. The aim of this paper is to assess the real role played by the occupational trauma in the rotator cuff tear. The data gathered so far have shown, on the one hand, a high prevalence of pre-existing inflammatory and degenerative diseases and, on the other, a rather modest influence of the trauma which, for this reason, has usually borne, as an immediate medico-legal consequence, the rejection of a cause-effect relationship between the accident and the rotator cuff lesion, without taking into any account whether the worker was likely to be affected by an occupational disease (ex table Ministerial Decree n. 81 April 9th 2008- item 78). In such cases a systematic and in-depth investigation of the occupational case history is suggested, in order to highlight the possible pre-existence of a former biomechanical overload of the upper limbs, so as to allow the physician to detect a pathology often misdiagnosed.

  16. Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study

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    Cochet, Hubert [Hopital Cardiologique du Haut-Leveque, CHU Bordeaux, Unite d' Imagerie Thoracique et Cardiovasculaire, Pessac (France); Couderc, Stephane; Pele, Eric; Moreau-Durieux, Marie-Helene; Hauger, Olivier [Hopital Pellegrin, CHU Bordeaux, Unite d' Imagerie Osteo-articulaire, Bordeaux (France); Amoretti, Nicolas [CHU Archet, Unite d' Imagerie Osteo-articulaire, Nice (France)

    2010-05-15

    To evaluate the impact of abduction and external rotation (ABER) positioning performed before image acquisition on the assessment of rotator cuff tears. Twenty-seven consecutive patients with clinically suspected rotator cuff tears underwent an initial CT arthrogram of the shoulder in neutral position, immediately followed by temporary ABER positioning, before a second CT acquisition in neutral position. Two observers blinded to potential pre-procedure ABER positioning independently analysed the randomly distributed images. Lesions were classified into partial-thickness (PT) and full-thickness (FT) tear subtypes. Lesion detection and measurements of pre- and post-ABER studies were compared. We found no influence of pre-test ABER positioning on FT detection or measurements. Every PT detected on pre-ABER study was also detected on post-ABER study (28/28 for reader 1, and 32/32 for reader 2). Seven and eight additional PT were found by readers 1 and 2, respectively, on post-ABER study. Lesion size increased after ABER in terms of area (P < 0.001 for both readers) and Ellman's grade (P = 0.02 and 0.002 for reader 1 and 2, respectively). ABER positioning before CT is associated with improved delineation of partial tears, a higher number of detected tears and modification of treatment planning. (orig.)

  17. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis

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    Smith, T.O., E-mail: toby.smith@uea.ac.uk [Department of Physiotherapy, University of East Anglia (United Kingdom); Back, T. [Department of Physiotherapy, Norfolk and Norwich University Hospital, London (United Kingdom); Toms, A.P. [Department of Radiology, Norfolk and Norwich University Hospital, London (United Kingdom); Hing, C.B. [Department of Orthopaedic Surgery, St George' s Hospital, London (United Kingdom)

    2011-11-15

    Aim: To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. Materials and methods: An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. Results: Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. Conclusion: Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.

  18. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects

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    Zanetti, M.; Hodler, J. [Dept. of Radiology, University Hospital Balgrist, Zurich (Switzerland); Jost, B.; Gerber, C. [Dept. of Orthopedic Surgery, University Hospital Balgrist, Zurich (Switzerland)

    2000-06-01

    Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings.Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27-53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined.Results. Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6-11 mm) than in the symptomatic group (mean 32 mm, range 7-50 mm) (t-test, P=0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P>0.05) between asymptomatic (mean 28 x 3 mm) and symptomatic patients (mean 32 x 3 mm).Conclusion. Small residual defects or retears (<1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant. (orig.)

  19. MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M. [Hospital Reina Sofia de Tudela, Servicio de Radiodiagnostico, Tudela, Navarra (Spain); Calmet, J.; Ballabriga, J.; Gine, J. [Hospital Universitari de Tarragona Joan XXIII, Servei de Cirurgia Ortopedica i Traumatologia, Tarragona (Spain); Olona, M. [Hospital Universitari de Tarragona Joan XXIII, Servei de Medicina Preventiva i Epidemiologia, Tarragona (Spain); Camins, A. [Hospital Universitari de Tarragona Joan XXIII, Institut de Diagnostic per la Imatge, Tarragona (Spain); Perez del Palomar, L. [Hospital Ernest Lluch, Servicio de Radiologia, Calatayud, Zaragoza (Spain)

    2006-10-15

    The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon. (orig.)

  20. Rotator cuff metastases: A report of two cases with literature review

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    Gokhan Soker

    2014-01-01

    Full Text Available Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered.

  1. Effect of prolotherapy on hemiplegic shoulder pain due to rotator cuff tendinopathy: a pilot study

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    Serdar Kesikburun

    2017-03-01

    Full Text Available Purpose: The aim of this study was to investigate the effect of prolotherapy on pain and shoulder range of motion in stroke patients with hemiplegic shoulder pain due to rotator cuff tendinopathy. Material and Methods: The data of 10 patients (mean age, 64.2+/-11.6 years who had a history stroke of more than six months and underwent prolotherapy treatment were collected retrospectively. The treatment included 3 sessions of dextrose pr olotherapy injections applied to rotator cuff tendon. Visual analogue scale pain scores and shoulder range of motions measured at baseline and two weeks later after end of the treatment were assessed. Results: Visual analogue scale shoulder pain scores of the patients decreased from 8.2+/-1.1 at baseline to 4.8+/-1.9 after prolotherapy The degrees of shoulder flexion and abduction increased significantly after the treatment. Conclusion: Preliminary results in this pilot study suggested the beneficial effect of proloterapi in the treatmentof hemiplegicshoulderpain. [Cukurova Med J 2017; 42(1.000: 13-18

  2. The Effect of Platelet-rich Fibrin Matrix on Rotator Cuff Healing in a Rat Model.

    Science.gov (United States)

    Hasan, S; Weinberg, M; Khatib, O; Jazrawi, L; Strauss, E J

    2016-01-01

    The purpose of the current study was to determine if the application of platelet-rich fibrin matrix could improve regeneration of the tendon-bone insertion site in a rat rotator cuff repair model. 25 Lewis syngeneic rats underwent bilateral tenotomy and repair of the supraspinatus tendon. 10 separate rats were used for PRFM harvest. All left (control) shoulders underwent transosseous rotator cuff repair, while all right (treatment) shoulders were repaired similarly with PRFM augmentation. 9 rats were sacrificed at 2-weeks and ten at 4-weeks for biomechanical testing. 3 separate rats were sacrificed at 2-weeks and 4-weeks each for histologic analysis of the insertion site. At 2 weeks, the experimental group repairs were significantly stronger in ultimate load to failure (P=0.01), stress (P=0.03), and stiffness (P=0.03). Differences in biomechanical testing were not found between the groups at 4 weeks. Histological analysis revealed less collagen organization and cartilage formation at the insertion site in the experimental group. Semiquantitative histologic analysis confirmed our qualitative assessment of the specimens. PRFM does not recapitulate the native enthesis, but rather induces an exuberant and disordered healing response that is characterized by fibrovascular scar tissue.

  3. Computed tomography of the soft tissues of the shoulder. Pt. 3. Calcifying tendinitis of the rotator cuff

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    Dihlmann, W.; Bandick, J.

    1988-01-01

    Computed tomography of the soft tissue of the shoulder in cases of calcifying tendinitis of the rotator cuff provides the following information: 1. Localisation of the calcium deposits within the rotator cuff. 2. Contours and density of the calcium deposits correlated with the clinical findings as described by Uhthoff et al. Ill-defined contours and non-homogeneous deposits are associated with more severe clinical features. 3. Computed tomography shows that apatite particles, which are not visible radiologically, may penetrate into the shoulder joint and produce synovitis with an effusion. This is of importance in local therapy.

  4. MRI of rotator cuff muscle atrophy in relation to glenohumeral joint incongruence in brachial plexus birth injury

    Energy Technology Data Exchange (ETDEWEB)

    Poeyhiae, Tiina H. [Helsinki University Central Hospital, Department of Radiology, PO Box 281, Helsinki (Finland); Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki (Finland); Nietosvaara, Yrjaenae A.; Peltonen, Jari I. [Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki (Finland); Remes, Ville M. [Helsinki University Central Hospital, Department of Orthopaedics, Surgical Hospital, Helsinki (Finland); Kirjavainen, Mikko O. [Helsinki University Central Hospital, Department of Orthopaedics and Traumatology, Helsinki (Finland); Lamminen, Antti E. [Helsinki University Central Hospital, Department of Radiology, PO Box 281, Helsinki (Finland)

    2005-04-01

    Purpose: To evaluate rotator cuff muscles and the glenohumeral (GH) joint in brachial plexus birth injury (BPBI) using MRI and to determine whether any correlation exists between muscular abnormality and the development of glenoid dysplasia and GH joint incongruity. Thirty-nine consecutive BPBI patients with internal rotation contracture or absent active external rotation of the shoulder joint were examined clinically and imaged with MRI. In the physical examination, passive external rotation was measured to evaluate internal rotation contracture. Both shoulders were imaged and the glenoscapular angle, percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the greatest thickness of the subscapular, infraspinous and supraspinous muscles were measured. The muscle ratio between the affected side and the normal side was calculated to exclude age variation in the assessment of muscle atrophy. All muscles of the rotator cuff were atrophic, with the subscapular and infraspinous muscles being most severely affected. A correlation was found between the percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the extent of subscapular muscle atrophy (r{sub s}=0.45, P=0.01), as well as between its ratio (r{sub s}=0.5, P P=0.01). Severity of rotator cuff muscle atrophy correlated with increased glenoid retroversion and the degree of internal rotation contracture. Glenoid retroversion and subluxation of the humeral head are common in patients with BPBI. All rotator cuff muscles are atrophic, especially the subscapular muscle. Muscle atrophy due to neurogenic damage apparently results in an imbalance of the shoulder muscles and progressive retroversion and subluxation of the GH joint, which in turn lead to internal rotation contracture and deformation of the joint. (orig.)

  5. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors.

    Science.gov (United States)

    Ebaugh, David; Spinelli, Bryan; Schmitz, Kathryn H

    2011-10-01

    Over 2.6 million breast cancer survivors currently reside in the United States. While improvements in the medical management of women diagnosed with breast cancer have resulted in a 5-year survival rate of 89%, curative treatments are associated with a high prevalence of shoulder and arm morbidity, which, in turn, can negatively impact a woman's quality of life. Breast cancer survivors frequently experience shoulder and arm pain, decreased range of motion, muscle weakness, and lymphedema. These symptoms can lead to difficulties with daily activities ranging from overhead reaching and carrying objects to caring for family and returning to work. Despite health care professionals awareness of these problems, a significant number of breast cancer survivors are confronted with long-term, restricted use of their affected shoulder and upper extremity. This problem may partially be explained by: (1) an incomplete understanding of relevant impairments and diagnoses associated with shoulder/arm pain and limited upper extremity use, and (2) the limited effectiveness of current rehabilitation interventions for managing shoulder pain and decreased upper extremity function in breast cancer survivors. Because breast cancer treatment directly involves the neuromusculoskeletal tissues of the shoulder girdle, it is understandable why breast cancer survivors are likely to develop shoulder girdle muscle weakness and fatigue, decreased shoulder motion, altered shoulder girdle alignment, and lymphedema. These impairments can be associated with diagnoses such as post-mastectomy syndrome, adhesive capsulitis, myofascial dysfunction, and brachial plexopathy, all of which have been reported among breast cancer survivors. It is our belief that these impairments also put women at risk for developing symptomatic rotator cuff disease. In this paper we set forth the rationale for our belief that breast cancer treatments and subsequent impairments of shoulder girdle neuromusculoskeletal tissues

  6. 肩袖全层撕裂的MRI表现%Complete Rotator Cuff Tear: MR Findings

    Institute of Scientific and Technical Information of China (English)

    郑卓肇; 谢敬霞; 范家栋; 运动医学科

    2001-01-01

    目的 总结肩袖全层撕裂的MRI表现。 材料与方法 回顾性分析21例肩关节MR造影证实的肩袖全层撕裂的MR图像。 结果 21例肩袖全层撕裂均发生在冈上肌腱。在T2W序列上,6例(28.9%)表现为冈上肌腱断裂并断裂端的回缩;12例(57.1%)表现为冈上肌腱变薄或增粗并伴有贯穿冈上肌腱全层的高信号;1例(4.7%)表现为冈上肌腱增厚并未贯穿全层的下表面高信号;2例(9.3%)冈上肌腱的形态和信号未见异常。 结论 冈上肌腱的断裂并回缩以及冈上肌腱形态增粗或变细并伴有贯穿肌腱全层的异常高信号为全层撕裂的主要MRI表现。%Objective To describe the MR findings of the full-thickness tears of the rotator cuff. Materials and Methods MRI findings in 21 cases with complete rotator cuff tears, proved with MR arthrography, were retrospectively analyzed. Results All 21 tears involved the supraspinatus tendon. On T2WI , the signs of the tears were as follows: interrupted tendinous continuity and retraction of musculotendinous junction (6 shoulders, 28.9%), increased signal intensity covering the entire layer of the thickened or thinned tendon (12 shoulders, 57.1%), focal high signal involving only the inferior surface of the thickened supraspinatus tendon (1 shoulder, 4.7%), and normal tendinous appearance (2 shoulders, 9.3%). Conclusion The main MR findings of full-thickness tears of the rotator cuff are discontinuity and retraction of the supraspinatus tendon, and increased signal intensity extending through the entire layer of the thickened or thinned tendon.

  7. Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury.

    Science.gov (United States)

    Yamaguchi, Takeshi; Ochiai, Nobuyasu; Sasaki, Yu; Kijima, Takehiro; Hashimoto, Eiko; Sasaki, Yasuhito; Kenmoku, Tomonori; Yamazaki, Hironori; Miyagi, Masayuki; Ohtori, Seiji; Takahashi, Kazuhisa

    2015-12-01

    This study evaluated dorsal root ganglia from C3-C7, analyzed gait, and compared the expression of calcitonin gene-related peptide (CGRP) which was a marker of inflammatory pain in a rat rotator cuff tear model in which the supraspinatus and infraspinatus tendons were detached; comparisons were made to a sham group in which only the tendons were exposed. Fluorogold was injected into the glenohumeral joint 21 days after surgery in both groups, and saline, steroids, or hyaluronic acid was injected into the glenohumeral joint in the rotator cuff tear group 26 days after surgery. The proportions of CGRP-immunoreactive neurons were higher and the gait parameters were impaired in the rotator cuff tear group compared to in the sham group. However, the CGRP expression was reduced and the gait was improved with steroid or hyaluronic acid injection compared to saline, suggesting that both hyaluronic acid and steroid injections suppressed of inflammation which thought to be provided pain relief. While there were no significant differences, the suppression of CGRP expression and the improved gait after hyaluronic acid and steroid injections suggested that both methods were effective for rat rotator cuff tear model.

  8. Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate whether the good and excellent functional results from arthroscopic repair of massive rotator cuff tears are maintained over the long term. METHODS: From the sample of the study conducted by our group in 2006, in which we evaluated the functional results from arthroscopic repair of massive rotator cuff tears, 35 patients were reassessed, 8 years after the first evaluation. The inclusion criteria were that these patients with massive rotator cuff tears operated by means of an arthroscopic technique, who participated in the previous study and achieved good or excellent outcomes according to the UCLA criteria. Patients whose results were not good or excellent in the first evaluation according to the UCLA criteria were excluded. RESULTS: Among the 35 patients reassessed, 91% of them continued to present good and excellent results (40% excellent and 51% good, while 3% presented fair results and 6% poor results. The time interval between the first and second evaluations was 8 years and the minimum length of follow-up since the immediate postoperative period was 9 years (range: 9-17 years, with an average of 11.4 years. CONCLUSION: The good and excellent results from arthroscopic repair of massive rotator cuff tears were mostly maintained (91%, with the same level of function and satisfaction, even though 8 years had passed since the first assessment, with a follow-up period averaging 11.4 years.

  9. Risk factors for pseudoparalysis in patients with massive rotator cuff tear%巨大肩袖损伤并发肩关节假性瘫痪的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    徐青镭; 李飞; 韩国一

    2016-01-01

    Background Massive rotator cuff tear is a common clinical disorder of the shoulder, which mainly manifests as shoulder joint pain and limited range of motion (ROM).Cofield proposed the definition of massive rotator cuff tear as massive rotator cuff tears > 5 cm;on the other hand, Gerber et al.defined rotator cuff tears involving 2 or more rotator cuff tendons as massive rotator cuff tears.Patients with chronic massive rotator cuff tears and severe muscle degeneration had unique and varying clinical manifestations.Some patients showed only mild to moderate pain while shoulder range of motion limitation was not obvious especially that active flexion and abduction activities were not affected;some other patients had moderate to severe shoulder joint pain accompanied by pseudoparalysis of the shoulder joint,i.e.,active flexion was imaging findings supporting the diagnosis of supraspinatus tendon inj ury;weak muscle force at shoulder external rotation position (0° abduction)or positive lag sign with appropriate MR imaging findings to support the diagnosis of infraspinatus tendon inj ury;weak muscle force at shoulder abduction and external rotation position (90° abduction)or positive lag sign,positive hornblower′s sign and appropriate diagnostic MR imaging findings of teres minor tendon damage;weak muscle force by improved Lafosse′s belly press test or positive lag sign accompanied with appropriate diagnostic MR imaging findings of subscapularis muscle injury.(2)T1-weighted MR imaging of shoulder joint showed fatty infiltration Goutallier grades of 3 and 4 in rotator cuff muscles. (3 )shoulder anteroposterior X-ray examination determined glenohumeral osteoarthritis with Hamada grades of 0-2. Exclusion criteria:(1)passive ROM limitation of the shoulder joint;(2)shoulder MR examination revealed that degeneration of rotator cuff muscles was less than the Goutallier grade 3;(3)shoulder anteroposterior X-ray examination determined glenohumeral osteoarthritis with Hamada

  10. Physical and rehabilitation medicine (PRM) care pathways: "patients after rotator cuff tear surgery".

    Science.gov (United States)

    Ribinik, P; Calmels, P; Barrois, B; Le Moine, F; Yelnik, A P

    2011-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after rotator cuff tear surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (ICF) (WHO).

  11. Proteomics perspectives in rotator cuff research: a systematic review of gene expression and protein composition in human tendinopathy.

    Directory of Open Access Journals (Sweden)

    Maria Hee Jung Sejersen

    Full Text Available Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics--the comprehensive study of protein composition--in tendon research.We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue.We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies and III (13 of 14, metalloproteinase (MMP-1 (6 of 12, -9 (7 of 7, -13 (4 of 7, tissue inhibitor of metalloproteinase (TIMP-1 (4 of 7, and vascular endothelial growth factor (4 of 7, and a decrease in MMP-3 (10 of 12. Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro.Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins that characterise specific tendon disorders or stages of tendinopathy. Thus, our results suggested an untapped potential for

  12. Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome after Rotator Cuff Repair?

    Science.gov (United States)

    Kirsch, Jacob Matthew; Nathani, Amit; Robbins, Christopher; Gagnier, Joel Joseph; Bedi, Asheesh; Miller, Bruce S.

    2016-01-01

    Objectives: Variations in scapular morphology have been associated with the development of atraumatic rotator cuff tears (RCT). Current theories suggest a morphologic predisposition for altered shoulder biomechanics favoring the development of RCTs. The critical shoulder angle (CSA) is a radiographic measure that accounts for both glenoid inclination and lateral extension of the acromion, and angles >35 degrees are reported to be correlated with the development of degenerative RCTs. The impact of the CSA on outcomes following rotator cuff repair (RCR) has not previously been investigated. The purpose of this study was to investigate the relationship between the CSA and clinical outcomes after rotator cuff repair. Methods: As part of a prospective observational cohort study we obtained CSA measurements for 144 patients with documented full-thickness RCTs who were followed up for a minimum of 48 weeks. Patients were then stratified based on RCT etiology and treatment. Demographic data as well as The Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score and Visual Analog Scale (VAS) for pain were collected at baseline, four, eight, 16, 32 and 48 weeks. The CSA for all of the patients was measured retrospectively, with all assessors being blinded to the data and we calculated interclass correlation coefficients (ICC) to measure agreement. The statistical analysis included longitudinal multilevel regression modeling to investigate the association of the CSA and the WORC, ASES and VAS for pain. Results: Controlling for demographic and clinical characteristics, patients with CSAs less than 38 degrees reported better outcome scores over time compared to those with CSAs greater than 38 degrees (WORC: B=-106.6, p=0.025, ASES: B=4.83, p=0.0001, VAS: B=-12.99, p=0.0001). Interobserver and intraobserver reliability for CSA measurements resulted in an ICC of 0.969 and 0.982 respectively, indicating excellent agreement. Conclusion: We found

  13. Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year

    OpenAIRE

    Arockia Doss

    2013-01-01

    This is a case report on excellent clinical outcome and neotendon infilling at one year follow up in a degenerative rotator cuff full thickness tear following percutaneous tenotomy and platelet rich plasma injection.

  14. A randomised controlled feasibility study investigating the use of eccentric and concentric strengthening exercises in the treatment of rotator cuff tendinopathy

    Directory of Open Access Journals (Sweden)

    Marcus Bateman

    2014-01-01

    Full Text Available Objectives: To conduct a feasibility study to compare concentric and eccentric rotator cuff strengthening exercises for rotator cuff tendinopathy. Methods: A total of 11 patients with rotator cuff tendinopathy who were on the waiting list for arthroscopic subacromial decompression surgery were randomised to perform eccentric rotator cuff strengthening exercises, concentric strengthening exercises or no exercises. Patients were evaluated in terms of levels of pain and function using the Oxford Shoulder Score and a Visual Analogue Scale initially, at 4 weeks and at 8 weeks. Results: The study design was found to be acceptable to patients and achieved a high level of 86% compliance. The drop-out rate was 0%. Two patients performing eccentric strengthening exercises improved sufficiently to cancel their planned surgery. Conclusion: Further research in this area is recommended. The study design was feasible and power calculations have been conducted to aid future research planning.

  15. Return to Sports After Arthroscopic Treatment of Rotator Cuff Calcifications in Athletes

    Science.gov (United States)

    Ranalletta, Maximiliano; Rossi, Luciano A.; Sirio, Adrian; Bruchmann, Guillermina; Maignon, Gastón D.; Bongiovanni, Santiago L.

    2016-01-01

    Background: Arthroscopic treatment of calcific deposits of rotator cuff tears has been described with successful results in the general population. However, despite the high frequency of this condition, there is no information in the literature regarding arthroscopic treatment of rotator cuff calcifications in athletes. Purpose: To analyze the time to return to sport, clinical outcomes, and complications of complete arthroscopic removal of intratendinous calcific deposits and repair of the tendon lesion without acromioplasty in athletes. Study Design: Case series; Level of evidence, 4. Methods: This study retrospectively evaluated 24 consecutive patients with a mean age of 36.2 years. The mean follow-up was 59 months (range, 24-108 months). Patients completed a questionnaire focused on the time to return to sport and treatment course. Pre- and postoperative functional assessment was performed using the Constant score and University of California Los Angeles (UCLA) score. Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. Results: Of the 24 patients, 23 (95.8%) were able to return to sports; 91.3% returned to the same level. The mean time to return to play was 5.3 months (range, 3-9 months): 26% of patients (6/23) returned to sports in less than 4 months, 61% (14/24) returned between 4 and 6 months, and 13% (3/24) returned after the sixth month. The mean Constant score increased from 26.9 preoperatively to 89.7 postoperatively (P tendon tears. Conclusion: In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes. Most patients return to the same level of proficiency regardless of the type of sport and

  16. Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model?

    Institute of Scientific and Technical Information of China (English)

    Yi Lu; Yue Li; Feng-Long Li; Xu Li; Hong-Wu Zhuo; Chun-Yan Jiang

    2015-01-01

    Background:The effect of selective and non-selective cyclooxygenase (COX) inhibitors on tendon healing was variable.The purpose of the study was to evaluate the influence of non-selective COX inhibitor,ibuprofen and flurbiprofen axetil and selective COX-2 inhibitor,celecoxib on the tendon healing process in a rabbit model.Methods:Ninety-six New Zealand rabbits were used as rotator cuff repair models.After surgery,they were divided randomly into four groups:Ibuprofen (10 mg·kg-1·d-1),celecoxib (8 mg·kg 1·d 1),flurbiprofen axetil (2 mg·kg 1·d-1),and control group (blank group).All drugs were provided for 7 days.Rabbits in each group were sacrificed at 3,6,and 12 weeks after tendon repair.Tendon biomechanical load failure tests were performed.The percentage of type Ⅰ collagen on the bone tendon insertion was calculated by Picric acid Sirius red staining and image analysis.All data were compared among the four groups at the same time point.All data in each group were also compared across the different time points.Qualitative histological evaluation of the bone tendon insertion was also performed among groups.Results:The load to failure increased significantly with time in each group.There were significantly lower failure loads in the celecoxib group than in the control group at 3 weeks (0.533 vs.0.700,P =0.002),6 weeks (0.607 vs.0.763,P =0.01),and 12 weeks (0.660 vs.0.803,P =0.002),and significantly lower percentage of type Ⅰ collagen at 3 weeks (l 1.5% vs.27.6%,P =0.001),6 weeks (40.5% vs.66.3%,P =0.005),and 12 weeks (59.5% vs.86.3%,P =0.001).Flurbiprofen axetil showed significant differences at 3 weeks (failure load:0.600 vs.0.700,P =0.024;percentage of type Ⅰ collagen:15.6% vs.27.6%,P =0.001),but no significant differences at 6 and 12 weeks comparing with control group,whereas the ibuprofen groups did not show any significant difference at each time point.Conclusions:Nonsteroidal anti-inflammatory drugs can delay tendon healing in the

  17. "Owl" Technique for All-Arthroscopic Augmentation of a Massive or Large Rotator Cuff Tear With Extracellular Matrix Graft.

    Science.gov (United States)

    Narvani, A Ali; Consigliere, Paolo; Polyzois, Ioannis; Sarkhel, Tanaya; Gupta, Rohit; Levy, Ofer

    2016-08-01

    Despite the vast improvement in techniques and technology for arthroscopic rotator cuff surgery, repairs of massive and large tears remain challenging because they are associated with significantly high failure rates. In recent years, patch augmentation has gained popularity as a technique to decrease these high failure rates. Arthroscopic patch augmentation of rotator cuff repair, however, is technically difficult. The purpose of this report is to describe a simple and reproducible technique for all-arthroscopic extracellular matrix graft augmentation. With this technique, which we refer to as the "owl" technique because the prepared extracellular augment resembles an owl, there are relatively few suture ends involved; therefore, augment introduction is straightforward with a reduced risk of suture ends becoming tangled. In addition, the way in which our augmentation is prepared helps to prevent it from becoming bunched up when being secured.

  18. Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete.

    Science.gov (United States)

    Wang, Allan W; Bauer, Stefan; Goonatillake, Matthew; Breidahl, William; Zheng, Ming-Hao

    2013-01-11

    Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12 months of increasing pain during gymnastics being unable to perform most skills. At 1 year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3 T MRI. The patient was able to return to national-level competition.

  19. An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation

    Directory of Open Access Journals (Sweden)

    Angela E Kedgley

    2013-01-01

    Full Text Available Purpose: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Materials and Methods: Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Results: Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. Conclusions: This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference ( P ≥ 0.10 was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Clinical Relevance: Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.

  20. Comparison of the Tendon Damage Caused by Four Different Anchor Systems Used in Transtendon Rotator Cuff Repair

    OpenAIRE

    Qing-Song Zhang; Sen Liu; Qiuyang Zhang; Yun Xue; Dongxia Ge; Michael J O'Brien; Savoie, Felix H.; Zongbing You

    2012-01-01

    Objectives. The objective of this study was to compare the damage to the rotator cuff tendons caused by four different anchor systems. Methods. 20 cadaveric human shoulder joints were used for transtendon insertion of four anchor systems. The Healix Peek, Fastin RC, Bio-Corkscrew Suture, and Healix Transtend anchors were inserted through the tendons using standard transtendon procedures. The areas of tendon damage were measured. Results. The areas of tendon damage (mean ± standard deviation, ...

  1. Arthroscopic Management of Full-Thickness Rotator Cuff Tears in Major League Baseball Pitchers: The Lateralized Footprint Repair Technique.

    Science.gov (United States)

    Dines, Joshua S; Jones, Kristofer; Maher, Patrick; Altchek, David

    2016-01-01

    Clinical outcomes of surgical management of full-thickness rotator cuff tears in professional baseball players have been uniformly poor. We conducted a study to investigate return-to-play data and functional performance using a novel arthroscopic repair technique. We hypothesized that arthroscopic rotator cuff repair would result in a high rate of return to professional pitching and favorable functional outcomes. We identified 6 consecutive Major League Baseball (MLB) pitchers who underwent surgical repair of full-thickness rotator cuff injuries using the lateralized footprint repair technique. At most recent follow-up, patients were evaluated to determine their ability to return to athletic activity. Functional outcomes were also assessed using player performance statistics. By mean follow-up of 66.7 months (range, 23.2-94.6 months), 5 (83%) of the 6 pitchers had returned to their preinjury level of competition for at least 1 full season. Despite the high rate of return to MLB play, few pitchers resumed pitching productivity at their preoperative level; mean number of innings pitched decreased from 1806.5 to 183.7. A slight performance reduction was also found in a comparison of preoperative and postoperative pitching statistics. Of note, the return rate was higher for players over age 30 years than for those under 30 years. Overhead athletes require a delicate balance of shoulder mobility and stability to meet functional demands. Anatomical adaptations at the glenohumeral joint should be considered when performing rotator cuff repair in these patients in order to preserve peak functional performance. This novel repair technique affords a high rate of return to MLB play, though elite overhead throwers should be counseled that pitching productivity might decrease after surgery.

  2. Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review

    OpenAIRE

    Merolla, Giovanni; Dave, Arpit C.; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2014-01-01

    Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the...

  3. Comparison of the tendon damage caused by four different anchor systems used in transtendon rotator cuff repair.

    Science.gov (United States)

    Zhang, Qing-Song; Liu, Sen; Zhang, Qiuyang; Xue, Yun; Ge, Dongxia; O'Brien, Michael J; Savoie, Felix H; You, Zongbing

    2012-01-01

    Objectives. The objective of this study was to compare the damage to the rotator cuff tendons caused by four different anchor systems. Methods. 20 cadaveric human shoulder joints were used for transtendon insertion of four anchor systems. The Healix Peek, Fastin RC, Bio-Corkscrew Suture, and Healix Transtend anchors were inserted through the tendons using standard transtendon procedures. The areas of tendon damage were measured. Results. The areas of tendon damage (mean ± standard deviation, n = 7) were 29.1 ± 4.3 mm(2) for the Healix Peek anchor, 20.4 ± 2.3 mm(2) for the Fastin RC anchor, 23.4 ± 1.2 mm(2) for the Bio-Corkscrew Suture anchor, 13.7 ± 3.2 mm(2) for the Healix Transtend anchor inserted directly, and 9.1 ± 2.1 mm(2) for the Healix Transtend anchor inserted through the Percannula system (P anchors). Conclusions. In a cadaver transtendon rotator cuff repair model, smaller anchors caused less damage to the tendon tissues. The Healix Transtend implant system caused the least damage to the tendon tissues. Our findings suggest that smaller anchors should be considered when performing transtendon procedures to repair partial rotator cuff tears.

  4. Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2015-02-01

    Full Text Available OBJECTIVE: To analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia.METHOD: 138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16; those with osteopenia, group 2 (n = 33; and normal individuals, group 3 (n = 55.RESULTS: In analyzing the University of California at Los Angeles (UCLA scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070. Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027.CONCLUSION: The results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry.

  5. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series

    Directory of Open Access Journals (Sweden)

    Marcello H. Nogueira-Barbosa

    2015-12-01

    Full Text Available Abstract Objective: The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods: Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results: Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5% patients (mean age, 50.9 years; age range, 42-58 years; 42% female. Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion: Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.

  6. Rare coexistence of gouty and septic arthritis after arthroscopic rotator cuff repair: a case report.

    Science.gov (United States)

    Ichiseki, Toru; Ueda, Shusuke; Matsumoto, Tadami

    2015-01-01

    Coexistence of septic arthritis and gouty arthritis is rare. In particular, no reports have described the development of both gouty and septic arthritis after arthroscopic shoulder surgery. The patient was an 83-year-old man who underwent arthroscopic rotator cuff repair. He had a history of diabetes mellitus (HbA1c: 7.4%), but not of gout, and the GFR was decreased (GFR=46). During the postoperative course fever suddenly developed and joint fluid retention was found. Uric acid crystals were detected when the joint fluid was aspirated, after which when the culture results became available sepsis due to methicillin sensitive Staphylococcus aureus (MSSA) was diagnosed. On the 2(nd) day after fever onset, lavage and debridement were performed under arthroscopy, with the subsequent course uneventful with no recurrence of the infection or gouty arthritis and no joint destruction. When uric acid crystals are found in aspirated joint fluid, gouty arthritis tends to be diagnosed, but like in the present case if infection also supervenes, joint destruction and a poor general state may result if appropriate intervention is not initiated swiftly. Accordingly, even if uric acid crystals are found, the possibility of coexistence of septic arthritis and gouty arthritis should be kept in mind.

  7. Role of Serum Fibrinogen Levels in Patients with Rotator Cuff Tears

    Directory of Open Access Journals (Sweden)

    Umile Giuseppe Longo

    2014-01-01

    Full Text Available Although rotator cuff (RC tendinopathy is a frequent pathology of the shoulder, the real understanding of its aetiopathogenesis is still unclear. Several studies showed that RC tendinopathy is more frequent in patients with hyperglycemia, diabetes, obesity, or metabolic syndrome. This paper aims to evaluate the serum concentration of fibrinogen in patients with RC tears. Metabolic disorders have been related to high concentration of serum fibrinogen and the activity of fibrinogen has been proven to be crucial in the development of microvascular damage. Thus, it may produce progression of RC degeneration by reducing the vascular supply of tendons. We report the results of a cross-sectional frequency-matched case-control study comparing the serum concentration of fibrinogen of patients with RC tears with that of a control group of patients without history of RC tears who underwent arthroscopic meniscectomy. We choose to enrol in the control group patients with pathology of the lower limb with a likely mechanic, not metabolic, cause, different from tendon pathology. We found no statistically significant differences in serum concentration of fibrinogen when comparing patients with RC tears and patients who underwent arthroscopic meniscectomy (P = 0.5. Further studies are necessary to clarify the role of fibrinogen in RC disease.

  8. Histomorphometric and ultrastructural analysis of the tendon-bone interface after rotator cuff repair in a rat model.

    Science.gov (United States)

    Kanazawa, Tomonoshin; Gotoh, Masafumi; Ohta, Keisuke; Honda, Hirokazu; Ohzono, Hiroki; Shimokobe, Hisao; Shiba, Naoto; Nakamura, Kei-Ichiro

    2016-09-20

    Successful rotator cuff repair requires biological anchoring of the repaired tendon to the bone. However, the histological structure of the repaired tendon-bone interface differs from that of a normal tendon insertion. We analysed differences between the normal tendon insertion and the repaired tendon-bone interface after surgery in the mechanical properties, histomorphometric analysis, and 3-dimensional ultrastructure of the cells using a rat rotator cuff repair model. Twenty-four adult Sprague-Dawley (SD) rats underwent complete cuff tear and subsequent repair of the supraspinatus tendon. The repaired tendon-bone interface was evaluated at 4, 8, and 12 weeks after surgery. At each time point, shoulders underwent micro-computed tomography scanning and biomechanical testing (N = 6), conventional histology and histomorphometric analysis (N = 6), and ultrastructural analysis with focused ion beam/scanning electron microscope (FIB/SEM) tomography (N = 4). We demonstrated that the cellular distribution between the repaired tendon and bone at 12 weeks after surgery bore similarities to the normal tendon insertion. However, the ultrastructure of the cells at any time point had a different morphology than those of the normal tendon insertion. These morphological differences affect the healing process, partly contributing to re-tearing at the repair site. These results may facilitate future studies of the regeneration of a normal tendon insertion.

  9. Hombro doloroso y lesiones del manguito rotador Painful shoulder and rotator cuff disorders

    Directory of Open Access Journals (Sweden)

    Karla Mora-Vargas

    2008-12-01

    Full Text Available Se presenta el caso de una mujer de 52 años conocida sana, sin antecedentes positivos, quien inicia con dolor y disfunción del miembro superior izquierdo, la cual fue tratada con antiinflamatorios no esteroideos inicialmente, sin embargo, al persistir los síntomas y apoyado con estudios radiológicos recibe tratamiento inyectado a nivel del hombro. Cuadro que evoluciona posteriormente a ruptura del manguito rotador, con su subsiguiente reparación quirúrgica y fisioterapia, logrando la recuperación casi total de su funcionabilidad. El síndrome de hombro doloroso es cada vez más frecuente en la población asociado con el aumento en la expectancia de vida, la actividad física y los factores intrínsecos de la anatomía del cuerpo, por lo cual se hace importante su consideración diaria.A previously healthy 52 years old woman, started with pain and dysfunction of her left arm, at the beginning she was treated conservatively with NSAIDS. Her symptoms continued and based on radiographic studies, she recived therapeutic intra-articular shoulder injections. Her medical situation got worse, and she was to have a rotator cuff tear, she needed surgery to repair the tear and physical therapy, achieving almost total recovery of her shoulder function. Since painful shoulder syndrome has been increasing because of ageing, work and the body’s intrinsic factors, that’s why it is important to remind this medical condition.

  10. Long-term functional evaluation of videoarthroscopic treatment of partial injuries of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    2015-04-01

    Full Text Available OBJECTIVE: To compare the functional results from high and low-grade isolated partial lesions of the supraspinatus tendon of bursal and articular types, after arthroscopic treatment.METHODS: Sixty-four patients with isolated partial lesions of the supraspinatus tendon were evaluated. The mean length of follow-up was 76 months (range: 29-193. The mean age was 59 years (range: 36-82. The dominant side was affected in 44 patients (68.8%. There were 35 bursal lesions (54.7% and 29 articular lesions (45.3%. We used the Ellman classification and characterized the lesions as low or high-grade according to whether they affected less than or more than 50% of the tendon thickness, respectively. Debridement was performed in 15 patients (23.5%, repair without completing the lesion in 11 (17% and repair after completing the lesion in 38 (59.5%. The functional assessments on the patients were done using the Constant & Murley and UCLA scores.RESULTS: The mean Constant & Murley score among the patients with bursal lesions was 82.64 ± 6.98 (range: 59.3-99 and among those with articular lesions, 83.57 ± 7.58 (range: 66-95, while the mean UCLA score in the bursal lesions was 33.37 ± 2.85 (range: 21-35 and in the articular lesions, 32.83 ± 2.95 (range: 22-35.CONCLUSION: Videoarthroscopic treatment of partial lesions of the rotator cuff presents good or excellent results when the low-grade lesions are debrided and the high-grade lesions are completed and repaired. These results are maintained over the long term, with a high satisfaction rate and few complications.

  11. Outcome and structural integrity of rotator cuff after arthroscopic treatment of large and massive tears with double row technique: a 2-year followup.

    Science.gov (United States)

    Carbonel, Ignacio; Martínez, Angel A; Aldea, Elisa; Ripalda, Jorge; Herrera, Antonio

    2013-01-01

    Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P < 0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P < 0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

  12. Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

    Directory of Open Access Journals (Sweden)

    Ignacio Carbonel

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI, and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001. Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001. MRI studies showed 24 cases of tear after repair (29%. Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

  13. The clinical anatomy of the insertion of the rotator cuff tendons.

    Science.gov (United States)

    Vosloo, M; Keough, N; De Beer, M A

    2017-02-16

    The rotator cuff (RC) insertions according to most anatomical texts are described as being separate from one another. However, clear fusion of the RC tendon fibres exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles (LT and GT) of the humerus. Current surgical repair methods (especially arthroscopic techniques) rarely mention or consider these connections during repair and suture anchor implantation. The general principles of RC surgery remain a controversial subject, due to various available techniques, surgeon experience and preference, and the contradicting success rates. This results from old-fashioned knowledge of the anatomy of the RC complex and its functional aspects. Therefore, the purpose of this project was to visualise and define the RC footprint and extension insertions with the aim of enhancing and improving knowledge of the basic anatomy in the hopes that this will be considered during orthopaedic repair. Twenty shoulders (16 cadaveric and 4 fresh) were used in the study. The fresh shoulders were received from the National Tissue Bank, and ethical clearance was obtained (239/2015). Reverse dissection was performed to better visualise the RC unit exposing the interdigitated rotator hood (extension insertions), as well as the complete RC unit (tendons + internal capsule) separated from the scapula and humerus. Once the insertions were exposed and documented, the RC muscle footprint (articular surface area) was measured and recorded, using AutoCAD 2016. No statistical significant difference between left and right (p = 0.424) was noted, but a significant difference between males and females (p = 0.000) was. Collectively, these findings indicate and strengthen evidence towards the notion that the RC muscles/tendons and the internal capsule are one complete and inseparable unit/complex. The fact that the RC unit is more complex in its structure and attachment

  14. Magnetic resonance arthrography of the shoulder: accuracy of gadolinium versus saline for rotator cuff and labral pathology

    Energy Technology Data Exchange (ETDEWEB)

    Helms, Clyde A.; McGonegle, Shane J.; Vinson, Emily N.; Whiteside, Michael B. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2011-02-15

    The purpose of this study was to evaluate the necessity of intra-articular gadolinium versus saline alone in magnetic resonance arthrography (MRA) of the shoulder. Our database was reviewed for 100 consecutive shoulder MRA examinations performed between January 2007 and December 2007. Patient information was blinded and images were retrospectively reviewed by at least two radiologists with dedicated musculoskeletal training. T2-weighted (T2W) images were initially analyzed in isolation to simulate MRA with saline alone. After a delay, the full study was analyzed including T1-weighted (T1W) and T2W images. If there was a significant discordance between the two analyses with regard to rotator cuff or labral pathology, the study was again reviewed by all evaluators in consensus to determine if the T1W images offered additional diagnostic information and increased diagnostic confidence. Of the 100 MRA examinations, there were 15 discordant cases. Two cases were discordant with regard to rotator cuff pathology and 13 were discordant on the basis of labral pathology. When the discordant cases were reviewed in consensus, the T2W images appeared to display rotator cuff and labral pathology as definitively as the T1W images. Interobserver and intraobserver variability was favored to have played a role in causing the discordances. MRA of the shoulder performed with joint distention provided by saline alone appears to offer equivalent diagnostic information to MRA performed with gadolinium enhancement. This protocol modification improves efficiency by eliminating several image series and provides a small cost savings by eliminating gadolinium. (orig.)

  15. Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gang Deuk; Oh, Jung Taek [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2008-12-15

    This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related

  16. Cross-sectional analysis of baseline differences of candidates for rotator cuff surgery: a sex and gender perspective

    Directory of Open Access Journals (Sweden)

    Davis Aileen M

    2009-02-01

    Full Text Available Abstract Background The word "sex" refers to biological differences between men and women. Gender refers to roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. Traditionally, treatment decisions have been based on patient's sex without including the gender. Assessment of disability secondary to musculoskeletal problems would not be complete or accurate unless potentially relevant biological and non-biological aspects of being a man or woman are taken into consideration. The purposes of this study were to: 1 investigate the difference in pre-operative characteristics between men and women who were candidates for rotator cuff surgery; and, 2 assess the relationship between level of disability and factors that represent sex and factors that signify gender. Method This was a cross-sectional study. The primary outcome measure of disability was a disease-specific outcome measure, the Western Ontario Rotator Cuff (WORC index, and independent variables were sex, age, hand dominance, shoulder side involvement, BMI, co-morbidity, medication use, work status, smoking habits, strength, range of motion, level of pathology, concurrent osteoarthritis, expectations for recovery, and participation restriction. Parametric, non-parametric, univariable, subgroup, and multivariable analyses were conducted. Results One hundred and seventy patients were included in the study. The mean age was 57 ± 11, 85 were females. Women reported higher levels of disability despite similar or lower levels of pathology. Scores of the WORC were strongly influenced by factors that represented "gender" such as participation restriction (F = 28.91, p Conclusion Gender-related factors such as expectations and participation limitations have an independent impact on disability in men and women undergoing rotator cuff related surgery.

  17. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: Hydrotherapy following rotator cuff repair.

    Science.gov (United States)

    Hay, Laura; Wylie, Katherine

    2011-07-01

    A short cut review was carried out to establish whether hydrotherapy is beneficial in rehabilitation after rotator cuff repair. 27 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of that best paper are tabulated. It is concluded that while there may be some short term benefit to passive range of movement, further research is needed.

  18. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

    Directory of Open Access Journals (Sweden)

    Tudisco Cosimo

    2013-01-01

    Full Text Available Abstract Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA, showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS, the Simple Shoulder Test (SST scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant

  19. Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review.

    Science.gov (United States)

    Merolla, Giovanni; Dave, Arpit C; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2015-03-01

    Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed.

  20. Effects of low-level laser therapy in combination with physiotherapy in the management of rotator cuff tendinitis.

    Science.gov (United States)

    Eslamian, Fariba; Shakouri, Seyyed Kazem; Ghojazadeh, Morteza; Nobari, Ozra Eslampanah; Eftekharsadat, Bina

    2012-09-01

    Rotator cuff tendinitis is one of the main causes of shoulder pain. The objective of this study was to evaluate the possible additive effects of low-power laser treatment in combination with conventional physiotherapy endeavors in these patients. A total of 50 patients who were referred to the Physical Medicine and Rehabilitation Clinic with shoulder pain and rotator cuff disorders were selected. Pain severity measured with visual analogue scale (VAS), abduction, and external rotation range of motion in shoulder joint was measured by goniometry, and evaluation of daily functional abilities of patients was measured by shoulder disability questionnaire. Twenty-five of the above patients were randomly assigned into the control group and received only routine physiotherapy. The other 25 patients were assigned into the experimental group and received conventional therapy plus low-level laser therapy (4 J/cm(2) at each point over a maximum of ten painful points of shoulder region for total 5 min duration). The above measurements were assessed at the end of the third week of therapy in each group and the results were analyzed statistically. In both groups, statistically significant improvement was detected in all outcome measures compared to baseline (p physiotherapy has superiority over routine physiotherapy from the view of decreasing pain and improving the patient's function, but no additional advantages were detected in increasing shoulder joint range of motion in comparison to other physical agents.

  1. Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Ahn, Myeong Im (Dept. of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea)), e-mail: whjee@catholic.ac.kr; Kim, Yang-Soo (Dept. of Orthopedic Surgery, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea))

    2010-03-15

    Background: Partial-thickness tear of the rotator cuff is a common cause of shoulder pain. Magnetic resonance (MR) arthrography has been described as a useful measure to diagnose rotator cuff abnormalities. Purpose: To determine the reliability and accuracy of MR arthrography with abduction and external rotation (ABER) view for the diagnosis of partial-thickness tears of the rotator cuff. Material and Methods: Among patients who underwent MR arthrographies, 22 patients (12 men, 10 women; mean age 45 years) who had either partial-thickness tear or normal tendon on arthroscopy were included. MR images were independently scored by two observers for partial-thickness tears of the rotator cuff. Interobserver and intraobserver agreements for detection of partial-thickness tears of the rotator cuff were calculated by using kappa coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate Z-score test. Differences in sensitivity and specificity for interpretations based on different imaging series were tested for significance using the McNemar statistic. Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER view were 83%, 90%, and 86%, and 83%, 80%, and 82%, respectively, whereas on overall interpretation including ABER view, the sensitivity, specificity, and accuracy of each reader were 92%, 70%, and 82%, and 92%, 80%, and 86%, respectively. Including ABER view, interobserver agreement for partial-thickness tear increased from kappa=0.55 to kappa=0.68. Likewise, intraobserver agreements increased from kappa=0.79 and 0.53 to kappa=0.81 and 0.70 for each reader, respectively. The areas under the ROC curves for each reader were 0.96 and 0.90, which were not significantly different. Conclusion: Including ABER view in routine sequences of MR arthrography increases the sensitivity, and inter- and intraobserver agreements for detecting partial-thickness tear of rotator cuff

  2. Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 2: Rotator Cuff.

    Science.gov (United States)

    Murray, Iain R; LaPrade, Robert F; Musahl, Volker; Geeslin, Andrew G; Zlotnicki, Jason P; Mann, Barton J; Petrigliano, Frank A

    2016-03-01

    Rotator cuff tears are common and result in considerable morbidity. Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing. Tears often progress without intervention, and current surgical treatments are inadequate. Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears. The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function after surgery. This article presents a review of current and emerging biologic approaches to augment rotator cuff tendon and muscle regeneration focusing on the scientific rationale, preclinical, and clinical evidence for efficacy, areas for future research, and current barriers to advancement and implementation.

  3. MORPHOLOGICAL AND SIGNAL CHARACTERISTICS OF ROTATOR CUFF TEARS ON CONVENTIONAL MRI AND MR ARTHROGRAPHY:COMPARING WITH GROSS ANATOMY AND HISTOPATHOLOGY

    Institute of Scientific and Technical Information of China (English)

    XU Jian-rong; DENG Xia; HUA Jia; CAI Wei-min; LI Lei; ZHU Jian-shan

    2005-01-01

    Objective To study the MR characterizations of supraspinatus and infraspinatus tendon lesions by comparing with gross anatomy and histopathology. Methods The study group consisted of 20 cadaver shoulders which were underwent the same imaging protocols of conventional MRI and MR arthrography. Results SE-T2WI images or MR arthrography respectively possessed of high specificity (95.6%, 100%), but low sensitivity (70.6%, 58.8%) for diagnosing rotator cuff tears. By uniting two images techniques, could remedy its limitations and would markedly increase the sensitivity (88.2%). There were many factors influencing the visualizations of partial thickness tears of rotator cuff on MR images, from which uppermost factors are tear extent, ruptured synovial capsule, scar and synovial proliferation. Conclusion MRI diagnoses of rotator cuff lesions (especially partial thickness tears) must carefully be estimated by combining T2WI images and MR arthrography.

  4. Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up.

    Science.gov (United States)

    Tauro, J C

    1998-01-01

    We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

  5. A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Porter, N.A.; Singh, J.; Tins, B.J.; Lalam, R.K.; Tyrrell, P.N.M.; Cassar-Pullicino, V.N. [Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2015-09-15

    Orthopaedic surgical studies have shown that variations in the vertical distance between the tip of the coracoid process and the supra-glenoid tubercle alter the shape of the subcoracoid outlet. Our objective was to measure the vertical distance between the coracoid tip and the supra-glenoid tubercle (CTGT) on MR and to assess whether this showed better correlation with rotator cuff pathology compared with the axial coraco-humeral distance. A retrospective review was performed of 100 consecutive shoulder MR arthrograms. Vertical distance between the coracoid tip and the supraglenoid tubercle was measured in the sagittal oblique plane. Separate assessment was then made of tendon pathology of the subscapularis, supraspinatus and long head of biceps tendons. Axial coraco-humeral distance was then measured. Correlation between tendon abnormalities and the two measurements was then made. Of the 100 cases, 42 had subscapularis tendon lesions, 21 had lesions of the long head of biceps and 53 had supraspinatus tendon lesions. Mean vertical distance from the coracoid tip to supraglenoid tubercle was greater in those with lesions of any of these tendons and was statistically significant for the supraspinatus group (P = 0.005). Reduced axial coraco-humeral distance was also seen in patients with tendinopathy, although with less statistically significant difference (p = 0.059). Our results support orthopaedic studies that have shown that the vertical distance between the coracoid tip and the supraglenoid tubercle increases the incidence and risk of rotator cuff disease by altering the shape of the subcoracoid outlet. (orig.)

  6. Architectural and Biochemical Adaptations in Skeletal Muscle and Bone Following Rotator Cuff Injury in a Rat Model

    Science.gov (United States)

    Sato, Eugene J.; Killian, Megan L.; Choi, Anthony J.; Lin, Evie; Choo, Alexander D.; Rodriguez-Soto, Ana E.; Lim, Chanteak T.; Thomopoulos, Stavros; Galatz, Leesa M.; Ward, Samuel R.

    2015-01-01

    Background: Injury to the rotator cuff can cause irreversible changes to the structure and function of the associated muscles and bones. The temporal progression and pathomechanisms associated with these adaptations are unclear. The purpose of this study was to investigate the time course of structural muscle and osseous changes in a rat model of a massive rotator cuff tear. Methods: Supraspinatus and infraspinatus muscle architecture and biochemistry and humeral and scapular morphological parameters were measured three days, eight weeks, and sixteen weeks after dual tenotomy with and without chemical paralysis via botulinum toxin A (BTX). Results: Muscle mass and physiological cross-sectional area increased over time in the age-matched control animals, decreased over time in the tenotomy+BTX group, and remained nearly the same in the tenotomy-alone group. Tenotomy+BTX led to increased extracellular collagen in the muscle. Changes in scapular bone morphology were observed in both experimental groups, consistent with reductions in load transmission across the joint. Conclusions: These data suggest that tenotomy alone interferes with normal age-related muscle growth. The addition of chemical paralysis yielded profound structural changes to the muscle and bone, potentially leading to impaired muscle function, increased muscle stiffness, and decreased bone strength. Clinical Relevance: Structural musculoskeletal changes occur after tendon injury, and these changes are severely exacerbated with the addition of neuromuscular compromise. PMID:25834081

  7. Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study.

    Science.gov (United States)

    Friel, Nicole A; McNickle, Allison G; DeFranco, Michael J; Wang, FanChia; Shewman, Elizabeth F; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R; Chubinskaya, Susan; Kramer, Susan M; Wang, Vincent M

    2015-12-01

    Highly purified capsaicin has emerged as a promising injectable compound capable of providing sustained pain relief following a single localized treatment during orthopedic surgical procedures. To further assess its reliability for clinical use, the potential effect of highly purified capsaicin on articular cartilage metabolism as well as tendon structure and function warrants clarification. In the current study, rabbits received unilateral supraspinatus transection and repair with a single 1 ml injection of capsaicin (R+C), PEG-only placebo (R+P), or saline (R+S) into the glenohumeral joint (GHJ). An additional group received 1 ml capsaicin onto an intact rotator cuff (I+C). At 18 weeks post-op, cartilage proteoglycan (PG) synthesis and content as well as cell viability were similar (p>0.05) across treatment groups. Biomechanical testing revealed no differences (p>0.05) among tendon repair treatment groups. Similarly, histologic features of both cartilage and repaired tendons showed minimal differences across groups. Hence, in this rabbit model, a single injection of highly purified capsaicin into the GHJ does not induce a deleterious response with regard to cartilage matrix metabolism and cell viability, or rotator cuff healing. These data provide further evidence supporting the use of injectable, highly purified capsaicin as a safe alternative for management of postoperative pain following GHJ surgery.

  8. Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears.

    Science.gov (United States)

    Warner, J P; Krushell, R J; Masquelet, A; Gerber, C

    1992-01-01

    Thirty-one shoulders in eighteen cadavera were dissected to allow study of the neurovascular anatomy of the rotator cuff and to help determine the limits of mobilization of the cuff for the repair of chronic massive retracted tears. The dissection demonstrated the diameter, length, and relationships of the suprascapular nerve and its branches and made clear the dangers of extensive mobilization and advancement of the supraspinatus and infraspinatus muscles. The suprascapular nerve ran an oblique course across the supraspinatus fossa, was relatively fixed on the floor of the fossa, and was tethered underneath the transverse scapular ligament. In twenty-six (84 per cent) of the thirty-one shoulders, there were no more than two motor branches to the supraspinatus muscle, and the first was always the larger of the two. In twenty-six (84 per cent) of the thirty-one shoulders, the first motor branch originated underneath the transverse scapular ligament or just distal to it. In one shoulder (3 per cent), the first motor branch passed over the ligament. The average distance from the origin of the long tendon of the biceps to the motor branches of the supraspinatus was three centimeters. In fifteen (48 per cent) of the thirty-one shoulders, the infraspinatus muscle had three or four motor branches of the same size. The average distance from the posterior rim of the glenoid to the motor branches of the infraspinatus muscle was two centimeters. The motor branches to the supraspinatus muscle were fewer, usually smaller, and significantly shorter than those to the infraspinatus muscle. The standard anterosuperior approach allowed only one centimeter of lateral advancement of either tendon and limited the ability of the surgeon to dissect safely beyond the neurovascular pedicle. The advancement technique of Debeyre et al., or a modification of that technique, permitted lateral advancement of each muscle of as much as three centimeters and was limited by tension in the motor

  9. Diagnostic value of MRI in rotator cuff tear%MRI对肩袖撕裂的诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐国生

    2013-01-01

    Objective To evaluate the diagnostic value of MRI in rotator cuff tear and to analyze imaging characteristics and mechanism underlying the damage.Methods MRI manifestations and clinical symptoms of 76 patients with rotator cuff tear were retrospectively analyzed.Results It was found that full thickness tears of the rotator cuff occurred in 25 cases,the supraspinatus tendon tears in 23 cases and,at the same time,the infraspinatus tendon elongation in 5 cases.6 cases were combined with subscapularis tendon tear,1 case with the long head of the biceps tendon rupture,and 2 cases with glenohumeral joint anterior glenoid labrum avulsion.Rotator cuff patrial tear appeared in all 51 cases.All occured in the supraspinatus tendon,of which 11occured in the upper surface side,32 in the lower surface side,8 within the tendon partial tear.Of these,8 exhibited the partial tear both in the upper surface and a lower surface and 3 presented with partial tear in lower surface and within the tendon simultaneously.Conclusion Shoulder MRI is an effective screening method for evaluating rotator cuff tear,which can provide a reliable basis for setting the right treatment in clinic.%目的 评价肩关节MRI对肩袖撕裂的诊断价值,并分析其影像特征及损伤机制.方法 回顾性分析76例肩袖撕裂的MRI表现及临床症状.结果 肩袖全层撕裂共25例.其中冈上肌腱撕裂23例,同时向冈下肌腱延伸5例,6例合并肩胛下肌腱部分撕裂,1例合并肱二头肌长头腱断裂,2例合并关节盂前上盂唇撕脱.肩袖部分撕裂共51例,全部发生在冈上肌腱.其中上表面侧11例,下表面侧32例,肌腱内部分撕裂8例.其中8例同时在上表面及下表面发生部分撕裂,3例同时合并下表面及肌腱内部分撕裂.结论 肩关节MRI是评价肩袖撕裂比较有效的检查方法,为临床制定正确的治疗方案提供可靠的依据.

  10. Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy

    DEFF Research Database (Denmark)

    Ingwersen, Kim G; Christensen, Robin; Sørensen, Lilli

    2015-01-01

    subgroups of SIS and have often had methodological flaws, making it difficult to specifically design target treatment for patients diagnosed with SIS. Therefore, it was considered important to focus on a subgroup such as tendinopathy, with a specific tailored intervention strategy based on evidence from...... of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy. Methods/Design: The current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with rotator...... home-based exercises three times a week. The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Discussion: Previous studies of exercise treatment for SIS have not differentiated between...

  11. Partial-thickness articular surface rotator cuff tears in patients over the age of 35: Etiology and intra-articular associations

    Directory of Open Access Journals (Sweden)

    Chetan S Modi

    2012-01-01

    Full Text Available Purpose: Partial-thickness articular-sided rotator cuff tears have a multifactorial etiology and are associated with degeneration of the tendon. They are often described as an injury of the young athlete, although they are also found in the older population. The aim of this study was to investigate the frequency and associations of partial-thickness articular-sided tears in patients over the age of 35 years. Design: Retrospective Materials and Methods: A retrospective study of all arthroscopic procedures for rotator cuff pathology in patients over the age of 35 years over a 2-year period by a single surgeon was performed. The included patients were divided into two groups based on the arthroscopic findings: those with a partial-thickness articular-sided rotator cuff tear and those with pure tendinopathy. The groups were then compared to identify the associated pathology with the rotator cuff lesions. 2×2 contingency table analysis and unpaired Student′s t-test were used for statistical analysis. Results: One hundred patients were included in the study of whom 62 had a partial articular-sided tear. Those with a partial articular-sided tear were older (P=0.0001, were more commonly associated with a documented injury (P=0.03, and more commonly had biceps degeneration (P=0.001 and synovitis (P=0.02 within the joint. Conclusion: Partial-thickness articular-sided tears are a common occurrence in patients requiring arthroscopic surgery for rotator cuff pathology over the age of 35 years. This probably reflects an injury in an already degenerate cuff. This would support the theory of intrinsic degeneration of the tendon in this age group and probably represent a different etiology to those seen in the young athletes. Level of Evidence: Level 3

  12. Fatty degeneration of the rotator cuff muscles on pre- and postoperative CT arthrography (CTA): is the Goutallier grading system reliable?

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eugene; Choi, Jung-Ah; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeongi-do (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Oh, Joo Han [Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seongnam-si, Gyeongi-do (Korea, Republic of); Ahn, Soyeon [Seoul National University Bundang Hospital, Medical Research Collaborating Center, Seongnam-si, Gyeongi-do (Korea, Republic of); Hong, Sung Hwan [Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Chai, Jee Won [SMG-SNU Boramae Medical Center, Department of Radiology, 425 Shindaebang-dong, Dongjak-gu, Seoul (Korea, Republic of)

    2013-09-15

    To retrospectively evaluate fatty degeneration (FD) of rotator cuff muscles on CTA using Goutallier's grading system and quantitative measurements with comparison between pre- and postoperative states. IRB approval was obtained for this study. Two radiologists independently reviewed pre- and postoperative CTAs of 43 patients (24 males and 19 females, mean age, 58.1 years) with 46 shoulders confirmed as full-thickness tears with random distribution. FD of supraspinatus, infraspinatus/teres minor, and subscapularis was assessed using Goutallier's system and by quantitative measurements of Hounsfield units (HUs) on sagittal images. Changes in FD grades and HUs were compared between pre- and postoperative CTAs and analyzed with respect to preoperative tear size and postoperative cuff integrity. The correlations between qualitative grades and quantitative measurements and their inter-observer reliabilities were also assessed. There was statistically significant correlation between FD grades and HU measurements of all muscles on pre- and postoperative CTA (p < 0.05). Inter-observer reliability of fatty degeneration grades were excellent to substantial on both pre- and postoperative CTA in supraspinatus (0.8685 and 0.8535) and subscapularis muscles (0.7777 and 0.7972), but fair in infraspinatus/teres minor muscles (0.5791 and 0.5740); however, quantitative Hounsfield units measurements showed excellent reliability for all muscles (ICC: 0.7950 and 0.9346 for SST, 0.7922 and 0.8492 for SSC, and 0.9254 and 0.9052 for IST/TM). No muscle showed improvement of fatty degeneration after surgical repair on qualitative and quantitative assessments; there was no difference in changes of fatty degeneration after surgical repair according to preoperative tear size and post-operative cuff integrity (p > 0.05). The average dose-length product (DLP, mGy . cm) was 365.2 mGy . cm (range, 323.8-417.2 mGy . cm) and estimated average effective dose was 5.1 mSv. Goutallier grades

  13. Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

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    Roberto Yukio Ikemoto

    2013-04-01

    Full Text Available OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%. The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001. Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001, 3º of external rotation (p < 0.396 and two vertebral levels for internal rotation (p < 0.025. CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

  14. Cross-Sectional Area of the Rotator Cuff Muscles in MRI - Is there Evidence for a Biomechanical Balanced Shoulder?

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    Samy Bouaicha

    Full Text Available To provide in-vivo evidence for the common biomechanical concept of transverse and craniocaudal force couples in the shoulder that are yielded by both the rotator cuff muscles (RCM and the deltoid and to quantitatively evaluate and correlate the cross-sectional areas (CSA of the corresponding RCM as a surrogate marker for muscle strength using MRI.Fifty patients (mean age, 36 years; age range, 18-57 years; 41 male, 9 female without rotator cuff tears were included in this retrospective study. Data were assessed by two readers. The CSA (mm2 of all rotator cuff muscles was measured on parasagittal T1-weighted FSE sequence at two different positions (at the established "y-position" and at a more medial slice in the presumably maximal CSA for each muscle, i.e., the "set position". The CSA of the deltoid was measured on axial intermediate-weighted FSE sequences at three positions. CSA measurements were obtained using 1.5 Tesla MR-arthrographic shoulder. Pearson's correlation for the corresponding CSA of the force couple as well as was the intraclass correlation coefficient for the inter- and intra-reader agreement was calculated.The mean CSA was 770 mm2 (±167 and 841 mm2 (±191 for the supraspinatus (in the y- and set-positions, respectively and 984 mm2 (±241 and 1568 mm2 (±338 for the infraspinatus. The mean CSA was 446 mm2 (±129 and 438 mm2 (±128 for the teres minor (in the y- and set-positions, respectively and 1953 mm2 (±553 and 2343 mm2 (±587 for the subscapularis. The three measurements of the deltoid revealed a CSA of 3063 mm2 (±839 for the upper edge, 3829 mm2 (±836 for the lower edge and 4069 mm2 (±937 for the middle of the glenoid. At the set position Pearson's correlation of the transverse force couple (subscapularis/infraspinatus showed a moderate positive correlation of r = 0.583 (p<0.0001 and a strong correlation when the CSA of the teres minor was added to the infraspinatus CSA (r = 0.665, p = 0.0008 and a strong positive

  15. A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy.

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    Jelsing, Elena J; Maida, Eugene; Smith, Jay

    2013-03-01

    Calcific rotator cuff tendinopathy caused by symptomatic calcium hydroxyapatite crystal deposition is a well-established cause of shoulder pain. In refractory or acutely symptomatic cases, sonographically guided percutaneous lavage and aspiration can significantly reduce pain in approximately 60%-92% of cases. Although the complication rate of sonographically guided percutaneous lavage and aspiration is apparently low, needle clogging attributable to impacted calcific debris has been described by several authors and in our experience can occur in daily practice. Traditionally, an inability to relieve the obstruction via needle repositioning or increased syringe plunger pressure has required needle removal and replacement. In this article, we outline a simple technique that can be used to restore patency of the obstructed lavage needle without necessitating needle removal and replacement.

  16. Evaluation of the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over

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    Alberto Naoki Miyazaki

    2015-06-01

    Full Text Available OBJECTIVES: To evaluate the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over.METHODS: Between 1998 and 2009, 168 patients underwent operations. Five cases were excluded. The remaining 163 patients were stratified according to their age group: 65-69 years (49.1%, 70-74 (26.4% and 75 years and over (24.5%. Their mean age was 71 years (range: 65-83. There were 63 male patients (38.7%. The mean length of time with pain, from the onset of symptoms to the surgery, was 23 months (range: 2 days to 240 months. Sixty-two patients (38% reported histories of trauma and 26 (16% reported that their pain worsened through exertion.RESULTS: From the UCLA criteria, 80.4% of the results were excellent, 16% good, 1.8% fair and 1.8% poor. Complications occurred in 11%. The final clinical result did not show any correlation with age progression, injury size or tendons affected. However, there was a significant association (p < 0.001 between the presence of trauma and larger injuries. The length of time between the onset of symptoms and the surgical procedure had a significant relationship (p < 0.027 with the postoperative results: the longer this time was, the worse the results were.CONCLUSION: Arthroscopic treatment of rotator cuff injuries in patients aged 65 years and over presented excellent and good results in 96.4% of the cases, according to the UCLA assessment, with a low complication rate. Advanced age did not show any influence on the postoperative clinical evolution, but the earlier the surgical treatment was instituted, the better the results were.

  17. Assessment of proprioceptive exercises in the treatment of rotator cuff disorders in nursing professionals: a randomized controlled clinical trial

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    Lisandra V Martins

    Full Text Available BACKGROUND: Shoulder pain in nursing professionals may lead to limitations in occupational and daily activities and consequently interfere with quality of life. OBJECTIVE: To compare the effects of two physical therapy programs which differed in the proprioceptive exercises used on the nursing professionals with rotator cuff disorder, according to quality of life, work satisfaction indicators, and pain intensity. METHOD: This study was an experimental, randomized, prospective, comparative trial with quantitative data analysis. The data sampling was carried out between the months of June 2010 and July 2011 by means of a questionnaire containing socio-demographic and professional information, the Western Ontario Rotator Cuff Index (WORC, the Occupational Stress Indicator (OSI, and the Visual Numeric Scale (VNS. Based on randomization, subjects were divided into two groups. Group 1 (control was submitted to stretching and strengthening exercises and cryotherapy. Group 2 (experimental was treated with the same protocol as the control group, with the addition of proprioception exercises. The data was analyzed by means of the Statistical Package for the Social Science version 16.0 for Windows. RESULTS: After physical therapy intervention, significant reduction in pain levels occurred in both groups, with a significant improvement in quality of life for Group 2. No changes were observed in the work satisfaction indicators after the two types of physical therapy interventions. CONCLUSIONS: The proprioceptive exercises were important in the treatment of musculoskeletal disorders, however the results did not allow us to determine which treatment was the most effective as there was no significant difference between groups.

  18. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

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    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Purpose: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. Conclusion: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25767776

  19. Comparison of three dimensional isotropic and two dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears

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    Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Cha, Jang Kyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jee, Suk Kyoung [Joeun Madi Hospital, Seoul (Korea, Republic of)

    2014-12-15

    To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

  20. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis

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    Centeno CJ

    2015-06-01

    Full Text Available Christopher J Centeno,1 Hasan Al-Sayegh,1 Jamil Bashir,1 Shaun Goodyear,2 Michael D Freeman3 1Centeno-Schultz Clinic, Broomfield, CO, USA; 2Forensic Research and Analysis, Portland, OR, USA; 3Department of Public Health and Preventive Medicine and Psychiatry, Oregon Health and Science University, Portland, OR, USA Introduction: Shoulder pain is a common musculoskeletal complaint in the general population. Bone marrow concentrate (BMC injections offer promising potential as a minimally invasive approach for treatment of shoulder pain in degenerative disease. In this study, we investigated the clinical outcomes of the BMC injections for treatment of shoulder pain and disability due to osteoarthritis (OA and rotator cuff tears in a treatment registry population. Methods: A total of 115 shoulders in 102 patients were treated with autologous BMC injections for symptomatic OA at the glenohumeral joint and/or rotator cuff tears. Data were collected for factors potentially influencing outcome, including age, sex, body mass index, and the type of condition treated (ie, OA or rotator cuff tear. Clinical outcomes were assessed serially over time using the disabilities of the arm, shoulder and hand score (DASH, the numeric pain scale (NPS, and a subjective improvement rating scale. Baseline scores were compared to the most recent outcome scores at the time of the analysis and adjusted for demographic differences. We reported comparisons of pre- and post-treatment scores, the differences between osteoarthritis and rotator cuff groups, and the predictive effects on the clinical outcomes. Results: At the most current follow-up assessment after treatment, the average DASH score decreased (improved from 36.1 to 17.1 (P<0.001 and the average numeric pain scale value decreased (improved from 4.3 to 2.4 (P<0.001. These changes were associated with an average subjective improvement of 48.8%. No differences were observed between outcomes among the shoulders treated

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

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    Freddy B. Marcondes

    2013-04-01

    Full Text Available BACKGROUND: Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. OBJECTIVES: Assessment of the shoulder range of motion (ROM, strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. METHOD: Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22 and Painful Group (n=27. The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation, isometric shoulder strength (internal and external rotation and posterior shoulder tightness by blind evaluators. RESULTS: The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05. The intragroup analysis (dominant versus non-dominant in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05. CONCLUSIONS: The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM, external rotation gain (ROM and deficits in external rotation strength than the tennis players without pain.

  2. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

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    Choi, Eunkyung; Park, Yongmin; Jeon, Younghoon

    2017-01-01

    Abstract Background: Positional change affects the cuff pressure of an endotracheal tube (ETT) in treacheally intubated patients. We compared the cuff pressure of a TaperGuard ETT and a cylindrical ETT after lateral rotation of head during middle ear surgery. Methods: Fifty-two patients aged 18–70 years underwent a tympanomastoidectomy under general anesthesia were randomly allocated to receive endotracheal intubation with cylindrical (group C, n = 26) or TaperGuard ETTs (group T, n = 26). After endotracheal intubation, the ETT cuff pressure was set at 22 cmH2O in the neutral position of head. After lateral rotation of head, the cuff pressure was measured again and readjusted to 22 cmH2O. In addition, the change of distance from the carina to the tip of the ETT was measured before and after the positional change. The incidence of cough, sore throat, and hoarseness was assessed at 30 minutes, 6 hours, and 24 hours after surgery. Results: There was no difference in demographic data between groups. After lateral rotation of head, the cuff pressure significantly increased in group T (11.9 ± 2.3 cmH2O) compared with group C (6.0 ± 1.9 cmH2O) (P 30 cmH2O was higher in group T (96.2%) than in group C (30.8%) (P < 0.001). In addition, the degree of displacement of an ETT was greater in group T (11.0 ± 1.7 mm) than in group C (7.2 ± 2.6 mm) (P < 0.001). The overall incidences of postoperative sore throat, hoarseness, and cough at 30 minutes, 6 hours, and 24 hours after surgery were comparable between two groups. Conclusion: The cuff pressure was higher in the TaperGuard ETT than in the cylindrical ETT after positional change of head from neutral to lateral rotation. In addition, after a positional change, the extent of displacement of ETT was greater in the TaperGuard ETT than in the cylindrical ETT. PMID:28272230

  3. Obesity Has Minimal Impact on Short-Term Functional Scores After Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy.

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    Morris, Brent J; Haigler, Richard E; Cochran, John M; Laughlin, Mitzi S; Elkousy, Hussein A; Gartsman, Gary M; Edwards, T Bradley

    2016-01-01

    The potential adverse effect of body mass index (BMI) on shoulder function scores after reverse shoulder arthroplasty (RSA) has not been investigated. We conducted a study to examine outcomes of RSA performed for rotator cuff tear arthropathy (RCTA) across BMI categories (normal weight, overweight, obese). We hypothesized that, compared with normal-weight patients, obese patients would have worse shoulder function scores, worse mobility, and more complications. Using a prospective shoulder arthroplasty registry, we identified 77 primary RSAs performed for RCTA with minimum 2-year follow-up. Thirty-four patients had normal weight (BMI 30 kg/m2). Shoulder function scores, mobility, and satisfaction were evaluated before surgery and at final follow-up. The 3 BMI groups were not significantly different on demographic factors, preoperative shoulder function scores, or preoperative mobility (P > .05). For each group, shoulder function scores and mobility significantly improved between the preoperative and final follow-up assessments (P shoulder function scores, mobility, and patient satisfaction can be expected after RSA for RCTA in patients regardless of BMI.

  4. Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

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    Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Orthopedics and Traumatology, Munich (Germany); Wolf, Petra [Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany)

    2011-07-15

    To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder. MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified. 112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p=0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029). Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought. (orig.)

  5. Stability and selectivity of a chronic, multi-contact cuff electrode for sensory stimulation in human amputees

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    Tan, Daniel W.; Schiefer, Matthew A.; Keith, Michael W.; Anderson, J. Robert; Tyler, Dustin J.

    2015-04-01

    Objective. Stability and selectivity are important when restoring long-term, functional sensory feedback in individuals with limb-loss. Our objective is to demonstrate a chronic, clinical neural stimulation system for providing selective sensory response in two upper-limb amputees. Approach. Multi-contact cuff electrodes were implanted in the median, ulnar, and radial nerves of the upper-limb. Main results. Nerve stimulation produced a selective sensory response on 19 of 20 contacts and 16 of 16 contacts in subjects 1 and 2, respectively. Stimulation elicited multiple, distinct percept areas on the phantom and residual limb. Consistent threshold, impedance, and percept areas have demonstrated that the neural interface is stable for the duration of this on-going, chronic study. Significance. We have achieved selective nerve response from multi-contact cuff electrodes by demonstrating characteristic percept areas and thresholds for each contact. Selective sensory response remains consistent in two upper-limb amputees for 1 and 2 years, the longest multi-contact sensory feedback system to date. Our approach demonstrates selectivity and stability can be achieved through an extraneural interface, which can provide sensory feedback to amputees.

  6. 组织工程修复肩袖损伤促进腱骨愈合的研究进展%Progress in tissue-engineering for tendon-to-bone healing after rotator cuff repair

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    赵晨; 王蕾

    2015-01-01

    Rotator cuff injury, considered as a resource of pain, disability and dyssomnia to serious decline in the quality of life, is a common disorder of the shoulder joint. Basic principles of rotator cuff repair aim at achieving high initial ifxation strength, maintaining mechanical stability and restoring the anatomic healing of the cuff tendon. After the routine surgical procedure for rotator cuff repair, the biology and histology of the normal enthesis are not restored. Tendon-to-bone healing occurs with a ifbrovascular scar tissue interface that is mechanically inferior to the native insertion site, which may lead to high re-rupture rate. For these reasons, new approaches are required to improve structural healing. Tissue engineering strategies have been suggested to improve the biological environment around the bone-tendon interface and to promote regeneration of the native insertion site. Although experimental applications of growth factors and scaffolds on animal models demonstrate promising results, techniques which can be used in human rotator cuff repair are still very limited. Tissue engineering to improve tendon-to-bone healing has bright future and requires more research before its clinical applications. This review will outline therapies of growth factors, scaffolds and stem cells in tendon healing and rotator cuff repair.

  7. Minimally Important Differences and Change Across Time in Patients Treated Surgically and Non-Surgically for Full-Thickness Rotator Cuff Tears

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    Miller, Bruce S.; Robbins, Christopher; Gagnier, Joel Joseph

    2016-01-01

    Objectives: The minimally important difference (MID) is the smallest change in an outcome measure that is perceived by patients as beneficial. The MIDs for the ASES and WORC scores have not been established in a homogenous population of patients with rotator cuff tears. The objective of the present study was to establish the MIDs for patients with known cuff tears who were treated both surgically and non-surgically, and to compare the MIDs over time. Methods: We included 209 subjects with known full-thickness rotator cuff tears who were followed prospectively for two years. The WORC and ASES scores were collected at baseline, 4, 8, 16, 32, and 48 weeks, 1 year and 2 years. At the final follow-up point patients filled out an end-of-study form which included questions regarding change in their condition after treatment. Results: For those that indicated being minimally better, the change from baseline for the ASES score was -20.57 (-2.94 to -38.20) and for the WORC was 418.60 (70.39 to 766.81); both indicated improvement in outcomes. When converted to the percentage change score the WORC change represented 19.93%. The plots of these new MID values for the ASES and WORC indicate that not only does the operative group improve more than the non-operative group but it does so to an extent that is greater than the MID. The non-operative group also improved across time, but the magnitude did not exceed the MID for either the WORC or the ASES. Conclusion: We found that the ASES and the WORC MIDs in patients with rotator cuff tears is different from that previously reported, and that the operative group change was greater than the non-operative group change. This information will directly improve our ability to: (1) Determine when patients with RCTs are changing in a meaningful manner; (2) Accurately power clinical studies using these outcome measures; (3) Make more informed choices of treatments in these patients. This is the first study to report MIDs for the ASES and WORC

  8. Resultados do tratamento artroscópico das rupturas do manguito rotador Outcomes of arthroscopic treatment for rotator cuff tears

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    Carlos Henrique Ramos

    2010-01-01

    Full Text Available OBJETIVO: Analisar os resultados do reparo artroscópico das rupturas do manguito rotador. MÉTODOS: Realizado estudo retrospectivo com avaliação dos resultados da técnica em 42 pacientes operados entre 2002 e 2006. O seguimento médio foi de 31 meses e a média de idade foi de 57 anos, sendo o lado dominante operado em 73,8% dos casos. Para avaliação foram usadas escalas de UCLA e Escala Visual Analógica da dor no pós-operatório. RESULTADOS: Os resultados foram satisfatórios em 85,7% (59,5% excelentes e 26,2% bons respectivamente e insatisfatórios em 14,3% dos pacientes. Nos casos com lesões associadas, a mais frequente foi no tendão da porção longa do bíceps (57,1%. Associação com outras lesões não comprometeu o resultado. O mesmo aconteceu com relação a idade e tempo de acompanhamento pós-cirurgia. Quanto ao tamanho da lesão, diferença significativa ocorreu nos casos de lesões grandes e maciças demonstrando resultados inferiores em relação às pequenas e médias. A função foi inferior principalmente nos casos de lesão maciça. CONCLUSÃO: A reparação artroscópica das lesões do manguito rotador (MR proporciona baixa morbidade cirúrgica e possibilita diagnóstico de lesões articulares associadas. O benefício do procedimento foi confirmado principalmente pela melhora significativa da dor, mesmo nos casos de lesões maiores.OBJECTIVE: To evaluate the results of arthroscopic treatment for rotator cuff tears. METHODS: A retrospective study was carried out demonstrating the results of this technique in 42 patients operated between 2002 and 2006. The mean follow-up was 31 months and average age was 57 years. The dominant limb was operated in 73.8% of cases. Function and pain were evaluated using criteria of UCLA Score System and Visual Analogic Scale respectively. RESULTS: The results were satisfactory in 85.7% (59.5% excellent and 26.2% good, with 14.3% unsatisfactory. The most frequent associated lesion was the

  9. Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis

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    McGarvey, Ciaran; Harb, Ziad; Smith, Christian; Ajuied, Adil [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Trauma and Orthopaedics, London (United Kingdom); Houghton, Russell [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Radiology, London (United Kingdom); Corbett, Steven [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Trauma and Orthopaedics, London (United Kingdom); Fortius Clinic, London (United Kingdom)

    2016-02-15

    To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA. Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears. (orig.)

  10. Effects of Preoperative Non-Steroidal Anti-Inflammatory Drugs on Pain Mitigation and Patients’ Shoulder Performance Following Rotator Cuff Repair

    Directory of Open Access Journals (Sweden)

    Alireza Rouhani

    2014-12-01

    Full Text Available Purpose: Pain is one of the most important factors adversely affecting clinical outcomes of operated patients. The present study aims at evaluating effects of preoperative COX2 non-steroidal anti-inflammatory inhibitors on pain mitigation and performance of patients with shoulder rotator cuff tear. Methods: This case-control study was conducted on 60 patients suffering from rotator cuff injury candidate for arthroscopic repair. The patients were classified in two parallel and matched groups. One group (case group was treated using Celecoxib (200mg/12h started 48 hours before surgery and continued for 10 days after operation. In the control group, the placebo was prescribed in the same way. Postoperative pain, side effects, sleep disturbance, and short-term outcomes were compared between two groups using DASH questionnaire. Results: Postoperative pain in the Celecoxib group significantly decreased in comparison with the control one. The difference was statistically meaningful (P<0.001. Well motion ability was seen in 80% of patients of the Celecoxib group. It was 26.6% in the placebo group since pain inhibited them from exercising more motions. In this regard, there was a statistically meaningful difference between these two groups (P=0.02. Sleep disturbance was meaningfully at higher levels in the placebo group (P=0.001. Following up the patients for three months, it was made clear that performance of the Celecoxib group was better than that of the placebo one. Conclusion: COX2 inhibitors are well efficient in patients’ pain management after arthroscopic rotator cuff repair surgery. It results in less life complications, less sleep disturbances, improvement of patients’ short-term clinical outcome, and more quick recovery.

  11. Intra-articular changes precede extra-articular changes in the biceps tendon following rotator cuff tears in a rat model

    Science.gov (United States)

    Peltz, Cathryn D.; Hsu, Jason E.; Zgonis, Miltiadis H.; Trasolini, Nicholas A.; Glaser, David L.; Soslowsky, Louis J.

    2011-01-01

    Background Biceps tendon pathology is common with rotator cuff tears. The mechanisms for biceps changes, and therefore its optimal treatment, are unknown. Our objective was to determine the effect of rotator cuff tears on regional biceps tendon pathology. We hypothesized that histological and compositional changes would appear before organizational changes, both would appear before mechanical changes, and changes would begin at the tendon’s insertion site. Methods Sixty-five Sprague-Dawley rats received either detachment of supraspinatus and infraspinatus tendons or sham surgery. Rats were sacrificed at 1, 4 or 8 weeks for regional measurements of histological, compositional, organizational (1, 4 and 8 weeks) or mechanical properties (4 and 8 weeks only). Results One week following tendon detachments, decreased organization and more rounded cell shape were found in the intra-articular space of the biceps tendon. Aggrecan expression was increased along the entire length of the tendon while all other compositional changes were at the tendon’s proximal insertion into bone only. With time, this disorganization and more rounded cell shape extended the length of the tendon. Organizational and cell shape changes also preceded detrimental mechanical changes, as decreased modulus in the intra-articular space was found after 8 weeks. Conclusions Results support a degenerative component to pathology in the biceps tendon. Additionally, changes resembling a tendon exposed to compressive loading occurring first in the intra-articular space indicate that the biceps tendon plays an increased role as a load bearing structure against the humeral head in the presence of rotator cuff tears. PMID:21816629

  12. Characteristics and stimulation potential with BMP-2 and BMP-7 of tenocyte-like cells isolated from the rotator cuff of female donors.

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    Franka Klatte-Schulz

    Full Text Available Tendon bone healing of the rotator cuff is often associated with non-healing or recurrent defects, which seems to be influenced by the patient's age and sex. The present study aims to examine cellular biological characteristics of tenocyte-like cells that may contribute to this impaired rotator cuff healing. Moreover, a therapeutic approach using growth factors could possibly stimulate tendon bone healing. Therefore, our second aim was to identify patient groups who would particularly benefit from growth factor stimulation. Tenocyte-like cells isolated from supraspinatus tendons of female donors younger and older than 65 years of age were characterized with respect to different cellular biological parameters, such as cell density, cell count, marker expression, collagen-I protein synthesis, and stem cell potential. Furthermore, cells of the donor groups were stimulated with BMP-2 and BMP-7 (200 and 1000 ng/ml in 3D-culture and analyzed for cell count, marker expression and collagen-I protein synthesis. Female donors older than 65 years of age showed significantly decreased cell count and collagen-I protein synthesis compared to cells from donors younger than 65 years. Cellular biological parameters including cell count, collagen-I and -III expression, and collagen-I protein synthesis of cells from both donor groups were stimulated with BMP-2 and BMP-7. The cells from donors older than 65 years revealed a decreased stimulation potential for cell count compared to the younger group. Cells from female donors older than 65 years of age showed inferior cellular biological characteristics. This may be one reason for a weaker healing potential observed in older female patients and should be taken into consideration for tendon bone healing of the rotator cuff.

  13. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block following arthroscopic rotator-cuff repair

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    Yamakado K

    2014-05-01

    Full Text Available Kotaro YamakadoDepartment of Orthopaedics, Fukui General Hospital, Fukui, JapanBackground: Rotator-cuff surgery is well recognized to be a painful procedure.Objectives: The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB] following arthroscopic rotator-cuff repair (ARCR.Materials and methods: This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB. The visual analog scale (at 6 hours and on the first, second, and third postoperative days and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated.Results: The respective visual analog scale scores (mm obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73 before surgery, 9.1 and 19.4 (P=0.12 at 6 hours after surgery, 24.4 and 44.6 (P=0.019 on the first postoperative day, 19.4 and 40.4 (P=0.0060 on the second postoperative day, and 18.5 and 27.8 (P=0.21 on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020, respectively.Conclusion: ca-SSNB was highly effective in controlling postoperative pain after ARCR.Keywords: shoulder, rotator cuff tear, postoperative pain control, continuous suprascapular nerve block, arthroscopic rotator cuff repair

  14. Arthroscope-assisted Small Incision Approach of Rotator Cuff Repair%关节镜辅助小切口治疗肩袖损伤

    Institute of Scientific and Technical Information of China (English)

    徐海涛; 刘志远; 邹明

    2013-01-01

    Objective To explore the technique and effect of arthroscope-assisted rotator cuff repair via a small incision approach.Methods From March 2008 to December 2011,22 cases of rotator cuff tear were treated by arthroscope-assisted repair with a small incision,including 16 of full-thickness rotator cuff tear and 6 of partial-thickness rotator cuff tears.Accurate positioning,completely subacromial decompression was carried out with a small incision assisted by arthroscopy guide.16 cases of full-thickness and 2 cases of partial-thickness rotator cuff tears were repaired with double anchor.The other 4 cases of partial-thickness rotator cuff tears were performed arthroscopic debridement.There were 7 cases combined with SLAP lesion.Results The operation time was 120 minutes in one case combined with type Ⅱ of SLAP injury,and ranged from 51 to 70 minutes (mean 62) in other cases.The time of acromioplasty and rotator cuff repair was 12 to 20 minutes (mean 17).The length of assisted small incision was 2 to 3.5 cm with an average of 2.8 cm.No nerve injury,limb swelling and fluid leakage was found.All patients were followed up for 10 to 18 months with an average of 13.2 months.The ASES score revealed excellence in 12 cases,good in 7 cases,fair in 3,and the fineness rate was 86.4% ;And the UCLA score was excellence in 9,good in 11,fair in 2,and the fineness rate was 90.9%.The ASES score and UCLC score of 10 months after the operation was 91 ± 12.5 and 33.2 ±3.5 respectively,both were improved significantly than 57 ± 9.6 and 12.9 ± 3.8 respectively of pre-operation(P < 0.05).Conclusions Arthroscopy plays an important role in the diagnosis and treatment of rotator cuff tears.Arthroscope-assisted rotator cuff repair with a small incision approach can achieve a reliable result with advantages as comprehensive and accurate diagnosis,minimal invasion,early rehabilitation and rapid recovery.%目的 探讨关节镜辅助小切口治疗肩袖损伤的方法和疗效.

  15. Rotator Cuff Tears

    Science.gov (United States)

    ... stiffness • Anesthesia complications • Sometimes lengthy recovery time The disadvantages of nonsurgical treatment are: • No improvements in strength • ... AAOS “Find an Orthopaedist” program on OrthoInfo.org. Copyright ©1995-2013 by the American Academy of Orthopaedic ...

  16. Ultrasound evaluation of the distal migration of the long head of biceps tendon following tenotomy in patients undergoing arthroscopic repair of tears of the rotator cuff.

    Science.gov (United States)

    Karataglis, D; Papadopoulos, P; Boutsiadis, A; Fotiadou, A; Ditsios, K; Hatzokos, I; Christodoulou, A

    2012-11-01

    This study evaluates the position of the long head of biceps tendon using ultrasound following simple tenotomy, in patients with arthroscopically repaired rotator cuff tears. In total, 52 patients with a mean age of 60.7 years (45 to 75) underwent arthroscopic repair of the rotator cuff and simple tenotomy of the long head of biceps tendon. At two years post-operatively, ultrasound revealed that the tendon was inside the bicipital groove in 43 patients (82.7%) and outside in nine (17.3%); in six of these it was lying just outside the groove and in the remaining three (5.8%) it was in a remote position with a positive Popeye Sign. A dynamic ultrasound scan revealed that the tenotomised tendons had adhered to the surrounding tissues (autotenodesis).The initial condition of the tendon influenced its final position (p Popeye sign was statistically influenced by the pre-operative co-existence of supraspinatus and subscapularis tears (p Popeye sign.

  17. Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 1 - Three-dimensional shoulder kinematics.

    Science.gov (United States)

    Sousa, Catarina de Oliveira; Camargo, Paula Rezende; Ribeiro, Ivana Leão; Reiff, Rodrigo Bezerra de Menezes; Michener, Lori Ann; Salvini, Tania Fátima

    2014-08-01

    This study described the three-dimensional shoulder motion during the arm elevation in individuals with isolated acromioclavicular osteoarthritis (ACO) and ACO associated with rotator cuff disease (RCD), as compared to controls. Seventy-four participants (ACO=23, ACO+RCD=25, Controls=26) took part of this study. Disability was assessed with the DASH, three-dimensional kinematics were collected during arm elevation in the sagittal and scapular planes, and pain was assessed with the 11-point numeric pain rating scale. For each kinematic variable and demographic variables, separate linear mixed-model 2-way ANOVAs were performed to compare groups. Both ACO groups had higher DASH and pain scores. At the scapulothoracic joint, the isolated ACO group had greater internal rotation than control, and the ACO+RCD group had greater upward rotation than both other groups. At the sternoclavicular joint, both groups with ACO had less retraction, and the isolated ACO group had less elevation and posterior rotation. At the acromioclavicular joint, the isolated ACO group had greater upward rotation, and both ACO groups had greater posterior tilting. Patients with ACO had altered shoulder kinematics, which may represent compensatory responses to reduce pain and facilitate arm motion during arm elevation and lowering.

  18. Biomechanical comparison of double-row versus transtendon single-row suture anchor technique for repair of the grade Ⅲ partial articular-sided rotator cuff tears

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-gang; ZHAO De-wei; WANG Wei-ming; REN Ming-fa; LI Rui-xin; YANG Sheng; LIU Yu-peng

    2010-01-01

    Background For partial-thickness tears of the rotator cuff, double-row fixation and transtendon single-row fixation restore insertion site anatomy, with excellent results. We compared the biomechanical properties of double-row and transtendon single-row suture anchor techniques for repair of grade Ⅲ partial articular-sided rotator cuff tears.Methods In 10 matched pairs of fresh-frozen sheep shoulders, the infraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique. This comprised placement of 2 medial anchors with horizontal mattress sutures at an angle of .≤45° into the medial margin of the infraspinatus footprint, just lateral to the articular surface, and 2 lateral anchors with horizontal mattress sutures. Standardized, 50% partial, articular-sided infraspinatus lesions were created in the contralateral shoulder. The infraspinatus tendon from the contralateral shoulder was repaired using two anchors with transtendon single-row mattress sutures. Each specimen underwent cyclic loading from 10 to 100 N for 50 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a motion capture system; stiffness and failure load were determined from testing data.Results Gap formation for the transtendon single-row repair was significantly smaller (P <0.05) when compared with the double-row repair for the first cycle ((1.74±0.38) mm vs. (2.86±0.46) mm, respectively) and the last cycle ((3.77±0.45) mm vs. (5.89±0.61) mm, respectively). The strain over the footprint area for the transtendon single-row repair was significantly smaller (P <0.05) when compared with the double-row repair. Also, it had a higher mean ultimate tensile load and stiffness.Conclusions For grade Ⅲ partial articular-sided rotator cuff tears, transtendon single-row fixation exhibited superior biomechanical properties when compared with double-row fixation.

  19. Tratamento conservador das lesões parciais e completas do manguito rotador Conservative treatment of partial and complete tears of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Osvandré Lech

    2000-09-01

    Full Text Available A lesão do manguito rotador é a mais freqüente patologia do ombro. Cerca de 180 pacientes foram tratados conservadoramente nos dois Serviços nos anos de 1996 e 1997. Este grupo recebeu uma ampla gama de tratamentos (apenas medicação, exercícios caseiros, infiltração, fisioterapia, etc.. Este estudo avaliou os resultados do tratamento conservador em 26 pacientes com rupturas parcial e total do manguito rotador. O protocolo consistiu de um programa com 6 meses de duração que incluiu terapia miofascial específica, exercícios ativos assistidos e de fortalecimento dos músculos do manguito rotador e da musculatura axioescapular. Os fatores de inclusão no estudo foram: 1 realizar todo o programa com apenas um reabilitador; 2 não ter recebido infiltração; 3 não ter tido cirurgia prévia; 4 não ter reumatopatia diagnosticada. Seis meses após a alta, dezoito pacientes (69,22% apresentavam resultado satisfatório, enquanto que os demais 08 casos (30,78% foram considerados insatisfatórios e tiveram indicação cirúrgica.The lesion of rotator cuff is the most frequent lesion of the shoulder. Circa 180 patients were conservatively treated in both Clinics during the years of 1976 and 1997. This group of patients received a wide range of treatments (only medication, home exercises, infiltration, physiotherapy, etc. This study evaluated the results of the conservative treatment in 26 patients with partial and total rupture of the rotator cuff. The protocol consisted of a program with duration of 6 months including specific miofascial therapy, assisted active exercises and of strengthening of the muscles of the rotator cuff and axioscapular musculature. The inclusion criteria of the study were: 1 to carry the program with just one reabilitator; 2 no previous infiltration; 3 no previous surgery; 4 absence of diagnosed rheumatopathy. Six months after the end of treatment, eighteen patients (69,22% presented with satisfactory results, while

  20. Leukocyte- and platelet-rich fibrin (L-PRF) for long-term delivery of growth factor in rotator cuff repair: review, preliminary results and future directions.

    Science.gov (United States)

    Zumstein, Matthias A; Berger, Simon; Schober, Martin; Boileau, Pascal; Nyffeler, Richard W; Horn, Michael; Dahinden, Clemens A

    2012-06-01

    Surgical repair of the rotator cuff repair is one of the most common procedures in orthopedic surgery. Despite it being the focus of much research, the physiological tendon-bone insertion is not recreated following repair and there is an anatomic non-healing rate of up to 94%. During the healing phase, several growth factors are upregulated that induce cellular proliferation and matrix deposition. Subsequently, this provisional matrix is replaced by the definitive matrix. Leukocyte- and platelet-rich fibrin (L-PRF) contain growth factors and has a stable dense fibrin matrix. Therefore, use of LPRF in rotator cuff repair is theoretically attractive. The aim of the present study was to determine 1) the optimal protocol to achieve the highest leukocyte content; 2) whether L-PRF releases growth factors in a sustained manner over 28 days; 3) whether standard/gelatinous or dry/compressed matrix preparation methods result in higher growth factor concentrations. 1) The standard L-PRF centrifugation protocol with 400 x g showed the highest concentration of platelets and leukocytes. 2) The L-PRF clots cultured in medium showed a continuous slow release with an increase in the absolute release of growth factors TGF-β1, VEGF and MPO in the first 7 days, and for IGF1, PDGF-AB and platelet activity (PF4=CXCL4) in the first 8 hours, followed by a decrease to close to zero at 28 days. Significantly higher levels of growth factor were expressed relative to the control values of normal blood at each culture time point. 3) Except for MPO and the TGFβ-1, there was always a tendency towards higher release of growth factors (i.e., CXCL4, IGF-1, PDGF-AB, and VEGF) in the standard/gelatinous- compared to the dry/compressed group. L-PRF in its optimal standard/gelatinous-type matrix can store and deliver locally specific healing growth factors for up to 28 days and may be a useful adjunct in rotator cuff repair.

  1. The preliminary comparative study between MRI and arthroscopy manifestation for rotator cuff injury%肩袖损伤MR I与关节镜下表现对比的初步研究

    Institute of Scientific and Technical Information of China (English)

    刘佳超; 陈建海; 黄伟; 王天兵; 姜保国

    2013-01-01

    目的:通过比较肩关节术前 MRI检查与关节镜下肩袖所见的异同,了解 MRI 对肩袖损伤诊断的准确性,并进一步明确肩袖损伤关节镜治疗的适应证。方法回顾性分析2007年7月至2010年12月北京大学人民医院创伤骨科行关节镜检查或治疗患者的59例肩部疾病患者,将MRI表现与关节镜所见进行对照分析。结果59例患者中,术前 MRI 检查明确诊断肩袖损伤36例,经关节镜证实肩袖撕裂35例,肩袖组织关节镜下结果完整,未见明显撕裂者1例;术前 MRI 检查未发现肩袖撕裂而关节镜下见撕裂7例,MRI检查与关节镜均未见肩袖撕裂者16例。MRI 对肩袖损伤诊断的敏感度为88.3%,特异度为94.1%,阳性预测值97.2%,阴性预测值69.6%。结论 MRI 是诊断肩袖损伤的有效辅助检查,但仍存在一定程度的漏诊,关节镜检查是诊断肩袖损伤最为可靠的辅助检查手段。%Objective Rotator cuff, a sleeve-like structure composed of supraspinatus, infraspinatus muscle,teres minor and subscapularis,is the major anatomical structure to maintain shoulder stability.Rotator cuff pathologies are frequently encountered in patients with pain at the shoulder.The rotator cuff can be visualized with different imaging techniques such as ultrasonography (US),arthrography,arthroscopy,computed tomography (CT)and magnetic resonance imaging (MRI).MRI had quickly become the favored method for preoperative diagnosis of the rotator cuff inj ury,with high soft tissue resolution ratio,sensitivity and accuracy.It is clinically significant to correctly understand the MRI manifestation of patients with the painful shoulder.We retrospectively analyzed the MRI examination and arthroscopy findings of 5 9 rotator cuff inj uries treated in one hospital.Methods (1)Subjects:From July 2007 to December 2010,a total of 59 patients (25 males and 34 females,aged from 24 to 83 years old,mean age 54.33 years),who underwent arthroscopic surgery for

  2. Effective background infusion rate of ropivacaine 0.2% for patient-controlled interscalene brachial plexus analgesia after rotator cuff repair surgery

    Institute of Scientific and Technical Information of China (English)

    Wei Yue; Li Min; Rong Yulan; Guo Xiangyang

    2014-01-01

    Background Continuous interscalene nerve block (CISB) is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2% for CISB after arthroscopic rotator cuff repair surgery in 95% of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter (ISC) was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2% with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit (PACU) after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95% of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h (95% CI,2.3-3.3 ml/h).The effective background rate in 95% of patients calculated with the isotonic regression analysis was 4.4 ml/h (95% CI,3.8-6.5 ml/h).Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50% and 95% of the patients was 2.8 and 4.4 ml/h,respectively.

  3. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears

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    Lee, Ro Woon; Choi, Soo-Jung; Ahn, Jae Hong; Shin, Dong Rock; Kang, Chae Hoon [University of Ulsan, College of Medicine, Department of Radiology, Asan Foundation, Gangneung Asan Hospital, Gangneung-si, Gangwon-do (Korea, Republic of); Lee, Man Ho [Andong Medical Center, Department of Radiology, Andong-si, Gyeongsangbuk-do (Korea, Republic of); Lee, Ki Won [University of Ulsan, College of Medicine, Department of Orthopedic Surgery, Asan Foundation, Gangneung Asan Hospital, Gangneung-si, Gangwon-do (Korea, Republic of)

    2016-12-15

    To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears. This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears. Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively). Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears. (orig.)

  4. Type Ⅲ Collagen and histological change in treatment for rat rotator cuff injury with subacromial corticosteroid injection%肩峰下激素局部注射治疗大鼠肩袖损伤

    Institute of Scientific and Technical Information of China (English)

    韦民; 王伟; 刘祖德

    2008-01-01

    Objective To study the effect of corticosteroid on rat rotator cuff injury healing by observing histological change and quantifying the dynamic change of type Ⅲ collagen. Methods Thirty-six Sprague-Dawley rats were randomly divided into 4 groups:6 rats group A (normal rotator cuff) ,6 rats in group B (rotator cuff injury), 12 rats in group C (normal rotator cuff treated with corticosteroid) ,and 12 rats in group D (rotator cuff injury treated with corticosteroid). In the rats of groups B and D, a partialthickness rotator cuff injury was created by cutting 50% of thickness and 5 mm of width of the bilateral infraspinatus tendon 5 mm from its humeral insertion. 0.05 ml corticosteroid (Diprospan) was injected into the subacromial space of the rats in groups C and D. Total infraspinatus tendons were harvested for HE, Masson staining,immunohistochemical staining and type Ⅲ collagen quantification. Results istological change : In corticosteroid treatment groups, the normal arrangement of the collagen bundles was replaced by the disorganized collagen bundles with fragmentation of the collagen bundles and collagen necrosis at 3rd week, and the arrangement was improved very slightly at 6th week. Type In collagen : ( 1 ) The type Ⅲ collagen levels were significantly increased after the rotator cuff injury ( P < 0.05 ) ; (2) At 3rd week, the type Ⅲ collagen levels in corticoateroid treatment groups were significantly higher than in normal rotator cuff group and rotator cuff injury group ( P < 0.01 ) ; (3) At 6th week, the type Ⅲ collagen levels in rotator cuff injury treated with corticosteroid group remained on a very high level; (4) The type Ⅲ collagen levels in normal rotator cuff treated with corticosteroid group were significantly increased at 3rd week, and returned to the normal at 6th week (P > 0.05). Conclusion Corticosteroid can induce type Ⅲ collagen synthesis during rotator cuff healing, but even a single dose of corticosteriod can cause

  5. Tratamento artroscópico da tendinite calcária do manguito rotador Arthroscopic treatment of calcifying tendinitis of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Arnaldo Amado Ferreira Neto

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico por via artroscópica em pacientes com tendinite calcária do manguito rotador. MÉTODO: Foi realizado um estudo retrospectivo com análise de 20 pacientes que foram submetidos ao tratamento artroscópico da tendinite calcária do ombro, de março de 1999 a novembro de 2005. Seis pacientes foram excluídos devido à perda do seguimento. Com seguimento médio de 41,4 meses, oito pacientes (57% eram do sexo feminino e seis (43% do masculino; sendo o lado direito acometido em 10 (71% e o esquerdo em quatro (29%. Nove casos (64% apresentavam calcificação no tendão supraespinal, dois (14% no infraespinal e três (21% envolvendo os dois tendões. RESULTADOS: Em todos os casos, realizou-se a ressecção dos depósitos de cálcio através da perfuração com agulha (Jelco® nº 14 e curetagem (minicureta. Dois ombros (14% foram submetidos à descompressão subacromial; um, (7% à exérese distal da clavícula; e, em três, (21% houve a necessidade de se fazer sutura tendão-tendão. Nenhum paciente foi submetido à reinserção tendão-osso. Pela escala da UCLA, a média da pontuação foi de 33 pontos (26-35, indicando que a maioria teve resultados bons. Na avaliação final radiográfica, nenhum paciente apresentava sinais de calcificações. CONCLUSÃO: O tratamento artroscópico da tendinite calcária do ombro permite a exérese da calcificação com segurança, obtendo-se resultados bons com relação à dor e à função do ombro.OBJECTIVE: To evaluate the clinical and radiographic results of arthroscopic treatment of the rotator cuff in patients with Calcifying Tendinitis. METHOD: A retrospective study of twenty patients submitted to arthroscopic treatment for rotator cuff Calcifying Tendinitis from March 1999 to November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57% were female and

  6. Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year [v1; ref status: indexed, http://f1000r.es/xz

    Directory of Open Access Journals (Sweden)

    Arockia Doss

    2013-01-01

    Full Text Available This is a case report on excellent clinical outcome and neotendon infilling at one year follow up in a degenerative rotator cuff full thickness tear following percutaneous tenotomy and platelet rich plasma injection.

  7. Analysis of College Badminton Athlete Rotator Cuff Injury from the Anatomical Point%从解剖学角度分析高校羽毛球运动员肩袖损伤

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective: Analysis college badminton athletes rotator cuff injury reasons from the point of anatomy view. Methods:Literature, questionnaire, expert interviews. Results: The reasons of the college badminton athletes rotator cuff injury is too much training, the local overburdened lack of knowledge of sports injuries physiological, psychological unsatisfactory level of training. Conclusion: To improve awareness of sports injuries, to promote science and practice, to avoid the dangers caused by injury, to strengthen strength training and medical supervision can effectively avoid rotator cuff injury occurred.%  目的:从解剖学的角度分析高校羽毛球运动员肩袖损伤的原因。方法:采用文献资料法、问卷调查法、专家访谈法。结果:高校羽毛球运动员肩袖损伤的原因是运动量过大、局部负担过重、缺乏运动损伤知识、生理及心理水平欠佳、训练水平不足。结论:提高运动损伤意识、提倡科学练习,避免损伤带来的危害性,加强力量训练和医务监督能有效避免肩袖损伤的发生。

  8. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear—A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yohei Ono

    2016-01-01

    Full Text Available Articular surface partial-thickness rotator cuff tears (PTRCTs are commonly repaired using two different surgical techniques: transtendon repair or repair after completion of the tear. Although a number of studies have demonstrated excellent clinical outcomes, it is unclear which technique may provide superior clinical outcomes and tendon healing. The purpose was to evaluate and compare the clinical outcomes following arthroscopic repair of articular surface PTRCT using a transtendon technique or completion of the tear. A systematic review of the literature was performed following PRISMA guidelines and checklist. The objective outcome measures evaluated in this study were the Constant Score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, physical examination, and complications. Three studies met our criteria. All were prospective randomized comparative studies with level II evidence and published from 2012 to 2013. A total of 182 shoulders (mean age 53.7 years; mean follow-up 40.5 months were analyzed as part of this study. Both procedures provided excellent clinical outcomes with no significant difference in Constant Score and other measures between the procedures. Both procedures demonstrated improved clinical outcomes. However, there were no significant differences between each technique. Further studies are required to determine the long-term outcome of each technique.

  9. Arthroscopic treatment of calcific rotator cuff tendinitis%关节镜下钙化性肩袖肌腱炎的手术治疗

    Institute of Scientific and Technical Information of China (English)

    王东辰; 孙磊; 田敏; 高玉镭; 张新广; 唐胜斌; 郑肖

    2012-01-01

    [目的]探讨关节镜下手术治疗钙化性肩袖肌腱炎的手术要点与临床疗效.[方法]经保守治疗无效的钙化性肩袖肌腱炎患者32例,男8例,女24例;年龄38 ~ 62岁,平均49.5岁.采用肩关节后、前、外侧入口置入关节镜及器械,分别于盂肱关节内和肩峰下间隙进行操作,定位并清除钙化灶.采用VAS疼痛评分、Constant-Murley评分对患者进行手术前后的评估.[结果] 32例术后早期均达到显著症状缓解,VAS疼痛评分由术前(7.5±0.9)分减少至术后3 d(3.0±0.6)分(P<0.001),所有患者均未发生严重并发症.平均随访18个月(8~ 30个月),VAS疼痛评分由术前(7.5±0.9)分,减少至末次随访时(0.1±0.3)分(P<0.001).Constant-Murley评分由术前(45.9 ±9.9)分,增加至末次随访时(90.4±6.7)分(P <0.001).术后X线显示仅2例患者钙化灶有少量残留,但症状消失,12个月后残留钙化物吸收.[结论]肩关节镜检下微创治疗钙化性肩袖肌腱炎是一种创伤小、恢复快、有效的治疗方法.手术要点在于迅速准确定位钙化灶,在保持肩袖原有连续性的前提下,尽量彻底清除钙沉积物.%[ Objective ] To explore the key issues in operation and outcome of arthroscopic treatment for calcific rotator cuff tendinitis. [ Methods] Thirty - two patients with calcific rotator cuff tendinitis resistant to conservative treatment were treated by arthroscopic removal of calcification, including 8 males and 24 females, aged 38 to 62 years with an average of 49. 5 years. Through posterior, anterior and lateral portals, glenohumeral arthroscopy and subacromial bursoscopy were conducted successively. As the calcific deposit was located correctively, visible calcification was completely removed. VAS pain score and Constant -Murley score were adopted for evaluation before and after surgery. [ Results ] In the early stage after operation, remarkable pain relief was obtained in all of the 32 patients. VAS scores

  10. Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 2 - muscle activity.

    Science.gov (United States)

    Sousa, Catarina de Oliveira; Michener, Lori Ann; Ribeiro, Ivana Leão; Reiff, Rodrigo Bezerra de Menezes; Camargo, Paula Rezende; Salvini, Tania Fátima

    2015-02-01

    This study aimed to compare muscle activity in individuals with isolated acromioclavicular osteoarthritis (ACO), ACO associated with rotator cuff disease (ACO+RCD), and controls. Seventy-four participants (23 isolated ACO, 25 ACO+RCD, 26 controls) took part in this study. Disability was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Muscle activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) was collected during arm elevation in the sagittal and scapular planes. Pain during motion was assessed with the numerical pain rating scale. Analysis of the DASH, pain and kinematics were reported in part 1 of this study. For each muscle, separate 2-way linear mixed-model ANOVAs were performed to compare groups. ACO+RCD group had more UT and AD activity than the the isolated ACO and control other groups, more AD activity than the isolated ACO group during the ascending phase, and more AD activity than the ACO and control groups during the descending phase in both planes. Isolated ACO group had less SA activity than the control group only in the sagittal plane. Alterations in shoulder muscle activity are present in individuals with isolated ACO and with ACO+RCD and should be considered in rehabilitation.

  11. Does a land-based compensatory strength-training programme influences the rotator cuff balance of young competitive swimmers?

    Science.gov (United States)

    Batalha, Nuno; Raimundo, Armando; Tomas-Carus, Pablo; Paulo, João; Simão, Roberto; Silva, António J

    2015-01-01

    During the repeated execution of the swimming strokes, the shoulder adductor and internal rotator muscles have a tendency to become proportionally stronger when compared to their antagonist group. This can lead to muscle imbalances. The aim of this study was to examine the effects of a compensatory training programme on the strength and balance of shoulder rotator muscles in young swimmers. A randomized controlled trial design was used. Forty male swimmers took part in the study and were randomly divided into two groups: an experimental group (n = 20) and a training group (n = 20). A control group (n = 16) of young sedentary male students was also evaluated. The experimental group subjects participated in a 16-week shoulder-strength programme with Thera-Band® elastic bands; the training group was restricted to aquatic training. Peak torque of shoulder internal rotator and external rotator (ER) was measured at baseline and after 16 weeks. Concentric action at 1.04 rad s(-1) (3 reps) and 3.14 rad s(-1) (20 reps) was measured using an isokinetic dynamometer. The strength-training programme led to an improvement of the ER strength and shoulder rotator balance in the experimental group (data from both shoulders at 1.04 rad s(-1)). Moreover, concentric action at 3.14 rad s(-1) presented significant differences only for the dominant shoulder. Findings suggest that the prescribed shoulder-strengthening exercises could be a useful training option for young competitive swimmers. They can produce an increase in absolute strength values and greater muscle balance in shoulder rotators.

  12. Evaluation of tracheal cuff pressure variation in spontaneously breathing patients

    OpenAIRE

    Plotnikow, Gustavo A; Roux, Nicolas; Feld, Viviana; Gogniat, Emiliano; Villalba, Dario; Ribero, Noelia Vairo; Sartore, Marisa; Bosso, Mauro; Quiroga, Corina; Leiva, Valeria; Scrigna, Mariana; Puchulu, Facundo; Distéfano, Eduardo; Scapellato, Jose Luis; Intile, Dante

    2013-01-01

    Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at differ...

  13. Rotator cuff - self-care

    Science.gov (United States)

    Your doctor will likely refer you to a physical therapist to learn exercises for your shoulder . You may ... activity. Also, when examined by your doctor or physical therapist, you should have: Full strength in the muscles ...

  14. Progresses of the non-operative therapy in the treatment of rotator cuff calcific tendinitis%肩袖钙化性肌腱炎的非手术治疗进展

    Institute of Scientific and Technical Information of China (English)

    崔晓; 王德强; 高勇

    2016-01-01

    肩袖钙化性肌腱炎(rotator cuff calcific tendinitis,RCCT)是一种常见的自限性肩部疾病,病理机制尚不明确.其治疗目的为缓解疼痛和改善关节活动度.RCCT的治疗方法很多,其中非术治疗创伤小、操作简单,临床应用广泛.因此本文就近年来RCCT的非手术治疗进展进行综述.%The rotator cuff calcific tendinitis(RCCT) is a common self-limited disease of shoulder,whose pathological mechanism is unclear.The purpose of treatment is to relieve pain and improve the range of joint motion.There are lots of methods in the treatment of RCCT,and its non-operative therapy is of mini-invasive and operative simplicity,so it is widely used in clinical practice.The progresses of non-operative therapy methods of RCCT are reviewed in this paper.

  15. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle.

    Science.gov (United States)

    Moor, B K; Bouaicha, S; Rothenfluh, D A; Sukthankar, A; Gerber, C

    2013-07-01

    We hypothesised that a large acromial cover with an upwardly tilted glenoid fossa would be associated with degenerative rotator cuff tears (RCTs), and conversely, that a short acromion with an inferiorly inclined glenoid would be associated with glenohumeral osteoarthritis (OA). This hypothesis was tested using a new radiological parameter, the critical shoulder angle (CSA), which combines the measurements of inclination of the glenoid and the lateral extension of the acromion (the acromion index). The CSA was measured on standardised radiographs of three groups: 1) a control group of 94 asymptomatic shoulders with normal rotator cuffs and no OA; 2) a group of 102 shoulders with MRI-documented full-thickness RCTs without OA; and 3) a group of 102 shoulders with primary OA and no RCTs noted during total shoulder replacement. The mean CSA was 33.1° (26.8° to 38.6°) in the control group, 38.0° (29.5° to 43.5°) in the RCT group and 28.1° (18.6° to 35.8°) in the OA group. Of patients with a CSA > 35°, 84% were in the RCT group and of those with a CSA shoulders without these pathologies. These findings suggest that individual quantitative anatomy may imply biomechanics that are likely to induce specific types of degenerative joint disorders.

  16. Arthroscopic rotator cuff repair with double-row allograft bone suture anchor%异体骨锚钉双排固定法修复肩袖损伤

    Institute of Scientific and Technical Information of China (English)

    刘玉杰; 李光辉; 李众利; 薛静; 王志刚; 蔡谮; 魏民; 朱娟丽

    2008-01-01

    目的 探讨异体皮质骨锚钉双排固定法修复肩袖损伤的价值.方法 关节镜监视下,采用同种异体皮质骨锚钉双排同定法修复肩袖损伤16例.其中男10例,女6例;年龄32~58岁,平均44岁.按Bigliani肩袖损伤分类法,小撕裂6例,中度撕裂8例,大撕裂2例.关节镜下肩袖清理和肩峰成形后,采用带线异体骨锚钉植入肱骨大结节肩袖附着处,双根缝线垂直褥式缝合冈上肌腱,分别打结固定后,将缝线交叉牵引到在肱骨大结节预制的骨道处,将缝线穿入另一个骨锚钉孔内并击入骨道内.4根缝线交叉呈网状覆盖撕裂的冈上肌腱由骨锚钉固定.根据撕裂创面大小决定骨锚钉植入数量.结果 所有患者术后得到随访,时间6~23个月,平均14个月.术后疼痛症状均消失,肩关节功能采用美国加州洛杉矶大学(UCLA)功能评分标准评估,术前(20.5±5.6)分,术后(33.4±5.8)分.优10例,良5例,可1例.术后肩关节稳定性良好,无锚钉拔出和损伤复发.结论 异体骨锚钉双排同定法修复肩袖损伤,镜下手术操作方便,骨锚钉嵌入固定牢靠,增加肩袖组织与骨创面的接触面积,有利于肩袖愈合.骨锚钉生物固定,无异物存留,价格低廉.%Objective To discuss the value of double-row allograft bone suture anchor in repair of rotator cuff injury. Methods Under assistance of arthroseope, 16 cases of rotator cuff lesions were repaired by using double-row allograft bone suture anchors. There were 10 males and 6 females at average age of 44 years (32-58 years). According to Bigliani classification, there were 6 cases of small ruptures, 8 medial ruptures and 2 large ruptures. After rotator cuff was trimmed and acromial bone was re-shaped under arthroscopy, 2 bone anchors attached to suture lines were implanted in the attachment point of rotate cuff of humerus greater tuberosity side by side. Then, the 4 ends of the 2 suture lines were vertically sutured through tendon of

  17. Observation on efficacy of mitek mini anchor in treatment of shoulder dislocation with torn rotator cuff%Anchor钉在肩关节脱位并肩袖损伤中应用的疗效观察

    Institute of Scientific and Technical Information of China (English)

    徐圣康; 罗斌; 熊为; 查琨; 刘家国; 张劲松; 赵猛

    2012-01-01

    Objective To explore the efficacy of mitek mini anchor( MMA )in the treatment of shoulder dislocation with fracture greater tuberosity and torn rotator cuff. Methods From July 2008 to January 2011,13 cases of shoulder dislocation with fracture greater tuberosity and torn rotator cuff were enrolled. The fracture fragments were exposured via deltoid muscles and pectoralis major, and got fixed with MMAand Krackow suture. Range of motion, clinical stability, muscles strength of upper limb and radio-graphic appearance were analyzed. Results All the patients were followed up for 10 ~ 16 months( mean 12 months ). The bone healing was satisfactory in all the cases. According to Neer scoring system, 11 cases were excellent and 2 cases were good. Conclusion MMAand titanium screw for the treatment of shoulder dislocation with fracture greater tuberosity and torn rotator cuff could provide sufficient stability to perform early functional rehabilitation and promote the recovery of shoulder dislocation, which is an ideal method.%目的 探讨Anchor钉在肩关节脱位并肱骨大结节撕脱性骨折及肩袖损伤中应用的疗效.方法 13例肩关节脱位并肱骨大结节撕脱性骨折及肩袖损伤患者行经三角肌-胸大肌入路显露骨折端,以Anchor钉行Krackow缝合方法结合钛钉内固定进行治疗.随访评价其肩关节稳定性、活动范围、上肢肌力、影像学改变.结果 所有患者得到随访,随访时间10~16个月,平均12个月,骨折均愈合良好.肩关节功能按Neer评分法,优11例,良2例.结论 Anchor钉结合钛钉修复肱骨大结节撕脱性骨折及肩袖损伤固定牢固、术后可早期功能锻炼,肩关节功能恢复良好,是一种较理想的手术方法.

  18. Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador Evaluation of the results from reoperations on patients with rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2011-01-01

    Full Text Available OBJETIVOS: Avaliar o resultado do tratamento cirúrgico, por via aberta ou artroscópica, dos pacientes com recidiva sintomática da lesão do manguito rotador. MÉTODOS: Foram avaliados 30 pacientes entre dezembro de 1990 e julho de 2007 submetidos a um novo procedimento cirúrgico pelo Grupo de Cirurgia de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen devido à deiscência da sutura do manguito rotador. Foram incluídos pacientes com recidivas sintomáticas da lesão e com tempo de seguimento mínimo pós-operatório de 24 meses. RESULTADOS: Pelos critérios de avaliação da UCLA, 21 (70% pacientes tiveram resultados excelentes e bons; nove (30% pacientes tiveram resultados regulares e ruins. CONCLUSÃO: O tratamento cirúrgico, por via aberta e artroscópica, das recidivas da lesão do manguito rotador tende a apresentar resultados piores que o reparo primário. Neste estudo, obtivemos 70% de resultados excelentes e bons. A presença de lesões extensas na segunda operação tende a evoluir com um maior número de resultados insatisfatórios. No nosso estudo, obtivemos melhores resultados com a cirurgia realizada por via artroscópica em comparação com a via aberta.OBJECTIVES: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. METHODS: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow- up. RESULTS: According to the UCLA evaluation criteria, 21 patients (70% showed excellent or good outcomes; and nine patients (30% showed fair

  19. Suprascapular Nerve: Is It Important in Cuff Pathology?

    Directory of Open Access Journals (Sweden)

    Lewis L. Shi

    2012-01-01

    Full Text Available Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

  20. Avaliação da microcirculação das bordas do tendão do supra-espinal nas lesões do manguito rotador Microvascular evaluation of the supraspinatus tendon borders in rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Roberto Yukio Ikemoto

    2007-12-01

    Full Text Available OBJETIVOS: Avaliar a microcirculação das bordas do tendão supra-espinal nas lesões do manguito rotador com a finalidade de determinar a necessidade ou não do desbridamento de suas bordas no momento do seu reparo cirúrgico. MÉTODOS: No período de junho a dezembro de 2004, foram avaliadas amostras recolhidas de 31 pacientes portadores de lesão completa do tendão supra-espinal, submetidos ao tratamento da lesão do manguito rotador por via artroscópica. Apresentavam idade entre 42 e 82 anos (média de 56,6 anos, sendo nove do sexo masculino e 22 do feminino. Durante a realização do procedimento, foram retiradas amostras de tecido da lesão do manguito rotador e enviadas para estudo anatomopatológico com coloração com hematoxilina-eosina. Após esse processo, foi realizada a contagem das fendas vasculares/mm². Utilizaram-se como grupo controle 10 amostras de tendões normais do supra-espinal de cadáveres frescos, submetidos aos mesmos processos anteriores. Os resultados obtidos foram avaliados estatisticamente através da aplicação do teste de Mann-Whitney. RESULTADOS: Entre as amostras, 28 apresentaram tecidos vascularizados e três, ausência de vascularização. O número médio de fendas vasculares/mm² nas amostras de lesões do manguito rotador foi estatisticamente maior que o do grupo controle. CONCLUSÃO: A maioria das bordas das lesões dos tendões do supra-espinal é hipervascularizada.OBJECTIVES: To evaluate microvasculature in the borders of the supraspinatus tendon in rotator cuff lesions in order to determine the need to debrid the borders when surgical repair is performed. METHODS: From June to December 224, samples were evaluated from 31 patients with full lesion of the supraspinatus tendon that had been submitted to arthroscopic rotator cuff lesion treatment. They were between 42 and 82 years of age (mean 56.6 years, nine of them male, and twenty-two female. During the procedure, samples of the rotator cuff

  1. To observe the curative effect of arthroscopic treatment of calcifying tendinitis of rotator cuff%关节镜治疗肩袖钙化性肌腱炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    孙官军; 银毅; 王志强; 彭旭; 李青山

    2016-01-01

    目的:回顾性分析关节镜下行肩袖钙化性肌腱炎病灶清除术的手术技巧及疗效。方法选取2013年1月~2015年6月在我院就诊的反复疼痛的肩袖钙化性肌腱炎患者9例,均行关节镜下病灶清理术,4位患者同时行肩峰成型术,1位患者行肩袖修复术,术后均行系统的康复训练。所有患者均在术前及术后随访时应用肩关节功能评分(Constant评分、ASES评分)及SST问卷评估其疗效,并记录关节活动度改善情况。术后随访复查肩关节前后位X线片。结果术后随访6月~2年,平均随访时间13.6个月,术后疼痛均明显缓解,功能明显改善;肩关节功能评分Constant评分由术前平均48.4分提高到术后89.9分,ASES评分平均由术前48.6分提高到术后94.2分,SST问卷评分由术前4.8分提高到术后9.4分,治疗前后比较,差异有统计学意义(P<0.05)。手术未出现血管神经及相关并发症。结论肩关节镜下钙化灶清理术是治疗保守治疗无效的肩袖钙化性肌腱炎的推荐方法,其具有简单有效,损伤小,恢复快等特点。%Objective To investigate the surgical techniques and clinical effects of arthroscopic treatment of calcifying tendinitis of rotator cuff. Methods From January 2013 to June 2015,9 cases with calcifying tendinitis of rotator cuff were with calcified lesion excision under arthroscopic treatment, 4 cases were treated with acromioplasty and 1 case had rotator cuff neoplasty. Systematic rehabilitation program was followed. All the cases were with Constant and ASES score in pre-operation and post-operation follow-up and SST questionnaire to evaluate the efficacy, and record the range of motion. All the patients were subject to X-ray examination on shoulder joint after surgery. Results Patients were followed-up from 6~24month,average 13.6 months. The degree of pain and function scores were significantly improved after operation. The average

  2. Lesões extensas do manguito rotador: avaliação dos resultados do reparo artroscópico Extensive rotator cuff injuries: an evaluation of arthroscopic repair outcomes

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2009-04-01

    Full Text Available OBJETIVOS: Avaliar o resultado do tratamento cirúrgico das lesões extensas do manguito rotador por via de acesso artroscópica. MÉTODOS: Entre junho de 1998 e outubro de 2006 foram reavaliados 61 pacientes com lesões extensas do manguito rotador submetidos a tratamento cirúrgico por técnica artroscópica pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo. Foram incluídos no estudo todos os pacientes com acometimento de pelo menos dois tendões ou com retração de pelo menos dois tendões até a borda da cavidade glenoidal e com no mínimo 12 meses de seguimento. RESULTADOS: Pelos critérios de avaliação da UCLA, 54 (89% pacientes tiveram resultados excelentes e bons; nenhum, regular; e sete (11%, ruins. Verificou-se índice de satisfação de 92% dos pacientes. A mobilidade articular no período pós-operatório dos pacientes passou da média de elevação de 93º para 141º, a média da rotação lateral foi de 32º para 48º e a média da rotação medial, de L1 para T10. Essas diferenças foram estatisticamente significantes. CONCLUSÃO: O reparo artroscópico das lesões extensas do manguito rotador traz resultados satisfatórios na maioria dos pacientes, com alto grau de satisfação.OBJECTIVES: To assess the outcomes of the surgical treatment of extensive rotator cuff injuries through arthroscopy. METHODS: Between June 1998 and October 2006, 61 patients with extensive rotator cuff injuries and submitted to surgical arthroscopy technique by the Shoulder and Elbow Group of the Department of Orthopaedics and Traumatology, Santa Casa de Misericórdia Medical School were reassessed. The study included all patients with at least two tendons affected or with retraction at least on two tendons up to the glenoidal cavity edge and with at least 12 months of follow-up. RESULTS: According to UCLA's evaluation criteria, 54 (89% patients

  3. Observer agreement of lower limb venous reflux assessed by duplex ultrasound scanning using manual and pneumatic cuff compression in patients with chronic venous disease and controls

    DEFF Research Database (Denmark)

    Broholm, R; Kreiner, S; Bækgaard, Niels;

    2011-01-01

    The study aimed to evaluate observer agreement between two experienced ultrasound operators examining deep venous reflux assessed by duplex ultrasound (DU) using either manual or pneumatic cuff compression. In addition, the two methods were compared with each other with regard to immediate...

  4. Avaliação funcional do reparo artroscópico das lesões completas do manguito rotador associado a acromioplastia Functional evaluation of arthroscopic repairs of complete rotator cuff tears associated to acromioplasty

    Directory of Open Access Journals (Sweden)

    Marco Antonio de Castro Veado

    2008-12-01

    Full Text Available OBJETIVO: Realizar avaliação funcional dos pacientes portadores de lesão completa do MR que foram submetidos ao reparo artroscópico associados à acromioplastia. MÉTODOS: Trata-se de um estudo retrospectivo realizado com pacientes submetidos a tratamento cirúrgico artroscópico para reparo da lesão do MR. Foram incluídos os pacientes operados entre junho/2000 e outubro/2004 nos Hospitais Mater Dei e Felício Rocho, em Belo Horizonte. Dos 102 pacientes submetidos à reconstrução, 11 foram retirados por não cumprirem os critérios de inclusão, sendo o número final igual a 91 ombros em 91 pacientes. A avaliação funcional foi realizada pela escala UCLA (Universidade da Califórnia em Los Angeles e pelo teste Simples. RESULTADOS: Na avaliação pós-operatória em 35 pacientes, os resultados foram considerados excelentes (38,4%; em 47, bons (51,6%; seis, regulares (6,6%; e três, ruins (3,3%. Desse modo, 82 (90,1% pacientes foram avaliados como tendo obtido resultado bom ou excelente e nove como regulares ou ruins, sendo estes insatisfatórios. CONCLUSÃO: O reparo artroscópico do manguito rotador, associado a acromioplastia, apresentou resultado funcional excelente ou bom, na maioria dos pacientes, quando avaliados pelo método funcional da UCLA.OBJECTIVE: To perform a function evaluation of patients with complete rotator cuff tears that were submitted to arthroscopic repair associated to acromioplasty. METHODS: This is a retrospective study made with patients submitted to arthroscopic surgical treatment to repair rotator cuff tears. Patients included were operated on from June 2000 to October 2004 at the Mater Dei and Felício Rocho Hospitals, in Belo Horizonte. Of the 102 patients submitted to reconstruction, 11 were removed from the study because they did not meet the inclusion criteria, and so the final number of the series was 91 shoulders of 91 patients. The functional evaluation scale was the UCLA scale and the simple test was

  5. Comparação dos exames complementares no diagnóstico das lesões do manguito rotador Comparison of complementary exams in the diagnosis of rotator cuff injuries

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    Gabriel El-Kouba

    2010-01-01

    Full Text Available OBJETIVO: A proposta do trabalho é avaliar a acurácia da radiografia simples, ultrassonografia e ressonância nuclear magnética no diagnóstico das lesões do manguito rotador, comparando-os com os achados em cirurgias abertas ou artroscópicas. Métodos: Foram avaliados protocolos do Serviço de Cirurgia do Ombro e Cotovelo dos pacientes submetidos ao tratamento cirúrgico por lesão de manguito rotador diagnosticados por radiografia, ultrassom e/ou ressonância no período de 2002-2007. Com base nos dados coletados, analisamos a sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia destes exames complementares, comparados aos achados durante os procedimentos cirúrgicos. RESULTADOS: Foram incluídos no estudo 147 pacientes, com média de idade de 46,09 anos. Todos os pacientes estudados haviam realizado um exame de radiografia, 101 apresentavam ultrassonografia e 72 pacientes realizaram ressonância magnética. Encontramos sensibilidade de 13,8%, especificidade de 2,6% e acurácia de 30% com a radiografia; sensibilidade de 57,6%, especificidade de 29,6 e acurácia de 51,4% com o ultrassom; e sensibilidade de 86,6%, especificidade de 22,2% e acurácia de 63,3% com a ressonância. CONCLUSÃO: A radiografia se mostrou um exame específico quando apresentou sinal do espelho. A ressonância e a ultrassonografia se mostraram métodos confiáveis apresentando elevada acurácia no diagnóstico das lesões do manguito rotador.OBJECTIVE: This paper proposes to evaluate the accuracy of x-rays, ultrasounds, and nuclear magnetic resonance in the diagnosis of rotator cuff injuries, comparing their findings with open surgery or arthroscopic findings. METHODS: Shoulder and Elbow Surgery Department protocols for patients undergoing surgical treatment for rotator cuff injury diagnosed by x-ray, ultrasound and/or resonance in our clinic, that were between 2002 and 2007. Based on the data collected, we analyzed the

  6. Research on the diagnostic significance of supraspinatus export slice X-ray radiography in rotator cuff injury%冈上肌出口位X线摄片在肩袖损伤诊断中的意义

    Institute of Scientific and Technical Information of China (English)

    梁红; 钟易

    2013-01-01

    Objective:To explore the application value of supraspinatus export slice X-ray radiography in rotator cuff injury.Methods:To conduct retrospective analysis on imaging data of 21 cases with rotator cuff injury diagnosed by MRI.Before the MRI examination,6 patients received the affected side shoulder X-ray films and 15 patients did the affected side supraspinatus export slice X-ray films.The results between the two groups were analyzed.Results:Twenty-one patients were diagnosed in rotator cuff injury by MRI,15 patients were in acromion-humeral head spacing stenosis varying degrees.The result from 3 cases of patients A-H spacing is 5.1~6.9mm.6 cases of patients A-H spacing were7.0~7.9mm,and 6 cases of patients A-H spacing is 8.0~9.0mm.No signs of bone lesions.Six cases of patients of shoulder anteroposterior X-ray normal.Conclusion:Supraspinatus export slice X-ray film can offered help to constitute the therapy plan of clinical treatment.%目的:探讨冈上肌出口位X线摄片在肩袖损伤影像学诊断中的应用价值.方法:回顾性分析21例经MRI确诊肩袖损伤的患者的相关影像学资料,15例患者在做MRI检查前摄取了侧肩关节冈上肌出口位X线片,6例患者仅摄取了侧肩关节X线正位片,将其影像学诊断结果进行对比.结果:21例患者MRI检查全部提示为肩袖损伤.15例患者摄取侧肩关节冈上肌出口位X线片测得肩峰-肱骨头(A-H)间距不同程度狭窄,其中3例患者A-H间距≤5.1~6.9mm、6例患者A-H间距≤7.0~7.9 mm、6例患者A-H间距≤8.0~9.0mm,所见构成骨未见明确骨质病变征象;6例患者仅摄取侧肩关节正位的X线片诊断均为阴性.结论:冈上肌出口位X线摄片能清晰测量A-H间距,提示肩袖损伤的存在,对患者的下一步检查及制定治疗方案具有重要的临床意义.

  7. Plasma rico em plaquetas no reparo artroscópico das roturas completas do manguito rotador Platelet-rich plasma in arthroscopic repairs of complete tears of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Eduardo Angeli Malavolta

    2012-01-01

    Full Text Available OBJETIVO: Avaliar os resultados funcionais e o índice de rerrotura do reparo do manguito rotador por via artroscópica associado ao uso do PRP. MÉTODOS: Série de casos prospectiva, avaliando os resultados do reparo artroscópico do manguito rotador em fileira simples associada ao uso do PRP. Foram incluídas apenas roturas isoladas do supraespinal, com retração inferior a 3cm. O PRP utilizado foi obtido pelo método de aférese, e aplicado em sua forma ativada, com a adição de trombina autóloga, na consistência líquida. A avaliação pós-operatória foi realizada de maneira padronizada, aos 12 meses de seguimento. Foram utilizadas as escalas de Constant-Murley, UCLA e EVA, além da análise da incidência de rerroturas através da ressonância magnética. RESULTADOS: Foram avaliados 14 pacientes (14 ombros. A escala de Constant-Murley evoluiu em média de 45,64 ± 12,29 no pré-operatório para 80,78 ± 13,22 no pós-operatório (p OBJECTIVE: To evaluate shoulder functional results and the re tear rate of arthroscopic repair of the rotator cuff augmented with platelet-rich plasma (PRP. METHODS: Prospective case series with single-row arthroscopic repair of the rotator cuff augmented with PRP. Only cases of isolated supraspinatus tears with retraction of less than 3 cm were included in this series. The PRP used was obtained by apheresis. It was applied on liquid consistency in its activated form, with the addition of autologous thrombin. Patients were evaluated after 12 months of the surgical procedure. The Constant-Murley, UCLA and VAS scales were used, and the retear rate was assessed using magnetic resonance imaging (MRI. RESULTS: Fourteen patients were evaluated (14 shoulders. The mean Constant-Murley score was 45.64 ± 12.29 before the operation and evolved to 80.78 ± 13.22 after the operation (p < 0.001. The UCLA score increased from 13.78 ± 5.66 to 31.43 ± 3.9 (p < 0.001. The patients' pain level decreased from a median of 7

  8. Resultados do tratamento cirúrgico da artropatia degenerativa do manguito rotador utilizando hemiartroplastia-CTA® Results of surgical treatment of denerative arthropathy of the rotator cuff using hemiarthroplasty-CTA®

    Directory of Open Access Journals (Sweden)

    Rômulo Brasil Filho

    2012-02-01

    Full Text Available OBJETIVO: Avaliar os resultados da artroplastia parcial de ombro tipo CTA® para o tratamento da artropatia degenerativa do manguito. MÉTODOS: De dezembro de 2006 a junho de 2009, 23 ombros de 23 pacientes foram submetidos à artroplastia parcial tipo CTA® para o tratamento de artropatia por lesão do manguito rotador. O tempo de seguimento pós-operatório variou de seis a 35 meses. A idade média foi de 74,1 anos. Houve predomínio do sexo feminino em 78,3% dos casos. O membro direito foi acometido em 18 pacientes. Todos os pacientes foram submetidos, sem melhora dos sintomas, ao tratamento fisioterápico prévio por pelo menos seis meses e foram submetidos à cirurgia pela mesma equipe cirúrgica. Nenhum dos pacientes havia realizado cirurgia prévia no ombro afetado. A avaliação dos pacientes no seguimento pós-operatório seguiu os critérios do escore da UCLA. RESULTADOS: Verificou-se melhora da dor em todos pacientes após a artroplastia. Pelo escore da UCLA, a média de pontos em relação à dor foi de 9,22 (variando de 10 a oito. Quanto à função, a média foi de seis (10 a dois. Encontramos nesses pacientes média de 2,39 na flexão frontal ativa (quatro a zero. Na força de flexão frontal a média foi de 4,09 com máxima de cinco e mínima de três. A média de pontos do escore da UCLA foi de 26,52. Noventa e cinco porcento dos pacientes ficaram satisfeitos com a cirurgia. CONCLUSÃO: A artroplastia parcial de ombro tipo CTA® tem resultados satisfatórios no tratamento da artropatia degenerativa do manguito rotador e apresenta baixa taxa de complicação.OBJECTIVE: To assess results of CTA® partial shoulder arthroplasty for treatment of degenerative arthropathy of the rotator cuff. METHODS: Between December 2006 and June 2009, 23 shoulders of 23 patients were submitted to CTA® type partial shoulder arthroplasty for treatment of arthropathy secondary to rotator cuff injury. Post-operative follow up time ranged from 6 to 35

  9. 手法结合正骨散外用治疗钙化性肩袖肌腱炎的疗效分析%Effect of Manipulation combined with Zhenggu powder in the Treatment of Rotator Cuff Calcifying Tendonitis

    Institute of Scientific and Technical Information of China (English)

    郑移兵; 佟云; 张雷; 齐越峰

    2013-01-01

    Objective:To study the effect o f manipulation combined with Zhenggu powder in the treatment of rotator cuff calcifying tendonitis.Methods:Fifteen patients with calcifying tendonitis who had received manipulation combined with Zhenggu powderwere followed-up for 2.3 months on average.VAS,Constant-Murley score and UCLA score were adopted for evaluation before and after treatment.Results:The VAS score,Constant-Murley score and UCLA score before treatment were respectively (7.8 ±1.2),(56.7 ±5.7),and (13.2 ±3.4).After the treatment with manipulation combined with Zhenggu powder,the above scores were respectively (2.3 ±0.7),(89.7 ±4.4),and (28.6 ±1.5).There were sig nificant differences in the above indexes before and after treatment (all P<0.01).Conclusion:Manipulation combined with Zhenggu powder is an effective method for the treatment of rotator cuff calcifying tendonitis.%目的:探讨和分析应用手法结合正骨散治疗钙化性肩袖肌腱炎的疗效.方法:对15例应用手法结合正骨散治疗钙化性肩袖肌腱炎的患者进行随访,平均随访时间2.3个月.治疗时采用手法配合传统中药正骨散进行治疗,对治疗前后进行VAS评分、Constant-Murley评分、UCLA评分.结果:15例患者治疗前VAS评分平均为7.8±1.2;Constant-Murley评分平均为56.7±5.7;UCLA评分平均为13.2±3.4.经手法结合正骨散治疗后VAS评分平均为2.3±0.7;Constant-Murley评分平均为89.7±4.4;UCLA评分平均为28.6±1.5.治疗前后比较差异均有统计学意义(P<0.01).结论:手法结合正骨散是治疗钙化性肩袖肌腱炎的一种有效的方法.

  10. What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

    Directory of Open Access Journals (Sweden)

    Favard Luc

    2011-01-01

    Full Text Available Abstract Background This study evaluates the preoperative conventional anteroposterior radiography and clinical testing in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical status as also the clinical testing in relation to the rotator cuff quality. The aim of the study is to define the usefulness of radiography and clinical examination in cuff tear arthropathy. Methods This study analyses the preoperative radiological (AP-view, (Artro-CT-scan or MRI-scan and clinical characteristics (Constant-Murley-score plus active and passive mobility testing and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006. All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84% or hemi-(8% or double cup-bipolar prosthesis (8%. Results A positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality. Conclusion A conventional antero-posterior radiograph can not provide any predictive information on the clinical status of the patient. The subscapular muscle can be well tested by the press belly test and the teres minor muscle can be well tested by the hornblower' sign and by the exorotation lag signs. The upward migration index and the presence of femoralization are good indicators for the evaluation of the posterior rotator cuff. An inferior coracoid tip positioning suggests rotator cuff disease.

  11. 切开修补治疗肩袖撕裂的中远期随访%A middle or long-term follow-up study on surgical repair of rotator cuff tears

    Institute of Scientific and Technical Information of China (English)

    王晓滨; 黄公怡; 薛庆云

    2008-01-01

    目的 对切开行肩袖修补术的肩袖撕裂患者行中远期随访,分析术前、术中因素对手术疗效的影响.方法 回顾性研究1987年5月至2002年10月在北京医院骨科进行切开手术修补撕裂肩袖的43例患者(44肩).男20例(21肩),女23例(23肩);手术时平均年龄53岁(22~76岁).13肩为小型撕裂(<1 cm),18肩为中型撕裂(1~3 cm),10肩为大型撕裂(3~5 cm),3肩为巨大型撕裂(>5 cm).撕裂累及冈上肌31肩,累及冈上肌和冈下肌9肩,累及冈上肌和肩胛下肌3肩,累及冈上肌、冈下肌和肩胛下肌1肩.以Mclaughlin术(肌腱-骨)修补25肩,以肌腱-骨联合肌腱-肌腱缝合法修补11肩,以肌腱-肌腱缝合法修补7肩,三角肌深部肌腱转位术(高岸式)修补1肩.术后平均随访88.2个月(52~250个月),以美国加州大学洛杉矶分校(University of California at Los Angeles,UCLA)功能评分评价患者手术前后的肩关节功能,以视觉模拟评分系统(visual analogue scale,VAS)分析患者对手术效果的主观评价.对患者的年龄、性别、优势手、外伤史、手术前病程和肩袖撕裂大小等因素对预后的影响行统计学分析.结果 44肩UCLA评分术前平均为(11.5±2.8)分,末次随访时平均为(29.7±5.3)分.36肩得分>28分,达到优或良;6肩为可;2肩得分<20分,评定为差.患者对39肩的手术疗效满意,主观满意率89%.患者主观满意度与UCLA评分呈显著正相关(r=0.72,P<0.01).肩袖撕裂的大小(r=-0.404,P=0.007)、术前病程(r=-0.332,P=0.028)与术后结果呈负相关,即肩袖撕裂范围越大、术前病程越长,手术疗效就越差.而手术患者的年龄、性别、优势手、外伤史与手术的预后无关.结论 切开修补治疗肩袖全层撕裂能获得满意的中远期疗效,肩袖的撕裂大小、术前病程与术后结果呈负相关.%Objective To evaluate the result of open rotator cuff repair and to identify potential preoperative or intraoperative

  12. Estudo radiográfico do índice acromial e sua relação com as lesões do manguito rotador Radiographic analysis of the acromion index and its association with rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2010-01-01

    Full Text Available OBJETIVO: O objetivo deste estudo é avaliar a relação da projeção lateral do acrômio com as lesões do manguito rotador (LMR na população brasileira. MÉTODOS: A projeção lateral do acrômio foi mensurada por meio de radiografias de ombros em sua incidência anteroposterior realizadas com a cavidade glenoidal em seu perfil absoluto e a cabeça do úmero em rotação neutra ou medial. Foi aferido o índice acromial (IA pela razão entre a distância do plano da cavidade glenoidal ao extremo lateral do acrômio e a distância do plano da cavidade glenoidal ao extremo lateral da cabeça do úmero. Este índice foi mensurado em 83 indivíduos (idade média de 54 anos com LMR e comparados com um grupo de 28 indivíduos (idade média de 48 anos que não as apresentavam. A presença ou ausência de LMR foi evidenciada por meio de ressonância magnética. RESULTADOS: O IA médio foi de 0,7194 nos pacientes com LMR e de 0,6677 nos indivíduos que não a apresentavam na população brasileira. Essa diferença foi estatisticamente significativa com um p = 0,001. CONCLUSÃO: Pode-se estabelecer relação do IA e lesão do manguito rotador na população brasileira.OBJECTIVE: The purpose of this study is to evaluate the association between lateral extension of the acromion and rotator cuff tears (RCT in the Brazilian population. METHODS: Lateral extension of the acromion was measured using anteroposterior radiographs of the shoulders, carried out with glenoid cavity in the absolute profile and the humeral head in neutral or internal rotation. The acromion index (AI was defined by the ratio of the distance from the glenoid cavity to the lateral border of the acromion, and the distance from the glenoid cavity to the lateral border of the humeral head. This index was measured in 83 patients with (average age 54 years with RCT and compared with a group with 28 patients (average age 48 years without RCT. The presence or absence of RCT was defined by

  13. Análise da resistência de fios cirúrgicos utilizados no reparo do manguito rotador Strength analysis of surgical sutures used to repair the rotator cuff

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    Marcus Valladares Guimarães

    2008-07-01

    Full Text Available OBJETIVO: Analisar a resistência final suportada por dois tipos de fio e pela interface âncora-fio em três diferentes implantes tipo âncora submetidos à tração contínua, com o propósito de indicar o mais apropriado para sutura de estruturas como o manguito rotador do ombro. MÉTODOS: Os testes foram feitos em três grupos: grupo 1 - parafuso âncora de titânio com fio Ethibond® #2; grupo 2 - parafuso âncora de titânio com fio Fiber Wire® #2; e grupo 3 - parafuso âncora de titânio 5,0mm Corkscrew®. RESULTADOS: No grupo 1, a carga máxima média até a soltura foi de 124,5 newtons (N, sendo a mínima de 105N e a máxima de 180N, com variação de 75N entre os dois extremos e desvio-padrão de 23,03N. No grupo 2, a carga máxima média até a soltura foi de 298N, mínima de 230N, máxima de 375N, com variação de 145N e desvio-padrão de 44,73N. No grupo 3, foi obtida a maior carga máxima média, sendo esta de 272N, a mínima de 205N e a máxima de 340N, com variação de 135N. A análise estatística demonstrou diferença significativa entre as médias de cargas resistidas entre os grupos 1 x 2 e 1 x 3 (p OBJECTIVE: To analyze the final strength withstood by two types of suture threads and by the anchor-suture interface in three different anchor implants submitted to continuous traction for the purpose of choosing the most appropriate to suture structures such as the shoulder rotator cuff. METHOD: Tests were performed in three groups: Group 1 - titanium anchor screw with Ethibond® #2 suture, Group 2 - titanium anchor screw with Fiber Wire® #2 suture, and Group 3 - Corkscrew® 5.0 mm anchor screw. RESULTS: In Group 1, mean maximum load till loosening was 124.5 124,5 Newtons (N, the minimum load was 105 N, and the maximum load was 180 N, with a range of 75 N between the two extremes, and standard deviation of 23.03 N. In Group 2, the mean maximum load till loosening was 298 N, the minimum load was 230 N, the maximum load was 375

  14. Avaliação dos resultados do reparo artroscópico de lesões do manguito rotador em pacientes com até 50 anos de idade Evaluation of the results from arthroscopic repair on rotator cuff injuries among patients under 50 years of age

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    Alberto Naoki Miyazaki

    2011-01-01

    Full Text Available OBJETIVO: Avaliar o resultado do tratamento cirúrgico das lesões do manguito rotador (LMR por via artroscópica nos pacientes com até 50 anos de idade. MÉTODOS: Entre agosto de 1998 e dezembro de 2007 foram reavaliados 63 pacientes com LMR submetidos a este tratamento pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médica da Santa Casa de São Paulo - "Pavilhão Fernandinho Simonsen". Foram incluídos no estudo todos os pacientes com LMR com idade até 50 anos e com seguimento mínimo pós-operatório de 24 meses. RESULTADOS: Pelos critérios de avaliação da UCLA, 59 (92% pacientes tiveram resultados excelentes e bons; cinco (8%, regulares; e nenhum ruim. A amplitude média dos movimentos na avaliação pós-operatória foi de 145˚ na elevação, 47˚ na rotação lateral e de T10 na rotação medial. Os resultados insatisfatórios estiveram associados com o tempo prolongado da lesão, demonstrando uma relação estatisticamente significante. CONCLUSÃO: O reparo artroscópico da LMR nos pacientes jovens traz resultados bons e excelentes na maioria dos pacientes.OBJECTIVE: To assess the results from arthroscopic surgical treatment of rotator cuff injuries among patients under 50 years of age. METHODS: Sixty-three patients with rotator cuff injuries who underwent arthroscopic surgical treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, in the Fernandinho Simonsen wing of Santa Casa Medical School, São Paulo, between August 1998 and December 2007, were reassessed. The study included all patients with rotator cuff injuries who were under 50 years of age and had been followed up postoperatively for at least 24 months. RESULTS: According to the UCLA evaluation criteria, 59 patients (92% showed excellent and good results; five (8% showed fair results; and none showed poor results. The postoperative evaluation showed that the mean range of

  15. ARTHROSCOPIC CORRECTION OF THE INJURIES OF THE COMPLEX «TENDON OF THE BICEPS LONG HEAD - THE ARTICULAR LIP» IN TREATMENT OF PATIENTS WITH FULL-LAYER RUPTURES OF THE ROTATOR CUFF

    Directory of Open Access Journals (Sweden)

    S. Y. Dokolin

    2013-01-01

    Full Text Available Damage of the long head of the biceps at the place of attachment to the articular tubercle supraglenoidal lip of shoulder, to the entrance and throughout intertubercle furrows are common causes of pain and dysfunction of the shoulder joint. At the same clinical manifestations of the morphology of such lesions may be different. The current literature discusses various options of surgical correction of the biceps injury. Variety of methods of surgical treatment and the lack of consensus in support of their application in different patients in different types of injuries were the basis for the present study. A prospective analysis of the functional results of surgical treatment of the 34 - year’s patients with associated rotator cuff (SSP+ISP+SSC+ and the tendon of the biceps muscle in age from 34 to 75 years. Options for surgical correction of the damaged part of the biceps were: biceps tenotomy, biceps tenotomy with intraarticular tenodez of the shoulder to the head before entering intertubercle furrow, biceps tenotomy and extraarticular subpectorialtenodez to the proximal humerus is intertubercle interferrent screw groove, as well as its attachment to the tendon suture large pectoral muscle. Choice of surgical approach depended on the patient's age, level of daily physical activity, morphology and localization of lesions. The best results were obtained when the extra-articular subpectorialtenodez of long head of the biceps to the proximal humerus interferrent screw and suture fixation to the pectoralis major muscle, the average follow-up was 16,6 ± 4,7 months.

  16. Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Nobuyasu Komasawa

    2015-01-01

    Full Text Available The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP and taper-shaped (taper cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n=20; HVLP group or taper-shaped (n=20; Taper group cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

  17. Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial.

    Science.gov (United States)

    Komasawa, Nobuyasu; Mihara, Ryosuke; Imagawa, Kentaro; Hattori, Kazuo; Minami, Toshiaki

    2015-01-01

    The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n = 20; HVLP group) or taper-shaped (n = 20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

  18. 关节镜微创治疗陈旧性肱骨大结节撕脱骨折合并肩袖损伤的临床疗效研究%Arthroscopic-assisted minimally invasive reduction and osteosynthesis of old avulsion fractures of the greater tuberosity with rotator cuff tear

    Institute of Scientific and Technical Information of China (English)

    陈志超; 顾祖超; 段鑫; 李志力

    2016-01-01

    目的:探讨关节镜微创治疗陈旧性肱骨大结节撕脱骨折合并肩袖损伤的临床疗效。方法回顾性分析2011年1月至2013年12月成都市第一人民医院收治的12例陈旧性肱骨大结节撕脱骨折合并肩袖损伤患者在关节镜下行肱骨大结节成形双固定螺钉肩袖修复的治疗方法。12例患者全部获得随访,随访时间6~24个月。按照美国加州洛杉矶大学 UCLA 功能评分标准,术前、术后6个月分别进行评估,观察其疗效。结果患者的美国加州洛杉矶大学 UCLA 功能评分术前为(20.6±5.3)分,术后6个月随访时评分为(31.5±3.6)分,差异有统计学意义(P <0.05),本组患者无明确的术后并发症。结论关节镜下肱骨大结节成形并肩袖修复是一种微创、疗效好、康复快的治疗方法。%Backgroud Old avulsion fracture of the greater tuberosity is a common clinical disease.Patients with no significant dislocation after fresh avulsion fracture of the greater tuberosity usually take conservative treatment,if conservative treatment effect is not ideal or the selection of early treatment method is unreasonable (conservative treatment for displaced fracture),the fragment tend to displace to posterosuperior of the proximal humerus,thus may cause malunion of greater tuberosity,lead to subacromial impingement and rotator cuff injury.All these pathological factors can often lead to pain and limited activity of the shoulder.Now conservative treatment is more often used for pain and restricted movement of the shoulder after avulsion fracture of the greater tuberosity, however,the effect is not ideal.From January 201 1 to December 2013,12 cases of avulsion fracture of the greater tuberosity with rotator cuff tear received arthroscopic-assisted minimally invasive reduction and osteosynthesis in Chengdu First People′s Hospital and obtained ideal clinical effect. Methods (1 )General data.From January 201 1 to December 2013,12 patients

  19. A preliminary study of effects of prostaglandin E2 on rotator cuff injuries%前列腺素E2在肩袖损伤中作用的研究

    Institute of Scientific and Technical Information of China (English)

    丁舒晨; 马超然; 王哲洋; 江友泉; 李政; 田臻; 邱裕生; 尹战海

    2013-01-01

    Objective To investigate the effects of prostaglandin E2 ( PGE2 ) on rotator cuff injuries. Methods The samples were divided into 5 groups, including tear group ( n=8 ), calciifed supraspinatus tendonitis group ( n=11 ), fresh cadaver group ( n=6 ), positive control group ( n=10 ) and negative control group ( n=10 ). The samples of the former 3 groups were tissues of supraspinatus tendons. The samples of the positive control group and negative control group were synoviums got from patients with serious osteoarthritis, and in the negative control group phosphate buffered saline ( PBS ) solution was used instead of primary antibodies. Before being stained with immunohistochemistry, all samples were detected by using microwave antigen retrieval. The primary antibodies were rabbit anti-human PGE2 monoclonal antibodies from ABCAM Company, which were diluted for 100 times. All the areas of cell aggregation were manually located, and the images were collected with a photomicroscope ( ×400 ). After the images were numbered, the computer random number generation software was utilized to select 8 numbered high power ifelds ( ×400 ) randomly. When all the areas except for the cell nucleus were taken as the regions of interest, the area and absorbance were measured by the Image-Pro Plus 6.0 ( IPP6.0 ) image processing software, and the mean optical density ( MOD ) was calculated. After that the expressions of PGE2 were evaluated, and the results were studied by t-test (α=0.05 ). Results The cytoplasm and extracellular matrix in the negative control group were both stained negatively, which were the same in the fresh cadaver group. In the positive control group, the cytoplasm and matrix showed strongly and weakly positive staining respectively, which were the same in the tear group. The cytoplasm and matrix in the calciifed supraspinatus tendonitis group both showed weakly positive staining. The MOD in the tear group was 0.3158±0.0204, which was 0.0907±0.0160 in the

  20. Shoulder Impingement/Rotator Cuff Tendinitis

    Science.gov (United States)

    ... athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do ... may be limited and painful. Doctor Examination Medical History and Physical Examination A er discussing your symptoms ...

  1. Rotator Cuff Tears: Surgical Treatment Options

    Science.gov (United States)

    ... the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon ... AAOS “Find an Orthopaedist” program on OrthoInfo.org. Copyright ©1995-2013 by the American Academy of Orthopaedic ...

  2. Proteomics perspectives in rotator cuff research

    DEFF Research Database (Denmark)

    Sejersen, Maria Hee Jung; Frost, Poul; Hansen, Torben Bæk;

    2015-01-01

    tendinopathies, and to evaluate perspectives of proteomics – the comprehensive study of protein composition - in tendon research. Materials and Methods We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included...

  3. 关节镜下治疗肩袖损伤合并肱二头肌长头腱病变的临床随访研究%Clinical follow up study of arthroscopic treatment of rotator cuff tear with concomitant biceps long head lesion

    Institute of Scientific and Technical Information of China (English)

    沈杰威; 朱以明; 鲁谊; 姜春岩

    2009-01-01

    目的 评估经皮关节内肌腱固定技术在关节镜下肩袖损伤重建患者中,治疗合并肱二头肌长头腱损伤的临床效果.方法 2006年3月-2008年3月,对30例肩袖损伤合并肱二头肌长头腱损伤的患者,采用经皮关节内肌腱固定技术进行肌腱固定治疗.按照肩关节ASKS评分、Constant-Murley评分和YAS疼痛评分,并对肱二头肌肌力、外观进行评估.结果 术后随访时间平均为23个月(12~37个月).30例肩关节ASKS评分术前平均为43.8分,术后平均为94.7分;Constant-Murley评分术前平均为52.8分,术后平均为94.1分;VAS疼痛评分术前平均为5.5分,术后平均为0.6分;三种评分术前和术后差异均有统计学意义(P<0.01).术后均未出现Popeye畸形和二头肌痉挛症状,屈肘肌力测量患侧与健侧基本相同,差异无统计学意义.29例对手术效果满意.结论 经皮关节内肌腱固定技术是治疗肱二头肌长头腱损伤的有效方法,术后肩关节功能和疼痛改善明显,可以较好地维持肱二头肌的肌力并且避免肱二头肌出现肌腹膨隆畸形.%Objective To evaluate the clinical and functional outcomes in a cohort of rotator cuff tear patients who underwent arthroscopic rotator cuff repair combined with biceps tenodesis using percutaneous intra-articular transtendon technique (PITT). Methods Thirty patients with rotator cuff tear who had concomitant biceps pathology or instability were treated between March 2006 and March 2008 with arthroscopic rotor cuff repair and biceps tenodesis using PITT technique. American Shoulder and Elbow Surgeons' score (ASES), Constant-Murley score and Visual Analog scale pain score were adopted for postoperative shoulder function evaluations. The cosmetic appearance and biceps strength were also evaluated. Results Postoperative follow up period was 23 months on average (range 12 to 37 months). ASES of the 30 shoulders was 43.8 preoperatively and 94.7 postoperatively. Constant

  4. 应力负荷下兔肩袖急性断裂重建后腱-骨修复动物模型建立及其修复过程中影像学评价%Construction of repair tendon-bone models in rabbits with postoperatibe acute rotator cuff rupture under stress and imaging evaluation during repairing

    Institute of Scientific and Technical Information of China (English)

    李森; 靳安民; 闵少雄; 张辉; 王清

    2011-01-01

    BACKGROUND: Though many kinds of animals were used as models in the experiment of rotator cuff injury under stress, yet there is no single can be as the standard experimental animal model.OBJECTIVE: To construct repair tendon-bone models of rabbits with acute rotator cuff rupture under stress and to evaluate the iconography in repairing.METHODS: New Zealand white rabbits were underwent transverse myotenotomy of supraspinatus tendon and tendon insertion site reconstruction. After surgery, all animals were randomly divided into the stress and non-stress groups. Rabbits in the non-stress group were raise in normal cage, and those in the stress group were trained passive flexion and extension at 2 weeks after the reconstruction of the supraspinatus tendon. MRI and ultrasound examination was performed at the 2, 4 and 8 weeks after operation .RESULTS AND CONCLUSION: MRI test results: T2WI showed that the areas of the low signals of the tissues connected tendon and bone were larger and the signals of synovial fluid reduced more visible in stress group than in non-stress group at 4 and 8 weeks after operation. Ultrasound examination results: the continuous echoes appeared at the site of the rabbit supraspinatus tendon-bone in 2 groups, which showed more obvious in stress group than in non-stress group at 4 and 8 weeks after operation.The findings demonstrated that, repair tendon-bone models of rabbits with postoperatibe acute rotator cuff rupture under stress are successful constructed, and certain stress can promote repairing of the tendon-bone of rotator cuff.%背景:目前尚无公认的动物模型可以作为应力负荷下肩袖损伤的相关研究标准的实验动物模型.目的:建立应力负荷下兔肩袖腱-骨急性断裂重建术后修复动物模型,并对其修复过程中进行影像学评价.方法:将新西兰白兔进行双侧肩关节行冈上肌腱离断术,并行冈上肌腱止点重建,术后随机分为应力负荷组与非应力负荷组.非

  5. 不同界面处理方法对肩袖止点腱-骨愈合影响的研究%EFFECT OF DIFFERENT SURGERY TECHNIQUES ON BONE-TENDON HEALING OF ROTATOR CUFF INSERTION

    Institute of Scientific and Technical Information of China (English)

    陶旭; 唐康来; 陈磊; 周建波; 曹洪辉; 常廷杰; 李辉; 许建中

    2011-01-01

    目的 腱-骨愈合是肩袖损伤修复的关键因素,通过生物力学及组织学观察探讨不同界面处理方法对兔肩袖止点腱-骨愈合的影响.方法 取42只成年日本短耳兔,雌雄不限,体重2.0~2.5 kg,随机分为3组,分别为皮质骨层组(n=18)、松质骨层组(n=18)、空白对照组(n=6).空白对照组不作任何处理,作为正常对照:皮质骨层组:全层切断冈上肌腱中1/2部分,将冈上肌腱直接缝合固定于肱骨大结节;松质骨层组:全层切断冈上肌腱中1/2部分,去除肱骨大结节骨皮质,将冈上肌腱缝合固定于肱骨大结节.术后4、8周处死实验动物,完整切取冈上肌腱与肱骨大结节及连接部,行大体观察、HE染色及生物力学测定.结果 术后4周,皮质骨层组和松质骨层组标本的冈上肌均较空白对照组萎缩,腱-骨连接部界限不明显;术后8周,两组冈上肌与空白对照组比较已无明显差异.组织学观察示皮质骨层组术后4周,界面组织层与新生骨组织层移行尚可;术后8周,界面组织层与新生骨组织层逐渐移行,骨侧形态接近正常.松质骨层组术后4周,界面组织层与新生骨组织层连接不紧密,胶原纤维排列凌乱;术后8周,骨侧大量新生骨组织,界面组织层变薄,平行的胶原纤维长入.生物力学测试示术后4、8周,皮质骨层组最大负荷均较松质骨层组高,且每组术后8周的最大负荷均较术后4周高,差异均有统计学意义(P<0.05);除抗拉强度及术后4周两组间断裂强度外,其余结果比较差异均有统计学意义(P<0.05).结论 兔肩袖断裂模型中,界面处理至皮质骨层在愈合强度及程度方面均优于处理至松质骨层.%Objective To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion. Methods Forty-two adult Japanese rabbits, weighing 2.0-2.5 kg and male or female, were selected. Thirty-six rabbits were given a sharply left

  6. Abduction and external rotation (ABER) MR arthrography of the shoulder. Benefits and limitations

    Energy Technology Data Exchange (ETDEWEB)

    Mostafa, A.; Gokan, Takehiko; Munechika, Hirotsugu; Ogawa, Takashi [Showa Univ., Tokyo (Japan). School of Medicine; El-Feky, A.A.

    2001-12-01

    The purpose of this study was to show the benefits and limitations of using abduction and external rotation (ABER) positions of the arm during MR arthrography of the shoulder in the evaluation of the rotator-cuff tendon, the capsulolabral complex and the shoulder joint after surgery. Forty-seven patients complaining of either shoulder instability, chronic shoulder pain, pain of unknown cause or pain following shoulder surgery were studied using the direct MR arthrography technique in both the standard neutral position with the arm adducted as well as with the arm in the ABER position. A correlation was obtained between the MR arthrography findings and the surgical findings in 10 reports and clinical presentations of the examined patients. Three patients [6%] were unable to perform ABER positioning. ABER oblique axial images were better than standard oblique coronal images in revealing undersurface tears of the rotator cuff particularly of the grade I type. Four tears were missed in standard images. Oblique axial images were better than standard axial images in demonstrating non-displaced anterior labral tears. One tear was missed and two tears were suspected in the standard images. Oblique axial images were less sensitive than oblique coronal images in the diagnosis of superior labral tears. Two tears were missed in ABER images. The ABER oblique axial MR arthrogram is a useful adjunct to the standard axial and oblique coronal MR arthrograms for assessment of capsulolabral abnormalities and rotator-cuff tendon tears despite some limitations. (author)

  7. Endotracheal Tube Cuff Management at Altitude

    Science.gov (United States)

    2014-02-05

    model study of endotracheal intubation including mechanical ventilation and four methods of cuff pressure management during ascent and descent...AFRL-SA-WP-SR-2014-0007 Endotracheal Tube Cuff Management at Altitude SSgt Tyler J. Britton, RRT1; Richard D. Branson, RRT2...REPORT TYPE Special Report 3. DATES COVERED (From – To) June 2012 – December 2013 4. TITLE AND SUBTITLE Endotracheal Tube Cuff Management

  8. Automated Control of Endotracheal Tube Cuff Pressure during Simulated Flight

    Science.gov (United States)

    2016-06-21

    controllers—Intellicuff, Hamilton Medical; Pyton, ARM Medical; Cuff Sentry, Outcome Solutions—were used to manage cuff pressures . The fourth group had...Medical; Pyton, ARM Medical; Cuff Sentry, Outcome Solutions—were used to manage cuff pressures . The fourth group had cuff pressure set at sea level...ventilator, while the other two devices are stand-alone products. The fourth group of ETTs had the cuff pressure measured by the respiratory

  9. Avaliação dos resultados da artroplastia parcial de ombro para tratamento da artropatia por lesão do manguito rotador Evaluating the results of partial shoulder arthroplasty for the treatment of arthropathy due to rotator cuff lesion

    Directory of Open Access Journals (Sweden)

    Sérgio Luiz Checchia

    2008-06-01

    Full Text Available OBJETIVO: Avaliar os resultados obtidos com a artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador. MÉTODOS: No período de junho de 1989 a março de 2004, 11 ombros de 11 pacientes foram submetidos a artroplastia parcial de ombro para o tratamento de artropatia por LMR. O tempo de seguimento variou de 27 a 183 meses, com média de 69 meses. A idade média foi de 69,1 anos, variando de 44 a 78 anos. Houve predomínio do sexo feminino em 90,9% dos casos (10 pacientes. O membro dominante foi acometido em 10 pacientes. Os métodos escolhidos para avaliação dos pacientes, no seguimento pós-operatório, basearam-se nos critérios da UCLA; no índice de satisfação dos pacientes em relação ao alívio da dor; e no método de avaliação de objetivos limitados, proposto por Neer et al. RESULTADOS: O índice de satisfação dos pacientes em relação ao alívio da dor foi de 81,8%. Com o método de avaliação da UCLA, observamos média de 22,7 pontos. Por meio do método de avaliação de objetivos limitados, proposto por Neer et al, obtivemos seis pacientes com resultados satisfatórios e cinco insatisfatórios. CONCLUSÃO: A artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador promove alívio do quadro doloroso e permite alguma melhora na função do membro para realização das atividades diárias; entretanto, é uma técnica que leva a altos índices de resultados insatisfatórios.OBJECTIVE: To evaluate the results achieved with partial arthroplasty of the shoulder to treat arthropathy due to rotator cuff lesion. METHODS: From June 1989 to March 2004, 11 shoulders of 11 patients were submitted to partial arthroplasty of the shoulder to treat an arthropathy due to rotator cuff lesion. Follow-up time varied from 27 to 182 months, with a mean of 69 months. Mean age was 69.1 years, ranging from 44 to 78 years. There was a predominance of the female gender, in 90.9% of

  10. Tradução e adaptação cultural do WORC: um questionário de qualidade de vida para alterações do manguito rotador Translation and cultural adaptation of WORC: a quality-of-life questionnaire for rotator cuff disorders

    Directory of Open Access Journals (Sweden)

    AD Lopes

    2006-09-01

    Full Text Available OBJETIVO: Realizar a tradução e a adaptação cultural do questionário WORC (The Western Ontario Rotator Cuff Index para a língua portuguesa para ulterior validação no Brasil. MÉTODOS: O protocolo aplicado consistiu em: 1 Preparação, 2 Tradução, 3 Tradução de volta à língua original (retro-tradução, 4 Interrogatório Cognitivo e 5 Relato de Informações. Ao serem concluídas as etapas de tradução e retro-tradução, as versões foram enviadas para os autores do WORC original, que as aprovaram para continuação do estudo. A versão em Português foi aplicada a 35 pacientes com disfunções do manguito rotador para verificar o nível de compreensão do instrumento. A idade média foi 57 anos (DP=13, 63% eram do sexo feminino e 74% tinham nível de escolaridade de primeiro grau incompleto. A versão brasileira final do WORC foi definida após se conseguir menos que 15% de "não compreensão" em cada item. Para análise das variáveis, foi utilizada estatística descritiva. RESULTADOS: Realizaram-se mudanças e substituições de termos e expressões para obter equivalência cultural do WORC. Alteraram-se também os termos "não compreendidos" pelos pacientes de acordo com as sugestões feitas por eles. CONCLUSÃO: Após a tradução e adaptação cultural do questionário, foi concluída a versão em Português do WORC que está em processo de validação para ser utilizada no Brasil.OBJECTIVE: To accomplish the translation of WORC (The Western Ontario Rotator Cuff Index into Portuguese and its cultural adaptation, for future validation in Brazil. METHOD: The protocol applied consisted of: 1 Preparation; 2 Forward translation; 3 Back translation; 4 Cognitive Debriefing; and 5 Information report. After concluding the forward and back-translations, the versions were sent to the authors of the original questionnaire, who gave their approval for the study to be continued. The Portuguese version was applied to 35 patients with

  11. Resultado da reparação do manguito rotador em lesões do tipo C1 e C2 de Snyder, considerando fumantes e não fumantes Outcome of rotator cuff repair in Snyder type C1 and C2 lesions, considering smokers and nonsmokers

    Directory of Open Access Journals (Sweden)

    Sérgio Correa Pinto Júnior

    2010-01-01

    Full Text Available OBJETIVO: Avaliar a influência do tabagismo nos resultados cirúrgicos do reparo das lesões completas do manguito rotador tipos C1 e C2 de Snyder. MÉTODOS: Foram avaliados 166 pacientes que haviam sido submetidos a tratamento cirúrgico para lesão completa do manguito rotador tipo C1 e C2 de Snyder, entre junho de 2002 a dezembro de 2006. Foram considerados critérios de inclusão um seguimento mínimo de 24 meses e ausência de cirurgias prévias no ombro acometido. Excluíram-se os pacientes que apresentavam outras lesões associadas. Foram avaliados os paciente fumantes e não fumantes de acordo com os critérios da Organização Mundial da Saúde (OMS. Houve predomínio de pacientes do sexo feminino (119 em relação ao masculino (47, e a idade média foi de 57 anos (38 a 78. Do total de 166 pacientes avaliados, foram considerados fumantes 21 pacientes e não fumantes 145. Os resultados finais foram avaliados pelos critérios da UCLA (University of California at Los Angeles e a análise estatística foi feita pelo programa Epi Info®. RESULTADOS: Pelos critérios da UCLA, os pacientes fumantes tiveram uma média final de 32,6 pontos, enquanto os não fumantes de 33,8. Na análise estatística pós-operatória houve diferença entre os dois grupos, com os pacientes não fumantes tendo melhor resultado final. CONCLUSÃO: O tabagismo interfere no resultado final das reparações de lesões pequenas e médias do manguito rotador.OBJECTIVE: To evaluate the influence of smoking on the results of surgical repair of complete lesions of the rotator cuff Snyder types C1 and C2. METHODS: We studied 166 patients who had undergone surgical treatment for complete lesion of the rotator cuff Snyder type C1 and C2, from June 2002 to December 2006. Inclusion criteria were a minimum follow-up period of 24 months and the absence of previous surgery on the affected shoulder. Patients with other associated injuries were excluded. We evaluated the smoking and

  12. Estudo prospectivo e comparativo dos resultados funcionais após reparo aberto e artroscópico das lesões do manguito rotador Prospective and comparative study on functional outcomes after open and arthroscopic repair of rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2011-10-01

    Full Text Available OBJETIVO: Avaliar prospectivamente o resultado cirúrgico dos pacientes submetidos ao reparo das lesões do manguito rotador por via aberta e artroscópica, quanto ao aspecto funcional, clínico e por exame de ultrassonografia (US, além de comparar a ocorrência de reruptura. MÉTODOS: Foram operados 60 pacientes pelo mesmo cirurgião, sendo 29 pacientes por via aberta e 31 por via artroscópica para reparo das lesões completas do manguito rotador (MR, entre agosto de 2007 e fevereiro de 2009 no Hospital Governador Israel Pinheiro (HGIP e Hospital Mater Dei (HMD em Belo Horizonte, MG. Os pacientes foram avaliados funcionalmente através do escore da UCLA feito no pré e no pós-operatório e exames de ressonância magnética realizados no pré-operatório. Todos os pacientes foram reavaliados com um período mínimo de 12 meses de pós-operatório, quando foi realizado também exame de US. RESULTADOS: Dos 29 pacientes operados por via aberta, 27 (93,1% apresentaram resultados bons/excelentes, com UCLA médio de 32 no pós-operatório. O seguimento médio foi de 14 meses. Três pacientes apresentaram reruptura ao US, sendo que um deles permaneceu assintomático. Dos 31 pacientes operados por via artroscópica, 29 (93,5% apresentaram resultados bons/excelentes, com UCLA médio de 33 no pós-operatório. O seguimento médio foi de 19 meses. Dois pacientes apresentaram reruptura, sendo que um deles permaneceu assintomático, e um paciente evoluiu com soltura de âncora com resultado insatisfatório. CONCLUSÃO: O reparo das lesões do manguito rotador apresenta bons resultados tanto por via aberta como artroscópica, com resultados funcionais semelhantes entre os grupos, bem como a taxa de reruptura.OBJECTIVE: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to

  13. 不同肩袖补片特点:应用强度、降解速率及酸性降解物的调控%Different materials for rotator cuff repair augmentation: intensity, degradation rate and acidity degradation products

    Institute of Scientific and Technical Information of China (English)

    任士友; 江长青; 张文涛

    2015-01-01

    BACKGROUND:It is unclearwhat kind of material for rotator cuff repair augmentation is the safest or most effective. OBJECTIVE:To review the basic research, clinical application and prospects of materials for rotator cuff repair augmentation. METHODS:Eligible studies were identified from electronic databases including EMbase, Medline, PubMed, OVID, Cochrane Library, Springerlink, CNKI, WanFang, and VIP. RESULTS AND CONCLUSION:There are four kinds of patches used for rotator cuff augmentation: tendon patches, non-degradable patches, extracelular matrix-based patches and degradable synthetic patches. Tendon patches have good mechanical strength, but postoperative foreign body reactions and increasing risk of infection and unable to recover the normal structure are problems to be solved. Non-degradable patches also have good mechanical strength, but the long-term safety is unclear. Extracelular matrix-based patches remain a lower mechanical strength and have a higher failure rate. Degradable synthetic patches are proposed to overcome these previous issues by combining wel-adjusted mechanical properties with biological additives and minimize risk of infection by completely absorbing in a time-dependent manner. However, migration of bioactive cels, regulation of degradation rate and suppression of acidic degradation products is are existing problems to be solved.%背景:采用何种材料作为肩袖补片是最安全的或最有效的仍没有共识或明确的指南.目的:综述肩袖补片材料的基础研究、临床应用现状及前景.方法:利用计算机检索EMbase、Medline、PubMed、OVID、Cochrane Library、Springerlink、万方数据库、中国知识资源总库及维普数据库,查阅国内外肩袖补片的基础研究与治疗肩袖撕裂的相关文献,并进行总结归纳.结果与结论:肩袖补片类型可分成肌腱补片、不可降解肩袖补片、细胞外基质肩袖补片及人工合成可降解型肩袖补片 4 类.肌腱补片、

  14. Avaliação funcional dos pacientes submetidos ao desbridamento artroscópico para tratamento das rupturas extensas e irreparáveis do manguito rotador Functional evaluation of patients who have undergone arthroscopic debridement to treat massive and irreparable tears of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados dos pacientes submetidos ao desbridamento artroscópico das lesões extensas e irreparáveis do manguito rotador. Métodos: Foram operados 27 pacientes no período de 2003 a 2007, sendo avaliados 22 desses. O procedimento cirúrgico consistiu de desbridamento artroscópico do coto dos tendões envolvidos, bursectomia, remoção do osteófito acromial e, eventualmente, tenotomia do bíceps e tuberoplastia. RESULTADOS: No pré-operatório todos apresentavam envolvimento dos tendões do supra e infraespinal. Na avaliação pós-operatória, 14 pacientes estavam com o redondo menor íntegro e três com ruptura parcial do subescapular. Houve melhora dos critérios da UCLA de 15 no pré-operatório para 31 no pós. Não houve melhora de força muscular, porém ocorreu redução da dor. Conclusão: Desbridamento artroscópico é um procedimento indicado para pacientes idosos com ruptura irreparável do manguito rotador, que tenham boa ADM, baixa demanda funcional e com o principal objetivo de reduzir a dor.OBJECTIVE: To evaluate the results in patients who have undergone arthroscopic debridement of massive and irreparable injury of the rotator cuff. METHODS: 27 patients were operated in the period from 2003 to 2007, during which 22 of them were evaluated. The procedure used consisted of arthroscopic debridement of the related tendons of the residual limb, bursectomy, acromial osteophyte removal, and eventually, biceps tenotomy and tuberoplasty. RESULTS: All patients showed involvement of the supraspinatus and infraspinatus tendons in the preoperative stage. In the postoperative evaluation, 14 patients had an teres minor muscle, and 3 had partial tears of the subscapularis tendon. There was an improvement in the UCLA criteria from 15 preoperatively to 31 postoperatively. There was no improvement in muscular strength, but there was a reduction in the pain. CONCLUSION: Arthroscopic debridement is a recommended procedure for

  15. 关节镜下微创手术治疗运动性肩袖损伤50例康复护理%Rehabilitation nursing care in the treatment of 50 cases of sport rotator cuff injury with minimally invasive arthroscopic surgery

    Institute of Scientific and Technical Information of China (English)

    宋学良; 于红英; 钭晓帆

    2011-01-01

    目的:探讨关节镜下微创手术治疗运动性肩袖损伤患者的康复护理方法.方法:对50例运动性肩袖损伤患者行关节镜下微创手术治疗,并给予个性化心理护理、疼痛护理及有计划的阶段性康复训练.结果:50例患者均未出现肩关节僵硬强直、创伤性骨性关节炎及神经损伤等并发症.随访3个月~1.5 年,根据美国UCLA肩关节评分标准评分优35例、良10例、可5例,优良率90%.患者自我满意度高.结论:关节镜下微创手术后早期阶段性康复训练能促进肩关节功能恢复,提高手术治疗的效果.%Objective: To explore the rehabilitation nursing methods in the treatment of sport rotator cuff injury with minimally invasive arthroscopic surgery. Methods: 50 patients with sport rotator cuff injury were treated with minimally invasive arthroscopic surgery and given individualized psychological care, pain care and planned staged rehabilitation training. Results: There was no occurrence of stiffness and rigidity of shoulder joint, traumatic osteoarthritis and nerve damage in these 50 patients. The patients were followed up for 3 months to 1.5 years, the scoring showed 35 cases were excellent, 10 cases good and 5 cases fair according to U.S. UCLA shoulder grading standard. The excellent and good rate was 90%. The patient's self - satisfaction was high. Conclusions: The early staged rehabilitation training can promote the functional recovery of shoulder joint and improve surgical outcome after minimally invasive arthroscopic surgery.

  16. Assessment of proprioceptive exercises in the treatment of rotator cuff disorders in nursing professionals: a randomized controlled clinical trial Avaliação dos exercícios proprioceptivos no tratamento dos distúrbios do manguito rotador em profissionais de enfermagem: um estudo clínico controlado e randomizado

    Directory of Open Access Journals (Sweden)

    Lisandra V Martins

    2012-01-01

    Full Text Available BACKGROUND: Shoulder pain in nursing professionals may lead to limitations in occupational and daily activities and consequently interfere with quality of life. OBJECTIVE: To compare the effects of two physical therapy programs which differed in the proprioceptive exercises used on the nursing professionals with rotator cuff disorder, according to quality of life, work satisfaction indicators, and pain intensity. METHOD: This study was an experimental, randomized, prospective, comparative trial with quantitative data analysis. The data sampling was carried out between the months of June 2010 and July 2011 by means of a questionnaire containing socio-demographic and professional information, the Western Ontario Rotator Cuff Index (WORC, the Occupational Stress Indicator (OSI, and the Visual Numeric Scale (VNS. Based on randomization, subjects were divided into two groups. Group 1 (control was submitted to stretching and strengthening exercises and cryotherapy. Group 2 (experimental was treated with the same protocol as the control group, with the addition of proprioception exercises. The data was analyzed by means of the Statistical Package for the Social Science version 16.0 for Windows. RESULTS: After physical therapy intervention, significant reduction in pain levels occurred in both groups, with a significant improvement in quality of life for Group 2. No changes were observed in the work satisfaction indicators after the two types of physical therapy interventions. CONCLUSIONS: The proprioceptive exercises were important in the treatment of musculoskeletal disorders, however the results did not allow us to determine which treatment was the most effective as there was no significant difference between groups. Trial registration ClinicalTrials.gov NCT01465932.CONTEXTUALIZAÇÃO: A dor no ombro em profissionais de enfermagem pode acarretar limitação das atividades diárias e ocupacionais e interferir na qualidade de vida. OBJETIVO: Comparar o

  17. Assessment of proprioceptive exercises in the treatment of rotator cuff disorders in nursing professionals: a randomized controlled clinical trial Avaliação dos exercícios proprioceptivos no tratamento dos distúrbios do manguito rotador em profissionais de enfermagem: um estudo clínico controlado e randomizado

    Directory of Open Access Journals (Sweden)

    Lisandra V Martins

    2012-12-01

    Full Text Available BACKGROUND: Shoulder pain in nursing professionals may lead to limitations in occupational and daily activities and consequently interfere with quality of life. OBJECTIVE: To compare the effects of two physical therapy programs which differed in the proprioceptive exercises used on the nursing professionals with rotator cuff disorder, according to quality of life, work satisfaction indicators, and pain intensity. METHOD: This study was an experimental, randomized, prospective, comparative trial with quantitative data analysis. The data sampling was carried out between the months of June 2010 and July 2011 by means of a questionnaire containing socio-demographic and professional information, the Western Ontario Rotator Cuff Index (WORC, the Occupational Stress Indicator (OSI, and the Visual Numeric Scale (VNS. Based on randomization, subjects were divided into two groups. Group 1 (control was submitted to stretching and strengthening exercises and cryotherapy. Group 2 (experimental was treated with the same protocol as the control group, with the addition of proprioception exercises. The data was analyzed by means of the Statistical Package for the Social Science version 16.0 for Windows. RESULTS: After physical therapy intervention, significant reduction in pain levels occurred in both groups, with a significant improvement in quality of life for Group 2. No changes were observed in the work satisfaction indicators after the two types of physical therapy interventions. CONCLUSIONS: The proprioceptive exercises were important in the treatment of musculoskeletal disorders, however the results did not allow us to determine which treatment was the most effective as there was no significant difference between groups.CONTEXTUALIZAÇÃO: A dor no ombro em profissionais de enfermagem pode acarretar limitação das atividades diárias e ocupacionais e interferir na qualidade de vida. OBJETIVO: Comparar o efeito da aplicação de dois programas fisioterap

  18. Cuff inflations do not affect night-time blood pressure

    DEFF Research Database (Denmark)

    Petersen, Emilie H; Theilade, Simone; Hansen, Tine W;

    2015-01-01

    Discomfort related to cuff inflation may bias 24 h ambulatory blood pressure (BP) measurements, especially during night-time. We accessed the impact of cuff inflations by comparing 24 h BP recorded with a cuff-less tonometric wrist device and an upper-arm oscillometric cuff device. Fifty...

  19. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry

    DEFF Research Database (Denmark)

    Graven-Nielsen, Thomas; Vaegter, Henrik Bjarke; Finocchietti, Sara

    2015-01-01

    Chronic musculoskeletal pain is linked with sensitization and standardized methodologies for assessment are needed. This study investigated 1) the test-retest reliability of computer-controlled cuff-pressure algometry (pain thresholds and temporal pain summation) on the arm and leg, and 2) condit...

  20. 自体富血小板血浆凝胶在关节镜下肩袖修补术中的应用%Clinical study of autologous platelet rich plasma gel in arthroscopic rotator cuff repair:a randomized, controlled trial

    Institute of Scientific and Technical Information of China (English)

    董佩龙; 唐晓波; 王健; 朱振安

    2015-01-01

    促进肩袖修复,提高肩关节功能,近期疗效满意。%Objective To investigate the effect of autologous platelet rich plasma (PRP) gel in arthroscopic rotator cuff re⁃pair. Methods All of 44 patients with rotator cuff tear undergent arthroscopic rotator cuff repair were randomly divided into two groups:PRP group (22 patients were received autologous PRP and hemocoagulase) and normal saline (NS) group (22 patients were received NS and hemocoagulase). All patients had the same accelerated rehabilitation protocol and were followed up in 1, 3, 12 months. Evaluation consisted of inflammatory reaction, wound healed, visual analogue scores (VAS), University of California at An⁃geles (UCLA) Shoulder Scores and American Shoulder and Elbow Surgeons (ASES) Scores. Results After operation, no inflam⁃matory reaction was in 20 cases of PRP group and 19 cases of NS group, mid inflammatory reaction 1 case in PRP group and 2 cas⁃es in NS group, moderate inflammatory reaction 1 case in PRP group and 1 case in NS group. Wound healed by first intention in all of PRP group and 21 patients of NS group. In PRP group, the preoperative, 3 months and 12 months postoperative VAS were 6.6±2.0, 3.4±1.8, 1.8±1.3, UCLA were 15.2±2.9, 24.3±2.7, 32.4±2.1, ASES were 35.6±12.4, 63.4±10.4, 92.3±7.5. In NS group, the preoperative, 3 months and 12 months postoperative VAS were 6.7 ± 1.9, 4.6 ± 1.9, 2.0 ± 1.2, UCLA were 14.8 ± 3.0, 21.2 ± 2.5, 31.7 ± 2.3, ASES were 32.7 ± 13.8, 55.8 ± 11.8, 90.7 ± 8.1. Three months postoperative VAS, UCLA, ASES were statistically signifi⁃cant differenece in PRP group and NS group. Twelve months postoperative VAS, UCLA, ASES were not statistically significant dif⁃ferenece in the two groups. Conclusion Using autologous PRP gel in arthroscopic rotator cuff repair can speed up the healing of operation incision with no adverse effect, reduce pain in the postoperation three months, accelerate the rotator cuff repair and re⁃covery of

  1. Rotationally actuated prosthetic helping hand

    Science.gov (United States)

    Norton, William E. (Inventor); Belcher, Jewell G., Jr. (Inventor); Carden, James R. (Inventor); West, Thomas W. (Inventor)

    1991-01-01

    A prosthetic device has been developed for below-the-elbow amputees. The device consists of a cuff, a stem, a housing, two hook-like fingers, an elastic band for holding the fingers together, and a brace. The fingers are pivotally mounted on a housing that is secured to the amputee's upper arm with the brace. The stem, which also contains a cam, is rotationally mounted within the housing and is secured to the cuff, which fits over the amputee's stump. By rotating the cammed stem between the fingers with the lower arm, the amputee can open and close the fingers.

  2. Análise comparativa do resultado da sutura artroscópica da lesão do manguito rotador em pacientes fumantes e não fumantes Comparative analysis on the result from arthroscopic suturing of rotator cuff injuries between smoking and non-smoking patients

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2011-04-01

    cuff injuries between smoking and non-smoking patients. METHODS: A group of 286 patients who underwent arthroscopic suturing of primary rotator cuff injuries between June 12, 2002, and May 14, 2008, was analyzed. The patients included in the study were evaluated using the UCLA scale, with a minimum follow-up of 12 months and average of 56.52 months. The variables studied were age, sex, side operated, dominance, profile of cigarette use and UCLA index. RESULTS: This study evaluated a total of 205 patients. Mean age (p = 0.289 and sex (p = 0.124 were analyzed statistically between the smoking and non-smoking patients and the two groups were considered to be similar. The average UCLA score for the non-smoking patients (143 was 34 (32 to 35. The average UCLA score for the smoking patients (51 was 33 (29 to 35. There was no statistically significant difference in UCLA score (p = 0.123 between the smoking and non-smoking patients. For the purposes of statistical analysis, we grouped the small and medium tears (107 and compared these with the large and extensive tears (80, between smokers and non-smokers. There was no statistically significant difference using the Mann-Whitney test regarding the small and medium tears (p = 818. There was a statistically significant difference using the Mann-Whitney test regarding the large and extended tears, between the smoking and non-smoking patients, such that the non-smokers showed better UCLA scores (p = 0.038. CONCLUSION: The results from arthroscopic suturing of large and extensive rotator cuff injuries are inferior among smoking patients.

  3. Avaliação da integridade anatômica por exame de ultrassom e funcional pelo índice de Constant & Murley do manguito rotador após reparo artroscópico Evaluation of anatomical integrity using ultrasound images, and functional integrity by the Constant & Murley score, of the rotator cuff following arthroscopic repair

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados funcionais e anatômicos do tratamento cirúrgico via artroscópica nas roturas completas do manguito rotador usando imagens de ultrassom e o índice funcional de Constant e Murley, investigando a correlação entre eles. MÉTODOS: Avaliados 100 pacientes (110 ombros. Seguimento médio de 48,8 ± 33,28 (12 a 141 meses. Média de idade de 60,25 ± 10,09 (36 a 81 anos. Rotura isolada do tendão supra-espinal esteve presente em 85 casos (77%; em associação com o infraespinal, em 20 (18%, e associado ao subescapular, em quatro ombros (4%. A associação de lesões supra-espinal, infraespinal e subescapular foi encontrada em um ombro (1%. De acordo com DeOrio e Cofield, as lesões foram classificadas em pequenas/médias em 85 ombros (77% e, grandes/extensas em 25 (23%. Avaliação clínica de resultados realizada de acordo com critérios de Constant e Murley. Resultados do ultrassom (US se referem aos laudos emitidos por diferentes radiologistas. Análise estatística de acordo com os métodos Qui-quadrado, teste exato de Fisher, teste t de Student, correlação de Pearson, Kruscall-Wallis e regressão logística (significância p OBJECTIVE: To evaluate the functional and anatomic results of surgical treatment under arthroscopy in cases of rupture of the rotator cuff using ultrasound images and the Constant and Murley functional score to investigate the correlation between them. METHODS: 110 patients (110 shoulders were evaluated. The medium follow up was 48.8 ± 33.28 months (12 to 141 months. The average age was 60.25 ± 10.09 (36 to 81 years. Isolated rupture of the supraspinal tendon occurred in 85 cases (77%, associated with infraspinatus in 20 cases (18% and subscapularis in four shoulders (4%. Associated tear lesions of the supraspinatus, infraspinatus and subscapularis was found in one shoulder (1%. The lesions were classified according to the DeOrio and Cofield score as small/medium in 85 shoulders (77% and

  4. Effect of stress load on bone-tendon repair process after the arthroscopic treatment of bone rivets for acute rotator cuff injury in rabbits%应力负荷对关节镜下骨铆钉治疗兔急性肩袖损伤后骨-肌腱修复过程的影响

    Institute of Scientific and Technical Information of China (English)

    蒋胜波; 董跃福; 刘旭东; 刘燕

    2013-01-01

    Objective To study the effect of stress stimulation in different intensity on bone-tendon repair process after acute rotator cuff injury in rabbits treated by bone rivets under arthroscopy. Methods According to whether performed postoperative function exercises, and the intensity of activity, 30 adult New Zealand white rabbits were randomly divided into 3 groups: high-intensity experimental group (range of motion of shoulder joint was -60° to 60° ), low-intensity experimental group (range of motion of shoulder joint was -15° to 15° ) and control group (free activity permitted). Models of rotator cuff injury in rabbits were established, and bone rivets were used to repair the injury under arthroscopy. Joint functional exercises were performed 1 week after the surgery, MRI examination of shoulder joint were undergone simultaneously. Animals were sacrificed at 2, 3, 4 week after the surgery by intravenous injection of air respectively, and the stiffness and ultimate tensile strength of specimens taken from supraspinatus tendon-bone interface were observed in each group. Results Gross observation showed no obvious differences among 3 groups. In low-intensity experimental group, MRI results showed homogeneous signals in muscle tendon, while no obvious high signal intensity in articular cavity; In high-intensity experimental group and control group, heterogeneous signals in muscle tendon and high signal intensity in articular cavity were found in MRI images. At 2, 3, and 4 week after the surgery, stiffness and maximum tensile strength in low-intensity group were significantly higher than those in control group and high-intensity group (P <0.05). Conclusion During the early repair process for acute rotator cuff injury treated by bone rivets under arthroscopy, low-intensity stimulation can improve biomechanical strength of bone-tendon interface, and therefore can get better effects compared with high-intensity stimulation.%目的探讨不同强度应力刺激对关

  5. Ultrasonic testing of tendon-bone repair in rabbits with postreconstructive acute ruptured rotator cuff under stress%应力负荷下兔肩袖急性断裂重建后腱-骨修复过程中的超声检测

    Institute of Scientific and Technical Information of China (English)

    李森; 靳安民; 张辉; 闵少雄; 王清

    2012-01-01

    BACKGROUND: Pervious studies have showed stress can promote tendon-bone repair, but studies related to ultrasonic testing during tendon-bone repair are few.OBJECTIVE: To study the changes in ultrasonic testing of tendon-bone in rabbits with postreconstructive acute ruptured rotator cuff under stress.METHODS: Adult male New Zealand white rabbits were selected for establishing animal models of tendon-bone repair with postreconstructive acute ruptured rotator cuff under stress, and then were randomly divided into two groups: stress group and non-stress group. Rabbits in the stress group were trained at 2 weeks after operation. Non-stress group was with caging and free. RESULTS AND CONCLUSION: At 2 weeks after operation, the echoes at the site of the rabbit supraspinatus tendon-bone were still discontinuous and the signals of inflammatory exudation appeared more evidently than before in the two groups. At 4 weeks after operation, the linear continuous echoes appeared at the site of the rabbit supraspinatus tendon-bone in two groups, which showed more obvious in the stress group than that in the non-stress group. At 6 weeks after operation, the echoes at the site of the rabbit supraspinatus tendon-bone were still discontinuous in two groups, the areas of discontinuous echoes in stress group tendon significantly reduced. At 8 weeks after operation, the echoes at the site of the rabbit supraspinatus tendon-bone were still discontinuous in two groups, the areas of echoes of the tissues combined tendon and bone is more spacious than before. A certain degree of stress stimulation plays an active role in the repairing of postoperative actue ruptured rabbit rotator cuff tendon-bone and ultrasonic testing can detect the dynamic role of tendon-bone repair with non-invasive and accurate.%背景:已有研究证明,应力刺激对肩袖腱-骨损伤后的修复起到促进作用,但超声动态检测其修复过程的相关研究还较少.目的:应用超声检测应力刺激促

  6. Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement Atividade dos músculos escapulares e do manguito rotator durante a elevação do braço: uma revisão da função normal e das alterações na síndrome do impacto

    Directory of Open Access Journals (Sweden)

    V Phadke

    2009-02-01

    Full Text Available OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.OBJETIVO: O objetivo deste manuscrito é revisar o conhecimento atual sobre como a ativação muscular e a produção de força contribuem para a cinemática do ombro em indivíduos saudáveis e em pessoas com síndrome do impacto. RESULTADOS: As porções média e inferior do músculo serrátil anterior produzem rotação para cima, inclina

  7. Accuracy of a new wrist cuff oscillometric blood pressure device: comparisons with intraarterial and mercury manometer measurements.

    Science.gov (United States)

    Watson, S; Wenzel, R R; di Matteo, C; Meier, B; Lüscher, T F

    1998-12-01

    Accurate measurement of arterial blood pressure is of great importance for the diagnosis and treatment of hypertension. Because of the chronic nature of antihypertensive drug therapy, the involvement of the patient in blood pressure control is desirable. Such an involvement, however, is only feasible if simple, user-friendly, and precise blood pressure measurement devices are available. In this study we tested a new wrist cuff oscillometric blood pressure measurement device in 100 consecutive patients undergoing cardiac catheterization. Blood pressures were simultaneously taken intraarterially (axillary artery) and with a mercury manometer and stethoscope or noninvasive measurement device (OMRON R3). Intraarterial measurements were directly compared with two measurements taken in random order with either an arm cuff mercury manometer or the wrist cuff device. Systolic and diastolic blood pressure as assessed with the mercury manometer was higher, especially when compared with the intraarterial and the wrist cuff values, which were comparable. Correlations of blood pressure values with intraarterial measurement were 0.86 systolic and 0.75 diastolic (P mercury manometer measurements. Reproducibility of both measurements was good for the wrist cuff device ([systolic/diastolic]: r = 0.94/0.92; P mercury manometer (r = 0.97/0.88; P mercury manometer were higher than intraarterial values and those of the wrist cuff. Both noninvasive devices overestimated high diastolic values.

  8. Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study

    Directory of Open Access Journals (Sweden)

    Häger-Ross Charlotte

    2010-09-01

    Full Text Available Abstract Background Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before. Methods Cervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS and compared to 49 healthy controls (CON. The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile. Results Together, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 ± 88 °/s and CON: 348 ± 92 °/s, p Conclusions Peak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.

  9. 21 CFR 870.1120 - Blood pressure cuff.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  10. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    NARCIS (Netherlands)

    Peters, J.H.; Hoogerwerf, N.

    2013-01-01

    In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulner

  11. COMPARATIVE STUDY OF SUBMENTAL INTUBATION CUFF IN VS CUFF OUT: A CASE SERIES

    Directory of Open Access Journals (Sweden)

    Aprajita

    2016-06-01

    Full Text Available In patients with panfacial trauma where short-term intraoperative control of airway is required, submental intubation is an alternative to tracheostomy as it is associated with lesser morbidity. It is also an interesting alternative to oral and nasal intubation as intraoperatively the tube does not cause any hindrance to the surgeon and occlusion can also be assessed simultaneously. Out of 10 cases of maxillofacial trauma operated in our hospital using submental intubation, the cuff of the pilot tube was brought out in 5 of them through the midline incision, while in remaining 5 it was left inside the nasopharynx. It was observed subsequently that cuff inside the nasopharynx had some advantage, viz. there were lesser chances of accidental extubation, rupture of cuff and the incision size need not be extended to extract the cuff which resulted into a cosmetically better scar.

  12. Observation on the efficacy of ultrasound-guided small needle-knife for treating rotator cuff calcification tendinitis%超声引导下小针刀治疗肩袖钙化性肌腱炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    王丽彬; 刘锐锋

    2016-01-01

    目的:观察超声引导下运用小针刀治疗肩袖钙化性肌腱炎(RCCT,Rotator Cuff Calcification Tendinitis)的临床疗效.方法:选取25例肩袖钙化性肌腱炎患者经超声引导运用小针刀对钙化病灶进行治疗,并于术后第1个月、第3个月、第6个月进行随访记录,通过视觉模拟评分法(VAS)评分、Neer肩关节功能评分,X线片变化情况评估治疗前、治疗后疼痛缓解程度、功能改善情况和影像学变化.结果:所有患者症状得以缓解,VAS评分、Neer肩关节功能评分均较治疗前显著改善(P<0.05).X线片变化情况显示,8例治疗后6个月钙化斑块完全消失,17例治疗后6个月仍有部分钙化斑块存在,但疼痛程度及功能障碍等临床症状均较治疗前改善.结论:超声检查既能对肩部肌腱及其周围软组织进行多方位成像,又能实时动态观察各肌肉、肌腱的运动情况,且对肌腱钙化灶组织分辨率高、声像特征明显,又无放射危害,在其引导下运用小针刀治疗肩袖钙化性肌腱炎能够改善症状、体征,缩短病程,提高治愈率,是一种准确安全、微创有效的疗法.

  13. Cuff inflation during ambulatory blood pressure monitoring and heart rate

    Directory of Open Access Journals (Sweden)

    Mia Skov-Madsen

    2008-11-01

    Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension

  14. 肩袖损伤和创伤性肩关节前方不稳定患者肩部疼痛与肩峰下滑囊组织中炎症反应的关系研究%Study on the relationship between shoulder pain and inflammatory reaction in the subacromial bursa tissues in patients with rotator cuff injury and traumatic shoulder joint anterior instability

    Institute of Scientific and Technical Information of China (English)

    王亮; 王予彬; 汤华林

    2015-01-01

    Objective:To explore the relationship between shoulder pain and inflammatory reaction in the subacromial bursa tissues in patients with rotator cuff injury or traumatic shoulder joint anterior instability.Methods:Twenty-five patients with rotator cuff injury(rotator cuff injury group)and 21 patients with traumatic shoulder joint anterior instability(shoulder joint instability group)were selected and treated with surgery.The degree of shoulder pain of all patients were evaluated by using the visual analogue score(VAS)before the surgery.The subacromial bursa tissues were fetched out during the surgery,and the level of tumor necrosis factor -α(TNF -α)and interleukin -1β(IL-1β)were measured by using enzyme linked immunosorbent assay.The VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues were compared between the 2 groups respectively,and correlation analysis were applied to study the relationship between the VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues in the 46 patients.Results:The VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues of rotator cuff injury group were higher than those of shoulder joint instability group(7.07 +/-1.06 vs 5.03 +/-0.74 points,t =7.648,P =0.003;189.61 +/-40.46 vs 115.91 +/-17.32 pg/100mg,t =8.252,P =0.000;4.40 +/-0.88 vs 2.67 +/-0.62 pg/100mg,t =7.561,P =0.000).The results of correlation analysis showed that the VAS scores of shoulder pain were positively correlated with the level of TNF -αand IL -1βin subacromial bursa tissues(r =0.952,P =0.000;r =0.945,P =0.000).Conclusion:The inflammatory reaction in the subacromial bursa tissues is the impor-tant cause of shoulder pain in patients with rotator cuff injury and patients with traumatic shoulder joint anterior instability.The inflammatory reaction of subacromial bursa tissues is more significant in patients with rotator cuff injury compared to patients with

  15. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases

    DEFF Research Database (Denmark)

    Suder, P.A.; Hougaard, K.; Frich, Lars Henrik

    1994-01-01

    , but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction...

  16. Calcific Tendonitis of the Rotator Cuff: An Unusual Case

    OpenAIRE

    2012-01-01

    Few case reports have described the surgical treatment of calcifying tendonitis of the subscapularis tendon. We present a case of symptomatic diffuse calcifying tendonitis involving the subscapularis and infraspinatus insertions that was difficult to detect arthroscopically. The patient was treated with arthroscopic incision of the tendinous insertions thorough removal of the calcific deposits and subsequent repair using a suture-anchor technique. Two years after the surgical procedure, the p...

  17. Arthroscopic treatment of calcifying tendinitis of the rotator cuff

    OpenAIRE

    2010-01-01

    OBJETIVO: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico por via artroscópica em pacientes com tendinite calcária do manguito rotador. MÉTODO: Foi realizado um estudo retrospectivo com análise de 20 pacientes que foram submetidos ao tratamento artroscópico da tendinite calcária do ombro, de março de 1999 a novembro de 2005. Seis pacientes foram excluídos devido à perda do seguimento. Com seguimento médio de 41,4 meses, oito pacientes (57%) eram do sexo feminino e seis ...

  18. Partial rotator cuff injury in athletes: bursal or articular?

    Science.gov (United States)

    Carvalho, Cassiano Diniz; Cohen, Carina; Belangero, Paulo Santoro; Figueiredo, Eduardo Antônio; Monteiro, Gustavo Cará; de Castro Pochini, Alberto; Andreoli, Carlos Vicente; Ejnisman, Benno

    2015-01-01

    O ombro doloroso é uma queixa muito comum entre os atletas, especialmente no caso dos arremessadores. As lesões parciais do manguito rotador podem ser muito dolorosas e causar limitação funcional importante na pratica esportiva do atleta. A incidência das lesões parciais do manguito é variável (13% a 37%). O diagnóstico clínico e radiológico é difícil e deve ser considerado em todo atleta que apresente sintomatologia da síndrome do manguito rotador, inclusive nos pacientes diagnosticados apenas com tendinopatia.

  19. Opioid rotation in the management of chronic pain: where is the evidence?

    NARCIS (Netherlands)

    Vissers, K.C.P.; Besse, K.; Hans, G.; Devulder, J.; Morlion, B.

    2010-01-01

    The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World H

  20. Opioid Rotation in the Management of Chronic Pain : Where Is the Evidence?

    NARCIS (Netherlands)

    Vissers, K. C. P.; Besse, K.; Hans, G.; Devulder, J.; Morlion, B.

    2010-01-01

    The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World H

  1. Analgesia para a sutura artroscópica do manguito rotador: estudo comparativo entre o bloqueio interescalênico do plexo braquial e o bloqueio da bursa subacromial contínuo Management of pain after the rotator cuff arthroscopic suture: comparative study among the interescalenic blockade and the continuous intrabursal infusion

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2007-10-01

    Full Text Available OBJETIVO: Comparar o nível de dor pós-operatória de pacientes submetidos à sutura artroscópica da lesão do manguito rotador (MR que receberam protocolos diferentes de analgesia pós-operatória. Demonstrar a relação entre dor e o sexo do paciente, a dimensão da lesão suturada e a utilização da capsulotomia interna. Verificar a prevalência dos efeitos colaterais. MÉTODO: Foram analisados três grupos de pacientes operados entre 1º de junho de 2004 e 31 de maio de 2007. O grupo I foi composto pelos pacientes que receberam bloqueio interescalênico com ropivacaína a 0,75%. No grupo II, o mesmo bloqueio foi acrescido de 150µg de clonidina. No grupo III foi administrado um bolus de 30ml de ropivacaína a 0,75% para infiltração dos portais artroscópicos e diretamente no espaço subacromial, seguido de infusão contínua de ropivacaína a 0,2% em bomba de infusão. Os pacientes foram submetidos à medição da escala analógica visual (EAV com 24 horas após o procedimento. As variáveis estudadas foram: EAV, sexo, tamanho da lesão, necessidade de capsulotomia interna e prevalência dos efeitos colaterais. O estudo avaliou 196 pacientes, dos quais foram excluídos 51, totalizando n = 145 pacientes. O total de pacientes no grupo I foi de 65; no grupo II, de 19; e no grupo III, de 61. RESULTADOS: O índice da EAV médio encontrado no grupo I foi de 3,88 ± 1,737 (3; no grupo II, de 3,8 ± 1,6 (3; e no grupo III, de 1,95 ± 1,6 (2. Houve diferença significativa ao comparar os grupos I e III (p OBJECTIVE: To compare the level of postoperative pain in patients submitted to arthroscopic suture of a rotator cuff lesion who had different analgesia protocols. To demonstrate the relationship between pain and the gender of the patient, the dimension of the lesion sutured, and the use of internal capsulotomy. To check the prevalence of side effects. METHODS: Three groups of patients operated on between June 01, 2004 and May 31, 2007 were

  2. The Effect of Endotraceheal Inflations Technique on Endotraceheal Cuff Pressure

    Science.gov (United States)

    2013-01-31

    pressures exerted by an endotracheal tube cuff pressure on the tracheal mucosa ( Guyton , Barlow, & Bresselievre, 1997). A 1984 study conducted by...20% of patients ( Guyton et äl, 1997). In an effort to reduce cuff induced tracheal ischemia, an improved cuff design was introduced in the late...pressure. Journal of the American Association of Nurse Anesthetists, 62(1), 77-81. Guyton , D., Barlow, M., Besselievre, T. (1997). Influence of

  3. Resistance Training With Ankle Weight Cuffs Is Feasible in Patients With Acute Exacerbation of COPD

    DEFF Research Database (Denmark)

    Kofod, Linette Marie; Døssing, Martin; Steentoft, Johnna;

    2017-01-01

    PURPOSE: Quadriceps muscle weakness is a serious complication of physical inactivity following hospitalization due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Preventing strength loss during AECOPD is therefore a high priority. We aimed to evaluate the feasibility...... of progressive knee-extension resistance training, using ankle weight cuffs on patients with AECOPD, based on prespecified criteria for feasibility. METHODS: Thirty-four patients (18 men, mean age 74 years, forced expiratory volume in 1 second = 33% predicted) with AECOPD participated in daily knee......-extension strength training. During training, the patients were seated on the bedside and performed 3 sets of 10-repetition maximum loads, using ankle weight cuffs. The primary outcome was the change in load from the first to last training sessions. The secondary outcomes were changes in maximal isometric knee...

  4. An in vitro comparison of tracheostomy tube cuffs

    Directory of Open Access Journals (Sweden)

    Maguire S

    2015-04-01

    Full Text Available Seamus Maguire,1 Frances Haury,2 Korinne Jew2 1Research and Development, Covidien Respiratory and Monitoring Solutions, Athlone, Ireland; 2Medical Affairs, Covidien Respiratory and Monitoring Solutions, Boulder, CO, USA Introduction: The Shiley™ Flexible adult tracheostomy tube with TaperGuard™ cuff has been designed through its geometry, materials, diameter, and wall thickness to minimize micro-aspiration of fluids past the cuff and to provide an effective air seal in the trachea while also minimizing the risk of excessive contact pressure on the tracheal mucosa. The cuff also has a deflated profile that may allow for easier insertion through the stoma site. This unique design is known as the TaperGuard™ cuff. The purpose of the observational, in vitro study reported here was to compare the TaperGuard™ taper-shaped cuff to a conventional high-volume low-pressure cylindrical-shaped cuff (Shiley™ Disposable Inner Cannula Tracheostomy Tube [DCT] with respect to applied tracheal wall pressure, air and fluid sealing efficacy, and insertion force.Methods: Three sizes of tracheostomy tubes with the two cuff types were placed in appropriately sized tracheal models and lateral wall pressure was measured via pressure-sensing elements on the inner surface. Fluid sealing performance was assessed by inflating the cuffs within the tracheal models (25 cmH2O, instilling water above the cuff, and measuring fluid leakage past the cuff. To measure air leak, tubes were attached to a test lung and ventilator, and leak was calculated by subtracting the average exhaled tidal volume from the average delivered tidal volume. A tensile test machine was used to measure insertion force for each tube with the cuff deflated to simulate clinical insertion through a stoma site.Results: The average pressure exerted on the lateral wall of the model trachea was lower for the taper-shaped cuff than for the cylindrical cuff under all test conditions (P<0.05. The taper

  5. Tenotomia com ou sem tenodese da cabeça longa do bíceps no reparo artroscópico do manguito rotador Tenotomy with or without tenodesis of the long head of the biceps for arthroscopic repair of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Roberto Yukio Ikemoto

    2012-01-01

    Full Text Available OBJETIVO: Comparação dos resultados funcionais nos pacientes submetidos à tenotomia com ou sem tenodese da CLB associada ao reparo da lesão do manguito rotador por visão artroscópica, com seguimento superior a dois anos. MÉTODO: Estudo retrospectivo não randomizado, com nível de evidência III, em que foram revisados os prontuários e realizada reavaliação clínica de 77 pacientes com lesão da cabeça longa do bíceps, sendo que 55 foram submetidos à tenotomia sem tenodese e 22 à tenotomia com a tenodese, com seguimento ambulatorial maior que dois anos. Foram avaliados idade, dominância, lado operado, tamanho das lesões classificadas por Gartsman, arco do movimento pré e pós-operatório, presença ou ausência do sinal do Popeye, dor na corredeira bicipital, avaliação segundo a escala University of California at Los Angeles e Elbow Strength Index. RESULTADOS: O UCLA médio total da amostra foi de 16,92 (8 a 25 para 31,45 (13 a 35 (p OBJECTIVE: To compare the functional results among patients un dergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff in juries, 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 tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of mo tion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA score and the elbow strength index. RESULTS: The mean UCLA score of the sample went from 16.92 (range: 8 to 25 to 31.45 (range: 13 to 35 (p < 0

  6. Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: results in a prospective series with limited fatty muscular degeneration.

    Science.gov (United States)

    Goutallier, D; Postel, J M; Van Driessche, S; Godefroy, D; Radier, C

    2006-01-01

    Recurrent tears after rotator cuff repairs are frequent. These could be influenced by excessive tension on a degenerated tendinous stump and by fatty degeneration of the cuff muscles. The goal of this study was to evaluate the anatomic and functional results of tension-free cuff repairs with the excision of macroscopic tendon lesions in a series with limited muscular fatty degeneration of the infraspinatus and a global fatty degeneration index of rotator cuff muscles equal to or lower than 2. We studied 27 tears, comprising 13 cases involving both supraspinatus and infraspinatus tears, 13 cases with 3-tendon tears, and 1 case with only a supraspinatus tear. All shoulders were operated on through a transacromial approach easily repaired with 2 titanium screws with washers. To obtain a repair without tension, a single advancement was performed in 20 cases and a double advancement of both the supraspinatus and infraspinatus was done in 7 cases. The shoulders were evaluated clinically preoperatively and postoperatively with the non-weighted Constant score and anatomically with computed arthrotomography scans. The mean age at operation was 59.5 years, and the length of follow-up ranged from 1 to 4 years. Of the cuffs, 23 (85%) were watertight 1 year after surgery. No predictive factor of retear could be found. The functional improvement was statistically significant only for watertight cuffs, with an improvement of the Constant score from 57.8 to 75. The only predictive factor of functional outcome in this watertight group was the preoperative Constant score. Single and double advancements yielded similar functional results regardless of the extent of the initial tear, provided that the cuff was watertight at revision.

  7. Excessive pressure in multichambered cuffs used for sequential compression therapy

    NARCIS (Netherlands)

    Segers, P; Belgrado, JP; Leduc, A; Leduc, O; Verdonck, P

    2002-01-01

    Background and Purpose. Pneumatic compression devices, used as part of the therapeutic strategy for lymphatic drainage, often have cuffs with multiple chambers that are, inflated sequentially. The purpose of this study was to investigate (1) the relationship between cuff chamber pressure (P(chamber)

  8. Occlusion cuff for routine measurement of digital blood pressure and blood flow

    DEFF Research Database (Denmark)

    Lassen, N A; Krähenbühl, B; Hirai, M

    1977-01-01

    A miniaturized blood pressure cuff made of plastic material and applicable to fingers and toes is described. The cuff was compared to rubber cuffs and to bladder-free cuffs. It was found to be more reliable than the former type and much easier to use than the latter type. It is recommended for us...

  9. Effect of cuff ischemia training on myocardial ischemia and left ventricular function in patients with single coronary artery chronic total occlusion%袖带法缺血训练对单支冠状动脉慢性完全闭塞病变患者心肌缺血及左心室功能的影响

    Institute of Scientific and Technical Information of China (English)

    独磊; 项洁

    2016-01-01

    Objective To determine the effects of cuff ischemia training on myocardial ischemia and cardiac function in patients with chronic total occlusion of single-vessel coronary artery disease .Methods 52 patients with chronic total occlu-sion of single-vessel coronary artery disease were randomly divided into training group and control group ,each of 26 cases.All patients were treated with conventional medical treatment ,the patients in training group performed six-months training .Vascular endothealial growth factor(VEGF) were determined by enzyme linked immunosorbent assay (ELISA).Single-photon emission computed tomography ( SPECT) was used to evaluate myocardial perfusion ,ultrasonic cardiogram was used to evaluate left ven-tricular function .Results After six months of training ,the VEGF concentration of training group was significantly higher than that before training and control group ,the differences were statistically significant ( P0.05).The VEGF concentration and total resting SPECT score(SRS) had a high negative correlation .After six months of training,the SPECT SRS of training group was lower than the previous training and control group ,LVEF,6min walk test were higher than before training and control group ,the differences were statistically significant(P0.05).The heart rate and blood pressure before and after training in control group had no significant changes ,the difference was not statistically significant (P>0.05).Con-clusion Cuff ischemia training may promote myocardial perfusion and left ventricular function in patients with chronic total occlusion of single-vessel coronary artery disease .%目的:观察袖带法缺血训练对单支冠状动脉慢性完全闭塞病变患者心肌缺血及左心室功能的影响。方法将52例单支冠状动脉慢性完全闭塞病变患者随机分为训练组和对照组各26例,2组均给予药物治疗,在此基础上对训练组患者训练6个月。于训练前后抽取患者外周血,ELISA法检

  10. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain.

    Science.gov (United States)

    Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

    2014-05-01

    [Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.

  11. The Advantage of Cyclosporine A and Methotrexate Rotational Therapy in Long-Term Systemic Treatment for Chronic Plaque Psoriasis in a Real World Practice

    Science.gov (United States)

    Choi, Chong Won; Kim, Bo Ri; Ohn, Jungyoon

    2017-01-01

    Background Psoriasis is a chronic inflammatory disease. In the treatment of psoriasis, cyclosporine is commonly prescribed systemic agents. However, long-term use of cyclosporine is not recommended because of side effects such as nephrotoxicity or hypertension. Objective To ascertain the improved safety of rotational therapy using cyclosporine and methotrexate, we investigated the frequency of abnormal results in laboratory test after long term rotational therapy using cyclosporine and methotrexate. Methods From January 2009 to June 2014, patients who were treated with cyclosporine or methotrexate were enrolled. The clinical data and usage of medications were reviewed. Laboratory tests were conducted before starting the treatment and regularly follow-up. The occurrences of any laboratory abnormalities during the treatments were investigated. Results A total of 21 psoriatic patients were enrolled. The mean of medication period and cumulative dose of cyclosporine and methotrexate were 497.81±512.06 days and 115.68±184.34 g in cyclosporine and 264.19±264.71 days and 448.71±448.63 mg in methotrexate. Laboratory abnormalities were found in total two patients after rotational therapy: two patients (9.5%) in aspartate aminotransferase/alanine aminotransferase and one patient (4.8%) in uric acid. No laboratory abnormalities were found in renal function test. Conclusion We found that the rotational approaches using cyclosporine and methotrexate reduced the possibility of the development of nephrotoxicity. In addition to other advantage such as quick switching from one agent to another, the rotational therapy using cyclosporine and methotrexate can minimize the adverse events during the systemic treatment of chronic plaque psoriasis. PMID:28223747

  12. The effects of rotation and positional change of stump tissues upon morphogenesis of the regenerating axolotl limb

    NARCIS (Netherlands)

    Carlson, Bruce M.

    1972-01-01

    Rotation of a skin cuff 180° around the proximodistal axis of the upper arm in the axolotl results in the formation of multiple regenerates in about 80° of cases after amputation of the limb through the rotated skin. Rotation of the dermis or the flexor and extensor muscles folowed by amputation pro

  13. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

    Science.gov (United States)

    Mahmoodpoor, Ata; Peyrovi-far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad Eslam Jamal

    2013-08-07

    Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

  14. Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Waleed A Almarakbi

    2014-01-01

    Full Text Available Background: The main function of an endotracheal tube (ETT cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L with those by just to seal technique (JS and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients′ tracheas were intubated. In the first group (n = 50, ETT cuff inflation was guided by PV-L, while in the second group (n. = 50 the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5 vs 5 (4.8-5.5, P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19 vs 33 (32-35, P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009, except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065. Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001. Conclusions : The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications.

  15. Effect of exercise therapy on displacement of the center of rotation of lumbar vertebrae in patients with non-specific chronic low back pain

    Directory of Open Access Journals (Sweden)

    Y. Javadian

    2015-06-01

    Full Text Available Background: The center of rotation (COR of the lumbar vertebrae is one of the important characteristics in evaluation of lumbar spine kinematics. Objective: The aim of this study was to investigate the effect of exercise therapy on displacement of the COR of lumbar vertebrae in patients with non-specific chronic low back pain. Methods: This interventional study was conducted in 30 patients with non-specific chronic low back pain referred to Shahid Beheshti hospital in Babol, 2012. The patients were randomly assigned to two equal groups. For 8 weeks, the patients in the intervention group performed routine plus stabilization exercises while the patients in the control group performed only routine exercises. Radiographic examination was performed in flexion, extension, and neutral views before and after the treatment and the followings were compared: the COR of each lumbar vertebra in global state (rotation of each vertebra relative to the sacrum and relative state (rotation of each vertebra relative to the lower vertebra and in full flexion-extension, flexion, and extension arcs. Data were analyzed using paired T-test and independent sample T-test. Findings: After treatment, the mean difference of the COR of the lumbar vertebrae was only significantly different between the two groups for relative measurement in L3 on y-axis in full flexion-extension arc. In flexion arc, the mean difference of the displacement of the COR was significantly different between the two groups for global measurement in L3 and L5 on y-axis and for relative measurement in L5 on y-axis. In extension arc, the mean difference of the COR of the lumbar vertebrae was not significantly different between the two groups for both global and relative measurements. Conclusion: With regards to the results, it is suggested to consider the displacement of the COR as an objective index in order to evaluate the effect of stabilization exercises.

  16. Effects of Wing-Cuff on NACA 23015 Aerodynamic Performances

    Directory of Open Access Journals (Sweden)

    Meftah S.M.A

    2014-03-01

    Full Text Available The main subject of this work is the numerical study control of flow separation on a NACA 23015 airfoil by using wing cuff. This last is a leading edge modification done to the wing. The modification consists of a slight extension of the chord on the outboard section of the wings. Different numerical cases are considered for the baseline and modified airfoil NACA 23015 according at different angle of incidence. The turbulence is modeled by two equations k-epsilon model. The results of this numerical investigation showed several benefits of the wing cuff compared with a conventional airfoil and an agreement is observed between the experimental data and the present study. The most intriguing result of this research is the capability for wing cuff to perform short take-offs and landings.

  17. Does closure of chronic pilonidal sinus still remain a matter of debate after bilateral rotation flap? (N-shaped closure technique

    Directory of Open Access Journals (Sweden)

    Awad Mohamed

    2006-01-01

    Full Text Available Background: Controversy still exists about the exact cause of pilonidal sinus either acquired or congenital, and also about what is the best surgical technique for the treatment of the disease. We successfully treated chronic pilonidal sinus with a new flap technique {N-shaped bilateral rotation flap} for closure of the defect. Materials and Methods: Thirty-two patients (30 men and two women were treated by eccentric elliptical excision of the diseased tissues down to the postsacral fascia and closure of the defect with our flap [which is a random pattern flap], then a closed suction drain was placed at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm lateral to the lower end of the suture line. Results: All our patients healed completely without recurrence during a period of average follow-up of two years. Mean hospital stay was 1.5 days (range 1-5 days. Mean time to complete healing was 11.9 days (range 6-18 days. Mean time off work was 13.7 days (range 10-21 days. Two patients had wound infection and one patient a partial breakdown. The recurrence rate was 0%. Conclusions: A tension-free suture via bilateral rotation flaps with a good suction at the button of the wound for drainage of blood from the bottom of the wound is the key to the success of repair without recurrence.

  18. Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

    Science.gov (United States)

    ARRIGONI, PAOLO; ROSE, GIACOMO DELLE; D’AMBROSI, RICCARDO; ROTUNDO, GIORGIO; CAMPAGNA, VINCENZO; PIRANI, PIERGIORGIO; PANASCÌ, MANLIO; PETRICCIOLI, DARIO; BERTONE, CELESTE; GRASSO, ANDREA; LATTE, CARMINE; COSTA, ALBERTO; VIOLA, GINO; DE GIORGI, SILVANA; PANELLA, ANTONELLO; PADUA, ROBERTO; BECCARINI, ALESSANDRO; SALCHER, BARBARA; OLIVIERI, MATTEO; MUGNAINI, MARCO; PANNONE, ANTONELLO; CEOLDO, CHIARA; LONGO, UMILE GIUSEPPE; DENARO, VINCENZO; CERCIELLO, SIMONE; PANNI, ALFREDO SCHIAVONE; AVANZI, PAOLO; ZORZI, CLAUDIO; RAGONE, VINCENZA; CASTAGNA, ALESSANDRO; RANDELLI, PIETRO

    2015-01-01

    Purpose the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. Conclusions painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. Level of evidence: level I, validating cohort study with good reference standards. PMID:26151035

  19. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

    Directory of Open Access Journals (Sweden)

    Ata Mahmoodpoor

    2013-07-01

    Full Text Available Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV ETT, Polyurethane (PU cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34% in group PVC, 8 (25% in Sealguard and 7 (21% in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

  20. Endotracheal tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system.

    Science.gov (United States)

    Sperry, R J; Johnson, J O; Apfelbaum, R I

    1993-06-01

    To determine whether endotracheal tube cuff pressure increases significantly with surgical retraction and cervical spine distraction during anterior cervical spine surgery with Caspar instrumentation, we prospectively studied 10 patients undergoing this procedure. The tracheas of all patients were intubated with a Mallinckrodt Hi-Lo endotracheal tube. Tracheal tube cuff pressures measured with a transducer system were 42.4 mm Hg +/- 7.0 mm Hg (SEM) after intubation and cuff inflation. Air was removed from the endotracheal tube cuff until the trachea was just barely sealed at a cuff pressure of 15.2 mm Hg +/- 1.6 mm Hg. The endotracheal tube cuff pressure was readjusted to "just-seal" pressure before the surgeons introduced the Caspar instrumentation. The cuff pressure with traction and distraction was 43.2 mm Hg +/- 5.0 mm Hg. This pressure was significantly increased from the "just-seal" pressure, and from the cuff pressure after instrumentation was discontinued (9.8 mm Hg +/- 2.3 mm Hg). We conclude that anterior cervical spine surgery with Caspar instrumentation is associated with a significant increase in endotracheal tube cuff pressure.

  1. Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?

    Science.gov (United States)

    Watson, Sheri; Aguas, Marita; Bienapfl, Tracy; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Yosses, Mary Beth; Yu, Larissa; Anastas, Zoe

    2011-06-01

    The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values.

  2. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    Directory of Open Access Journals (Sweden)

    Møller Ann M

    2010-12-01

    Full Text Available Abstract Background To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. Method In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. Results In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100 cm H2O and the pressure exceeded 30 cm H2O (upper recommended level for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121 cm H2O and above 60 cm H2O (upper recommended level for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O. There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. Conclusion For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.

  3. 76 FR 10578 - Cuffs Run Pumped Storage, LLC; Notice of Preliminary Permit Application Accepted for Filing and...

    Science.gov (United States)

    2011-02-25

    ... Energy Regulatory Commission Cuffs Run Pumped Storage, LLC; Notice of Preliminary Permit Application... 18, 2010, Cuffs Run Pumped Storage, LLC filed an application for a preliminary permit, pursuant to section 4(f) of the Federal Power Act, proposing to study the feasibility of the Cuffs Run Pumped...

  4. Cuff overinflation and endotracheal tube obstruction: case report and experimental study

    Directory of Open Access Journals (Sweden)

    Mack Martin G

    2010-04-01

    Full Text Available Abstract Background Initiated by a clinical case of critical endotracheal tube (ETT obstruction, we aimed to determine factors that potentially contribute to the development of endotracheal tube obstruction by its inflated cuff. Prehospital climate and storage conditions were simulated. Methods Five different disposable ETTs (6.0, 7.0, and 8.0 mm inner diameter were exposed to ambient outside temperature for 13 months. In addition, every second of these tubes was mechanically stressed by clamping its cuffed end between the covers of a metal emergency case for 10 min. Then, all tubes were heated up to normal body temperature, placed within the cock of a syringe, followed by stepwise inflation of their cuffs to pressures of 3 kPa and ≥12 kPa, respectively. The inner lumen of the ETT was checked with the naked eye for any obstruction caused by the external cuff pressure. Results Neither in tubes that were exposed to ambient temperature (range: -12°C to +44°C nor in those that were also clamped, visible obstruction by inflated cuffs was detected at any of the two cuff pressure levels. Conclusions We could not demonstrate a critical obstruction of an ETT by its inflated cuff, neither when the cuff was over-inflated to a pressure of 12 kPa or higher, nor in ETTs that had been exposed to unfavorable storage conditions and significant mechanical stress.

  5. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    DEFF Research Database (Denmark)

    Rokamp, K.Z.; Secher, N.H.; Møller, Ann

    2010-01-01

    ABSTRACT: BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without...... and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. CONCLUSION: For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked...

  6. Controle da pressão do cuff na unidade terapia intensiva: efeitos do treinamento Cuff pressure control in intensive care unit: training effects

    Directory of Open Access Journals (Sweden)

    Renata de Martin Penitenti

    2010-06-01

    Full Text Available OBJETIVOS: A pressão do cuff é transmitida de forma direta na parede da traquéia e isto pode ocasionar lesões. O objetivo deste trabalho foi verificar a eficácia de um treinamento com a equipe de enfermagem no controle da pressão do cuff. MÉTODOS: Foi realizado um levantamento retrospectivo das mensurações da pressão de cuff de janeiro de 2007 a junho de 2008, verificando-se o percentual de inadequação. Posteriormente, foi elaborado um programa de treinamento da equipe de enfermagem durante o mês de Junho 2008 em todos os três turnos de trabalho. Após o encerramento dessa fase de treinamento, o percentual de adequação na pressão de cuff foi verificado prospectivamente durante os meses de Julho a Dezembro. Foi comparado o percentual de inadequação da pressão do cuff entre os turnos de trabalho (matutino, vespertino e noturno e entre os períodos pré-treinamento e pós-treinamento pelo teste qualitativo de qui-quadrado, considerando-se como significativa diferença acima de 5% (pOBJECTIVES: Direct cuff pressure to the tracheal wall can cause damage. This paper aimed to verify the effectiveness of nursing team training on cuff pressure control. METHODS: A retrospective survey was initially made on the records of cuff pressure measurements from January 2007 to June 2008 and the inadequacy percent was verified. Next, a nursing team training program was provided involving all nursing shift teams during June 2008, and after the training the appropriate cuff pressures proportion was prospectively recorded between June and December 2008. The proportion of inappropriate cuff pressure was compared between the work shifts (morning, afternoon and evening-night and between pre- and post-training, using the qualitative Chi-square test. The 5% limit (p<0.05 was considered for significant differences. RESULTS: For the pre-training period, inappropriate cuff pressure measures (over 30cmH2O during morning, afternoon and evening-night shifts

  7. Work above shoulder level and degenerative alterations of the rotator cuff tendons

    DEFF Research Database (Denmark)

    Svendsen, Susanne Wulff; Gelineck, John; Mathiassen, S.E.;

    2004-01-01

    mechanics, and house painters. The participants were right-handed, ages 40–50 years, and had been employed in their trades for not less than 10 years. Seventy-one percent of invited subjects participated (136 of 192). Lifetime upper arm elevation was assessed by direct measurements combined with individual...... and humeral head cysts. The MRI findings were evaluated by radiologists who were blinded to exposure status and symptoms. Results An exposure–response relationship was found between lifetime upper arm elevation and supraspinatus tendinopathy, with an age-adjusted odds ratio of 1.27 (95% confidence interval 1...

  8. Influence of corticoids on healing of the rotator cuff of rats – biomechanical study

    Directory of Open Access Journals (Sweden)

    Leonardo Dau

    2014-08-01

    Full Text Available Objective:To compare healing strength of the infraspinatus tendon of rats with corticoid inoculation, regarding maximum tension, maximum force and rupture force, after injury and experimental repair.Methods:A total of 60 Wistar rats were subjected to tenotomy of the infraspinatus tendon, which was then sutured. Before the surgery, they were divided into a control group (C inoculated with serum and a study group (S inoculated with corticoids over the tendon. After repair, the rats were sacrificed in groups of 10 individuals in the control group and 10 in the study group at the times of one week (C1 and S1, three weeks (C3 and S3 and five weeks (C5 and S5. The rats were dissected, separating out the infraspinatus tendon with the humerus. The study specimens were subjected to a traction test, with evaluation of the maximum tension (kgf/cm2, maximum force (kgf and rupture force (kgf, comparing the study group with the respective control groups.Results:Among the rats sacrificed one week after the procedure, we observed greater maximum tension in group C1 than in group S1. The variables of maximum force (kgf and rupture force did not differ statistically between the groups investigated. In the same way, among the rats sacrificed three weeks after the procedure, group C3 only showed greater maximum tension than group S3 (p = 0.007, and the other variables did not present differences. Among the rats sacrificed five weeks after the procedure (C5 and S5, none of the parameters studied presented statistical differences.Conclusion:We concluded that corticoid diminished the resistance to maximum tension in the groups sacrificed one and three weeks after the procedure, in comparison with the respective control groups. The other parameters did not show differences between the study and control groups.

  9. Hombro doloroso y lesiones del manguito rotador Painful shoulder and rotator cuff disorders

    OpenAIRE

    Karla Mora-Vargas

    2008-01-01

    Se presenta el caso de una mujer de 52 años conocida sana, sin antecedentes positivos, quien inicia con dolor y disfunción del miembro superior izquierdo, la cual fue tratada con antiinflamatorios no esteroideos inicialmente, sin embargo, al persistir los síntomas y apoyado con estudios radiológicos recibe tratamiento inyectado a nivel del hombro. Cuadro que evoluciona posteriormente a ruptura del manguito rotador, con su subsiguiente reparación quirúrgica y fisioterapia, logrando la recupera...

  10. [Current and known aspects of the arterial supply of the rotator cuff].

    Science.gov (United States)

    Hermann, B; Steiner, D

    1989-01-01

    The basic arterial supply of the shoulder is well known, some details for example the supply of the m. supraspinatus are not studied yet. Preparation of shoulder-specimens after injection of silicone-caoutchouc are done to examine the vascular system. The arterial supply of the shoulder is described as a system of four rings. The results are discussed in combination with the literature.

  11. Loss of rotator cuff tendon-to-bone interface pressure after reattachment using a suture anchor.

    Science.gov (United States)

    Brassart, Nicolas; Sanghavi, Sanjay; Hansen, Ulrich N; Emery, Roger J; Amis, Andrew A

    2008-01-01

    The purpose of this study was to examine the tendon-to-bone interface pressure, contact area, and force after reattaching a tendon to bone by use of a suture and suture anchor. Repairs were made in 8 ovine shoulders in vitro, by use of 3 suture types in each: Ethibond, polydioxanone, or Orthocord. A Tekscan pressure sensor was placed between the tendon and bone and monitored for 1 hour after the repair. The principal finding was a significant loss of approximately 60% of the contact parameters immediately after the suture was tied, followed by further significant loss over the next hour to a mean of only 14% of the initial readings. We concluded that pressure measurement systems that only record the initial maximum pressure would yield overly optimistic results for the actual repair pressure after the repair is completed. The Tekscan system, however, allowed us to monitor pressure reductions that occurred both during and after the repair.

  12. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair

    Science.gov (United States)

    Bedi, Asheesh; Fox, Alice J.S.; Harris, Paul E.; Deng, Xiang-Hua; Ying, Liang; Warren, Russell F.; Rodeo, Scott A.

    2017-01-01

    Introduction Studies have demonstrated a significant decrease in skeletal mass, bone mineral density, and impaired fracture healing in the diabetic population. However, the effect of sustained hyperglycemia on tendon-to-bone healing is unknown. Materials and methods Forty-eight male, Lewis rats underwent unilateral detachment of the supraspinatus tendon followed by immediate anatomic repair with transosseous fixation. In the experimental group (n = 24), diabetes was induced preoperatively via intraperitoneal injection of streptozotocin (STZ, 65 mg/kg) and confirmed with both pre- and post-STZ injection intraperitoneal glucose tolerance tests (IPGTT). Animals were sacrificed at 1 and 2 weeks post-operatively for biomechanical, histomorphometric, and immunohistochemical analysis. Serum hemoglobin A1c (HbA1c) levels were measured at 2 weeks postoperatively. Statistical comparisons were performed using Student t tests with significance set at P diabetic compared to control animals (P diabetic and control groups, respectively (P Diabetic animals demonstrated significantly less fibrocartilage and organized collagen, and increased AGE deposition at the tendon-bone interface (P diabetic animals demonstrated a significantly reduced ultimate load-to-failure (4.79 ± 1.33N vs 1.60 ± 1.67N and 13.63 ± 2.33N vs 6.0 ± 3.24N for control versus diabetic animals at 1 and 2 weeks, respectively) and stiffness compared to control animals (P diabetic patients with poor glycemic control. Level of Evidence Basic Science Study. PMID:20303293

  13. The Biomechanical Role of Scaffolds in Augmented Rotator Cuff Tendon Repairs

    Science.gov (United States)

    2012-01-01

    continue to evolve, the surgical management of these tears still poses a significant challenge to the orthopedic community, as evidenced by the 20% to...2005;21:1090-8. doi:10.1016/j.arthro. 2005.05.010 18. Klintberg IH, Gunnarsson AC, Svantesson U, Styf J, Karlsson J. Early loading in physiotherapy

  14. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis.

    Science.gov (United States)

    Hockey, C A; van Zundert, A A J; Paratz, J D

    2016-09-01

    Correct inflation pressures of the tracheal cuff are recommended to ensure adequate ventilation and prevent aspiration and adverse events. However there are conflicting views on which measurement to employ. The aim of this review was to examine whether adjustment of cuff pressure guided by objective measurement, compared with subjective measurement or observation of the pressure value alone, was able to prevent patient-related adverse effects and maintain accurate cuff pressures. A search of PubMed, Web of Science, Embase, CINAHL and ScienceDirect was conducted using keywords 'cuff pressure' and 'measure*' and related synonyms. Included studies were randomised or pseudo-randomised controlled trials investigating mechanically ventilated patients both in the intensive care unit and during surgery. Outcomes included adverse effects and the comparison of pressure measurements. Pooled analyses were performed to calculate risk ratios, effect sizes and 95% confidence intervals. Meta-analysis found preliminary evidence that adjustment of cuff pressure guided by objective measurement as compared with subjective measurement or observation of the pressure value alone, has benefit in preventing adverse effects. These included cough at two hours (odds ratio [OR] 0.42, confidence interval [CI] 0.23 to 0.79, P=0.007), hoarseness at 24 hours (OR 0.49, CI 0.31 to 0.76, P measurement to guide adjustment or observation of the pressure value alone may lead to patient-related adverse effects and inaccuracies. It is recommended that an objective form of measurement be used.

  15. A novel paper cuff for vascular reconstruction in canine liver transplantation.

    Science.gov (United States)

    Fukumoto, T; Ku, Y; Tominaga, M; Maeda, I; Kuroda, Y; Saitoh, Y

    1996-01-01

    A new, simple method of producing optimal cuffs using thin paper and then setting it in resin for vascular reconstruction in canine liver transplantation is herein described. Thin Paper was cut into a paper tape strip. By fixing both ends of this paper tape, a cylinder paper core of any desired size could thus be obtained. The paper core was immersed into a two-liquid mixture-type resin, removed, and left to harden. The paper cuffs (0.2 mm or less in thickness) were then used for anastomoses of the portal vein and the infrahepatic inferior vena cava in a series of 10 consecutive canine liver transplantations. Out of 10 animals, 8 survived for more than 5 days. The vascular patency in these 8 animals at the cuff anastomotic sites was 100% at postmortem. We therefore conclude that this paper cuff appears to be useful for various types of experimental liver transplantations in large animals.

  16. Molecular signatures of age-associated chronic degeneration of shoulder muscles.

    Science.gov (United States)

    Raz, Yotam; Henseler, Jan Ferdinand; Kolk, Arjen; Tatum, Zuotian; Groosjohan, Niels Kuipers; Verwey, Nisha E; Arindrarto, Wibowo; Kielbasa, Szymon M; Nagels, Jochem; 't Hoen, Peter A C; Nelissen, Rob G H H; Raz, Vered

    2016-02-23

    Chronic muscle diseases are highly prevalent in the elderly causing severe mobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorly understood due to multifactorial causes, slow progression with age and variations between individuals. Understanding the underlying molecular mechanisms could lead to new treatment options which are currently limited. Shoulder complaints are highly common in the elderly, and therefore, muscles of the shoulder's rotator cuff could be considered as a model for chronic age-associated muscle degeneration. Diseased shoulder muscles were characterized by muscle atrophy and fatty infiltration compared with unaffected shoulder muscles. We confirmed fatty infiltration using histochemical analysis. Additionally, fibrosis and loss of contractile myosin expression were found in diseased muscles. Most cellular features, including proliferation rate, apoptosis and cell senescence, remained unchanged and genome-wide molecular signatures were predominantly similar between diseased and intact muscles. However, we found down-regulation of a small subset of muscle function genes, and up-regulation of extracellular region genes. Myogenesis was defected in muscle cell culture from diseased muscles but was restored by elevating MyoD levels. We suggest that impaired muscle functionality in a specific environment of thickened extra-cellular matrix is crucial for the development of chronic age-associated muscle degeneration.

  17. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    Directory of Open Access Journals (Sweden)

    Joseph Tennyson

    2016-11-01

    Full Text Available Introduction: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS transportation. Measurement of endotracheal tube (ETT cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods: We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results: We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90. The mean ETT cuff pressure was 70 (95% CI= [61-80] cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p120 cmH2O, the maximum pressure on the analog gauge. Conclusion: Patients presenting to HEMS after intubation by the referral agency (EMS or hospital have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.

  18. Wavelet Packet Analysis for Angular Data Extraction from Muscle Afferent Cuff Electrode Signals

    Science.gov (United States)

    2001-10-25

    from rabbits. In order to estimate ankle flexion /extension angles, we recorded ENG signals from the left Tibial and Peroneal nerves, both during FES...study, angle predictions have yet to be assessed regarding inter-rabbit variability. Keywords – Natural sensors, neural prosthesis , implanted cuff...fixating the knee and ankle joints in place (see [3] for more details) . For extracting the ENG signals, tripolar cuff electrodes were implanted onto the

  19. Reliability of pressure cuff induced transient limb ischemia in conscious rabbits

    Institute of Scientific and Technical Information of China (English)

    Zhang Nanrong; Zheng Wanjun; Wen Yi; Hu Qiongyu; Jin Sanqing

    2014-01-01

    Background The protective effects of transient limb ischemia (TLI) induced by several cycles of intermittent pressure cuff inflation and deflation for a period have been widely investigated,however the reliability of this protocol has not been clearly verified.Our study aimed to investigate the reliability of pressure cuff induced TLI in conscious rabbits.Methods Eight New Zealand rabbits were subjected to TLI without anesthesia.TLI consisted of 3 cycles of ischemia and reperfusion induced by inflating the cuff placed on the left lower limb to 200 mmHg for 5 minutes followed by deflating the cuff for 5 minutes.Skin color,pulse oxygen saturation (SpO2),pulse rate (PR),plethysmogram waveform (Pleth),and ultrasound detection of the blood flow in the extremity distal to the ischemic segment were observed to confirm ischemia and reperfusion during TLI.The frequency of severe limb movement during TLI was also recorded to assess the amenability of this protocol in conscious rabbits.Results The skin color of the extremity distal to the ischemic segment changed from bright red to dark purple after inflating the cuff to 200 mmHg,and returned to normal after cuff deflation.Pleth,PR and SpO2 disappeared during ischemia and restored during reperfusion in the monitor.Blood flow of the left posterior tibial artery was completely blocked by a pressure of 200 mmHg during ischemia,and recovered immediately after cuff deflation.The frequency of severe limb movement in supine position was higher than that in prone position (P<0.05),but there was no severe limb movement that could result in disturbance to ischemia when the rabbits were placed in prone position.Conclusion Pressure cuff inflating to 200 mmHg for 5 minutes and deflating for 5 minutes is a reliable regimen to induce TLI in conscious rabbits.

  20. Mononuclear cell therapy reverts cuff-induced thrombosis in apolipoprotein E-deficient mice

    Directory of Open Access Journals (Sweden)

    Lima Leandro C F

    2012-07-01

    Full Text Available Abstract Background Stem/progenitor cell-based therapy has successfully been used as a novel therapeutic strategy for vascular diseases triggered by endothelial dysfunction. The aim of this study was to investigate the effects of mononuclear cell (MNC therapy in situ on carotid cuff-induced occlusive thrombus in the apolipoprotein E knockout (apoE-/- mouse. Methods Spleen-derived MNCs were isolated from green fluorescent protein (GFP-transgenic mice for cell treatment. A cuff-induced thrombus model was produced by placing a nonconstrictive silastic collar around the left common carotid artery in 20-week-old female apoE-/- mice. After 10 days, the cuff was removed, and the animals received in situ MNCs (Cuff-MNC or vehicle (Cuff-Vehicle and were compared with sham-operated animals (Sham. Results The histological analysis showed that the MNC treatment reverted occlusive thrombus formation compared to the vehicle and the vessel lumen area to that observed in the Sham group (MNC, 50 ± 4; Vehicle, 20 ± 4; Sham, 55 ± 2 x103 μm2; p -/- mice. Conclusion In situ short-term MNC therapy was able to revert cuff-induced occlusive thrombi in the carotid arteries of apoE-/- mice, possibly through the homing of EPCs, reduction of oxidative stress and decreased apoptosis.

  1. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    DEFF Research Database (Denmark)

    Rokamp, K.Z.; Secher, N.H.; Møller, Ann;

    2010-01-01

    ABSTRACT: BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without...... the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. RESULTS: In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54...... patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure...

  2. [Are complications of gastric banding decreased with cuff fixation?].

    Science.gov (United States)

    Kasalický, M; Fried, M; Pesková, M

    2002-01-01

    The gastric bandage is reliable method for long time control of weight loss in failed conservative cure of morbid obese patients. Since 1983 we have been concerned with bariatric surgery at the First Surgical Department of General Faculty Hospital of Charles University. 691 morbid obese patients (BMI 49.7 kg/m2, mean age of 38.1) underwent gastric banding (GB)--by laparotomy 58 obese patients and since 1993 by laparoscopy 633 obese patients. After 12 months the mean weight loss was 21.1 kg (14-32 kg) and after 24 month the mean weight loss was 38.7 kg (27-73 kg). In period of 1993-1998 the most frequent late complication in the group of 517 obese patients after laparoscopic nonadjustable gastric banding (LNGB) was in 5.1% dilatation of upper gastric pouch or slippage of anterior stomach wall above the band with vomiting and failure of gastric evacuation. In majority we removed GB laparoscopically. To prevent this complication we modified GB with fixing band with a cuff made from the anterior gastric wall. To test the effectiveness of this method we implemented in 1998-1999 a prospective randomized study. In the group of 80 morbid obese patients we created in 40 patients (n1-GB+C) LNGB with the cuff fixation and in 40 patients (n2-GB-C) without fixation. We followed-up of this patients after LNGB was in 6 weeks, 6 months and 12 months with measurement of pouch volume by endoscopy with calibrate endocannula. One year after GB in the group n1-GB+C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB-C the mean increase of the pouch volume was 33.6 ml, i.e. 154.1% of the original size. The slippage or dilatation of the pouch was in group nl in one case while in group n2 in three cases (p < 0.001).

  3. New parachute cuff and positive end-expiratory pressure to minimize tracheal injury and prevent aspiration.

    Science.gov (United States)

    Nordin, U; Lyttkens, L

    1979-01-01

    A new parachute cuff has been tested in combination with a positive end-expiratory pressure (PEEP) on mongrel dogs. During positive-pressure ventilation the intracuff and intratracheal pressures showed synchronous, identical pressure variations, and therefore theoretically with this type of cuff the pressure against the tracheal wall would be minimal. The cuff provided a seal against gas leakage from the lungs throughout the entire test period, i.e., for up to 7 h. To avoid aspiration of mouth contents during the passive exhalation phase, different amounts of PEEP were tested. A PEEP of 4.0--8.0 cm H2O always produced a seal against a column of fluid in the mouth exerting a hydrostatic pressure of 5.4--8.8 cm H2O against the cuff. This seal was maintained during the whole test period. No difference in sealing capacity was found when the cuff was used with a normal respiratory frequency (20/min) and with high-frequency positive-pressure ventilation (60/min). When the PEEP is eliminated, e.g., when the respirator is disconnected for suction of the endotracheal tube, the sealing effect will be abolished. As the cuff extends up into the larynx there will be no pooling of fluid above the cuff. The risk of aspiration can therefore be diminished by suction of oral cavity before disconnecting the respirator. With the use of the pneumatic valve principle together with high-frequency positive-pressure ventilation, an open respirator system can produce a continuous PEEP, thereby preventing aspiration even during suctioning of the tracheal tube.

  4. Rotating flow

    CERN Document Server

    Childs, Peter R N

    2010-01-01

    Rotating flow is critically important across a wide range of scientific, engineering and product applications, providing design and modeling capability for diverse products such as jet engines, pumps and vacuum cleaners, as well as geophysical flows. Developed over the course of 20 years' research into rotating fluids and associated heat transfer at the University of Sussex Thermo-Fluid Mechanics Research Centre (TFMRC), Rotating Flow is an indispensable reference and resource for all those working within the gas turbine and rotating machinery industries. Traditional fluid and flow dynamics

  5. An affordable cuff-less blood pressure estimation solution.

    Science.gov (United States)

    Jain, Monika; Kumar, Niranjan; Deb, Sujay

    2016-08-01

    This paper presents a cuff-less hypertension pre-screening device that non-invasively monitors the Blood Pressure (BP) and Heart Rate (HR) continuously. The proposed device simultaneously records two clinically significant and highly correlated biomedical signals, viz., Electrocardiogram (ECG) and Photoplethysmogram (PPG). The device provides a common data acquisition platform that can interface with PC/laptop, Smart phone/tablet and Raspberry-pi etc. The hardware stores and processes the recorded ECG and PPG in order to extract the real-time BP and HR using kernel regression approach. The BP and HR estimation error is measured in terms of normalized mean square error, Error Standard Deviation (ESD) and Mean Absolute Error (MAE), with respect to a clinically proven digital BP monitor (OMRON HBP1300). The computed error falls under the maximum standard allowable error mentioned by Association for the Advancement of Medical Instrumentation; MAE <; 5 mmHg and ESD <; 8mmHg. The results are validated using two-tailed dependent sample t-test also. The proposed device is a portable low-cost home and clinic bases solution for continuous health monitoring.

  6. Rotating Wavepackets

    Science.gov (United States)

    Lekner, John

    2008-01-01

    Any free-particle wavepacket solution of Schrodinger's equation can be converted by differentiations to wavepackets rotating about the original direction of motion. The angular momentum component along the motion associated with this rotation is an integral multiple of [h-bar]. It is an "intrinsic" angular momentum: independent of origin and…

  7. LMA Extubation in Pediatric Patients: A Comparison of Inflated and Deflated LMA Cuff Methods

    Directory of Open Access Journals (Sweden)

    Mahin Seyedhejazi

    2014-07-01

    Full Text Available Background and Objectives: Extubating LMA (Laryngeal mask airway can be performed either with inflated or deflated cuff. In this study the effects and complications of these two methods were compared in children.Materials and Methods: In a clinical trial, 180 patients under 11 years old with ASA I/II who were scheduled for elective surgeries for less than one hour with no need for muscle relaxation were randomly divided into two groups. In group D, LMAs were extubated after oral cavity suctioning and cuff deflation. In group I, LMAs were extubated without suctioning and deflating the cuffs.Results: In group I after removing the LMA, mean heart rate significantly increased, mean diastolic blood pressure significantly increased, and mean arterial blood saturation significantly decreased. In Group D, none of these changes occurred. Despite a higher incidence of complications in the group I, difference was not significant.Conclusions: LMA removal with inflated cuff increases hemodynamic changes and decreases the arterial blood saturation. Hence, when hemodynamic stability and saturation of arterial blood is particularly important for us, extubating the LMA with deflated cuff is recommended. Keywords: LMA; Complication; Inflated; Deflated

  8. Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years

    Directory of Open Access Journals (Sweden)

    Sandra Regina Ramos Silva

    2014-01-01

    Full Text Available OBJECTIVE: to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40. METHODS: high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group. They were compared to 20 subjects from the original sample with lower blood pressure values (Control group. RESULTS: the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02 in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided. CONCLUSIONS: data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes.

  9. Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy -A case report-.

    Science.gov (United States)

    Lee, Hyung-Chul; Yun, Mi-Ja; Goo, Eui-Kyoung; Bahk, Jae-Hyon; Park, Hee-Pyoung; Jeon, Young-Tae; Lee, Sang Chul

    2010-12-01

    We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-old male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient's head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient's head to obtain easy access to the patient is essential for safe anesthetic care.

  10. Current Status of Open Surgical Treatment Protocols for Subacromial Impingement Syndrome Associated with Rotator Tear

    Directory of Open Access Journals (Sweden)

    Oktay Gazi

    2012-06-01

    Full Text Available Objective: The aim of this study was to evaluate the recent treatment protocols for Neer stage III subacromial impingement syndrome with open anterior acromioplasty and rotator cuff repair. Material and Methods: Twenty-two patients (8 males, 14 females; mean age: 52.9±10.2 who were diagnosed with a rotator cuff tear based on clinical and radiological findings between 2009 and 2010 participated in the study.. We used the open surgical decompression technique which was previously described by Neer. The ruptured tendon ends were isolated and were fixed to the bones with appropriate suture anchors and transosseoz sutures. Preoperative, postoperative and the final follow-up Constant and UCLA shoulder scores were evaluated. Results: The mean preoperative Constant score was 34.4±6.6 and UCLA score was 13.8±3.3. The mean postoperative Constant score was 73±7.6 and UCLA score was 31.7±3.3. Significant improvement was observed in postoperative shoulder scores (p<0.01 and postoperative shoulder range of motion in all patients (p<0.01. Conclusion: Currently, clinical and functional results of open and arthroscopic subacromial rotator cuff decompression are similar. However, many surgeons prefer the open method and achieve successful results. (The Me di cal Bul le tin of Ha se ki 2012; 50: 59-63

  11. An implantable CMOS signal conditioning system for recording nerve signals with cuff electrodes

    DEFF Research Database (Denmark)

    Papathanasiou, Konstantinos; Lehmann, Torsten

    2000-01-01

    We propose a system architecture for recording nerve signals with cuff electrodes and develop the key component in this system, the small-input, low-noise, low-power, high-gain amplifier. The amplifier is implemented using a mixture of weak- and strong-inversion transistors and a special off-set ......-set compensation technique; its performance is validated using Spice simulations....

  12. The effect of mucosal cuff shrinkage around dental implants during healing abutment replacement.

    Science.gov (United States)

    Nissan, J; Zenziper, E; Rosner, O; Kolerman, R; Chaushu, L; Chaushu, G

    2015-10-01

    Soft tissue shrinkage during the course of restoring dental implants may result in biological and prosthodontic difficulties. This study was conducted to measure the continuous shrinkage of the mucosal cuff around dental implants following the removal of the healing abutment up to 60 s. Individuals treated with implant-supported fixed partial dentures were included. Implant data--location, type, length, diameter and healing abutments' dimensions--were recorded. Mucosal cuff shrinkage, following removal of the healing abutments, was measured in bucco-lingual direction at four time points--immediately after 20, 40 and 60 s. anova was used to for statistical analysis. Eighty-seven patients (49 women and 38 men) with a total of 311 implants were evaluated (120 maxilla; 191 mandible; 291 posterior segments; 20 anterior segments). Two-hundred and five (66%) implants displayed thick and 106 (34%) thin gingival biotype. Time was the sole statistically significant parameter affecting mucosal cuff shrinkage around dental implants (P < 0.001). From time 0 to 20, 40 and 60 s, the mean diameter changed from 4.1 to 4.07, 3.4 and 2.81 mm, respectively. The shrinkage was 1%, 17% and 31%, respectively. The gingival biotype had no statistically significant influence on mucosal cuff shrinkage (P = 0.672). Time required replacing a healing abutment with a prosthetic element should be minimised (up to 20/40 s), to avoid pain, discomfort and misfit.

  13. Microvascular anastomosis using fibrin glue and venous cuff in rat carotid artery.

    Science.gov (United States)

    Sacak, Bulent; Tosun, Ugur; Egemen, Onur; Sakiz, Damlanur; Ugurlu, Kemal

    2015-04-01

    Conventional anastomosis with interrupted sutures can be time-consuming, can cause vessel narrowing, and can lead to thrombosis at the site of repair. The amount of suture material inside the lumen can impair the endothelium of the vessel, triggering thrombosis. In microsurgery, fibrin sealants have the potential beneficial effects of reducing anastomosis time and promoting accurate haemostasis at the anastomotic site. However, there has been a general reluctance to use fibrin glue for microvascular anastomoses because the fibrin polymer is highly thrombogenic and may not provide adequate strength. To overcome these problems, a novel technique was defined for microvascular anastomosis with fibrin glue and a venous cuff. Sixty-four rats in two groups are included in the study. In the experimental group (n = 32), end-to-end arterial anastomosis was performed with two stay sutures, fibrin glue, and a venous cuff. In the control group (n = 32), conventional end-to-end arterial anastomosis was performed. Fibrin glue assisted anastomosis with a venous cuff took less time, caused less bleeding at the anastomotic site, and achieved a patency rate comparable to that provided by the conventional technique. Fibrin sealant assisted microvascular anastomosis with venous cuff is a rapid, easy, and reliable technique compared to the end-to-end arterial anastomosis.

  14. Achieving a Safe Endotracheal Tube Cuff Pressure in the Prehospital Setting: Is It Time to Revise the Standard Cuff Inflation Practice?

    Science.gov (United States)

    Carhart, Elliot; Stuck, Logan H; Salzman, Joshua G

    2016-01-01

    Numerous studies have reported unsafe endotracheal tube (ETT) cuff pressures (CP) in the prehospital environment. The purpose of this study was to identify an optimal cuff inflation volume (CIV) to achieve a safe CP (20-30 cmH2O). This observational study utilized 30 recently harvested ovine tracheae, which were warmed from refrigeration in a water bath at 85°F prior to testing. Each trachea was intubated with five different ETT sizes (6.0-8.0 mm), and each size tube was tested with six cuff inflation volumes (5-10 cc). The order of ETT size for each trachea and CIV for each size ETT was randomly pre-assigned. Data were descriptively summarized and categorized before mixed-effects logistic regression was used to determine optimal CIV. Only 113 CP measurements (12.6%, N = 900) were within the optimal range (M = 54.75 cmH2O, SD = 38.52), all of which resulted from a CIV 6 or 7 cc (61% and 39%, respectively). CIVs of 5 cc (n = 150) resulted in underinflation (30 cmH2O) in all instances, regardless of ETT size. The odds of achieving a safe CP were greater with CIV of 6 cc for tube sizes 6.0 (OR = 15.9, 95% CI = 3.85-65.58, p safe CP between CIV of 6 and 7 cc for tube sizes 7.0, 7.5, or 8.0 mm. Neither trachea circumference (M = 7.11 cm, SD = 0.40), nor tissue temperature (M = 81.32°F, SD = 0.93) were found to be significant predictors of CP (p = 0.20 and 0.81, respectively). Our study showed a high frequency of CP measurements outside of the desired norms. The CIV range of 6-7 cc resulted in the highest likelihood of achieving the desired cuff pressure range, while cuffs inflated with 8-10 cc resulted in dangerously high CPs in all instances. In the absence of a more ideal solution, the results of this study suggest that narrowing the recommended CIV from 5-10 cc to 6-7 cc might be a reasonable target for any tube size.

  15. Nerve cuff electrode using embedded magnets and its application to hypoglossal nerve stimulation

    Science.gov (United States)

    Seo, Jungmin; Hye Wee, Jee; Hoan Park, Jeong; Park, Pona; Kim, Jeong-Whun; Kim, Sung June

    2016-12-01

    Objective. A novel nerve cuff electrode with embedded magnets was fabricated and developed. In this study, a pair of magnets was fully embedded and encapsulated in a liquid crystal polymer (LCP) substrate to utilize magnetic force in order to replace the conventional installing techniques of cuff electrodes. In vitro and in vivo experiments were conducted to evaluate the feasibility of the magnet-embedded nerve cuff electrode (MENCE). Lastly, several issues pertaining to the MENCE such as the cuff-to-nerve diameter ratio, the force of the magnets, and possible concerns were discussed in the discussion section. Approach. Electrochemical impedance spectrum and cyclic voltammetry assessments were conducted to measure the impedance and charge storage capacity of the cathodal phase (CSCc). The MENCE was installed onto the hypoglossal nerve (HN) of a rabbit and the movement of the genioglossus was recorded through C-arm fluoroscopy while the HN was stimulated by a pulsed current. Main results. The measured impedance was 0.638 ∠ -67.8° kΩ at 1 kHz and 5.27 ∠ -82.1° kΩ at 100 Hz. The average values of access resistance and cut-off frequency were 0.145 kΩ and 3.98 kHz, respectively. The CSCc of the electrode was measured as 1.69 mC cm-2 at the scan rate of 1 mV s-1. The movement of the genioglossus contraction was observed under a pulsed current with an amplitude level of 0.106 mA, a rate of 0.635 kHz, and a duration of 0.375 ms applied through the MENCE. Significance. A few methods to close and secure cuff electrodes have been researched, but they are associated with several drawbacks. To overcome these, we used magnetic force as a closing method of the cuff electrode. The MENCE can be precisely installed on a target nerve without any surgical techniques such as suturing or molding. Furthermore, it is convenient to remove the installed MENCE because it requires little force to detach one magnet from the other, enabling repeatable installation and removal. We

  16. Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension.

    Science.gov (United States)

    Zheng, Yali; Poon, Carmen C Y; Yan, Bryan P; Lau, James Y W

    2016-09-01

    Ambulatory blood pressure monitoring (ABPM) has become an essential tool in the diagnosis and management of hypertension. Current standard ABPM devices use an oscillometric cuff-based method which can cause physical discomfort to the patients with repeated inflations and deflations, especially during nighttime leading to sleep disturbance. The ability to measure ambulatory BP accurately and comfortably without a cuff would be attractive. This study validated the accuracy of a cuff-less approach for ABPM using pulse arrival time (PAT) measurements on both healthy and hypertensive subjects for potential use in hypertensive management, which is the first of its kind. The wearable cuff-less device was evaluated against a standard cuff-based device on 24 subjects of which 15 have known hypertension. BP measurements were taken from each subject over a 24-h period by the cuff-less and cuff-based devices every 15 to 30 minutes during daily activities. Mean BP of each subject during daytime, nighttime and over 24-h were calculated. Agreement between mean nighttime systolic BP (SBP) and diastolic (DBP) measured by the two devices evaluated using Bland-Altman plot were -1.4 ± 6.6 and 0.4 ± 6.7 mmHg, respectively. Receiver operator characteristics (ROC) statistics was used to assess the diagnostic accuracy of the cuff-less approach in the detection of BP above the hypertension threshold during nighttime (>120/70 mmHg). The area under ROC curves were 0.975/0.79 for nighttime. The results suggest that PAT-based approach is accurate and promising for ABPM without the issue of sleep disturbances associated with cuff-based devices.

  17. In vitro evaluation of the method effectiveness to limit inflation pressure cuffs of endotracheal tubes

    Directory of Open Access Journals (Sweden)

    Rafael de Macedo Coelho

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVE: Cuffs of tracheal tubes protect the lower airway from aspiration of gastric contents and facilitate ventilation, but may cause many complications, especially when the cuff pressure exceeds 30 cm H2O. This occurs in over 30% of conventional insufflations, so it is recommended to limit this pressure. In this study we evaluated the in vitro effectiveness of a method of limiting the cuff pressure to a range between 20 and 30 cm H2O. METHOD: Using an adapter to connect the tested tube to the anesthesia machine, the relief valve was regulated to 30 cm H2O, inflating the cuff by operating the rapid flow of oxygen button. There were 33 trials for each tube of three manufacturers, of five sizes (6.5-8.5, using three times inflation (10, 15 and 20 s, totaling 1485 tests. After inflation, the pressure obtained was measured with a manometer. Pressure >30 cm H2O or <20 cm H2O were considered failures. RESULTS: There were eight failures (0.5%, 95% CI: 0.1-0.9%, with all by pressures <20 cm H2O and after 10 s inflation (1.6%, 95% CI: 0 5-2.7%. One failure occurred with a 6.5 tube (0.3%, 95% CI: -0.3 to 0.9%, six with 7.0 tubes (2%, 95% CI: 0.4-3.6%, and one with a 7.5 tube (0.3%, 95% CI: -0.3 to 0.9%. CONCLUSION: This method was effective for inflating tracheal tube cuffs of different sizes and manufacturers, limiting its pressure to a range between 20 and 30 cm H2O, with a success rate of 99.5% (95% CI: 99.1-99.9%.

  18. Validation of simple and inexpensive algometry using sphygmomanometer cuff and neuromuscular junction monitor with standardized laboratory algometer

    Directory of Open Access Journals (Sweden)

    Padmaja Durga

    2016-01-01

    Conclusion: The sphygmomanometer cuff technique and electrical stimulation with the peripheral nerve stimulator to measure pain threshold and tolerance provide a simple, efficient, repeatable measure of pain intensity and can be used as suitable alternatives to standard algometers.

  19. Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study

    Directory of Open Access Journals (Sweden)

    Sandhu Jaspal S

    2008-01-01

    Full Text Available Abstract Background A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude. Methods Sphygmomanometer cuffs with widths 14 cm and 7 cm were applied to the upper extremities of 20 healthy, normotensive volunteers (9 males and 11 females with age ranging from 22 to 27. Systolic blood pressure was measured first and then the cuff was inflated to about 20–30 mm Hg above it and was kept inflated for 15 minutes. Recordings were done prior to, for the period of tourniquet inflation, and following release of the tourniquet. Results Nerve conduction was found to be more severely affected by the 14 cm cuff than the 7 cm cuff. Conclusion Wider cuffs resulted in more severe changes in the nerve. This brings us to the conclusion that though lower inflation pressures are required for the occlusion of the blood supply using wider cuffs, the nerve conduction is more severely affected by the wider ones. Both electrophysiological changes and occlusion pressure should be kept in mind while choosing the width of the cuff.

  20. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position

    Science.gov (United States)

    2014-01-01

    Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. Conclusions An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position. PMID:25210501

  1. User-independent assessment of conditioning pain modulation by cuff pressure algometry

    DEFF Research Database (Denmark)

    Graven-Nielsen, Thomas; Izumi, Masashi; Petersen, Kristian Kjær;

    2017-01-01

    BACKGROUND: The use of conditioning pain modulation (CPM) is hampered by poor reproducibility and lack of user-independent paradigms. This study refined the CPM paradigm by applying user-independent cuff algometry. METHODS: In 20 subjects, the CPM effect of conditioning with cuff stimulation...... (pain intensity standardized) and contralateral test stimuli were additionally evaluated (leg-arm, leg-leg, arm-thigh). The test-retest reliability in two sessions 1 month apart was assessed in five CPM protocols. RESULTS: In all protocols, the PDT, PVAS6 and PTT increased during conditioning compared...... with baseline (p CPM effect (i.e. conditioning minus baseline) for PVAS6, PTT and PPT increased for increasing conditioning intensities (p CPM effects were not significantly different for changes in conditioning durations or conditioning/test stimulus locations. In two sessions...

  2. Estimation of central aortic pressure waveform features derived from the brachial cuff volume displacement waveform.

    Science.gov (United States)

    Butlin, Mark; Qasem, Ahmad; Avolio, Alberto P

    2012-01-01

    There is increasing interest in non-invasive estimation of central aortic waveform parameters in the clinical setting. However, controversy has arisen around radial tonometric based systems due to the requirement of a trained operator or lack of ease of use, especially in the clinical environment. A recently developed device utilizes a novel algorithm for brachial cuff based assessment of aortic pressure values and waveform (SphygmoCor XCEL, AtCor Medical). The cuff was inflated to 10 mmHg below an individual's diastolic blood pressure and the brachial volume displacement waveform recorded. The aortic waveform was derived using proprietary digital signal processing and transfer function applied to the recorded waveform. The aortic waveform was also estimated using a validated technique (radial tonometry based assessment, SphygmoCor, AtCor Medical). Measurements were taken in triplicate with each device in 30 people (17 female) aged 22 to 79 years of age. An average for each device for each individual was calculated, and the results from the two devices were compared using regression and Bland-Altman analysis. A high correlation was found between the devices for measures of aortic systolic (R(2)=0.99) and diastolic (R(2)=0.98) pressure. Augmentation index and subendocardial viability ratio both had a between device R(2) value of 0.82. The difference between devices for measured aortic systolic pressure was 0.5±1.8 mmHg, and for augmentation index, 1.8±7.0%. The brachial cuff based approach, with an individualized sub-diastolic cuff pressure, provides an operator independent method of assessing not only systolic pressure, but also aortic waveform features, comparable to existing validated tonometric-based methods.

  3. Cuff leak test and laryngeal survey for predicting post-extubation stridor

    OpenAIRE

    Patel, Anit B; Chizobam Ani; Colin Feeney

    2015-01-01

    Background and Aims: Evidence for the predictive value of the cuff leak test (CLT) for post-extubation stridor (PES) is conflicting. We evaluated the association and accuracy of CLT alone or combined with other laryngeal parameters with PES. Methods: Fifty-one mechanically ventilated adult patients in a medical-surgical intensive care unit were tested prior to extubation using; CLT, laryngeal ultrasound and indirect laryngoscopy. Biometric, laryngeal and endotracheal tube (ETT) parameters wer...

  4. Optimizing nerve cuff stimulation of targeted regions through use of genetic algorithms.

    Science.gov (United States)

    Brill, Natalie; Tyler, Dustin

    2011-01-01

    A nerve cuff electrode is a viable technology for use in a neuroprostheses system to restore loss of function due to neurological injury. The Flat Interface Nerve Electrode (FINE) is a nerve cuff that gently reshapes the nerve to bring the axons closer to the stimulating contacts. The overall goal of this work is to optimize nerve cuff stimulation in upper extremity nerves. Recently, highly efficient and accurate linear models of neuronal activation have been developed in our lab. Using the fast calculations from the newly developed linear activation method, nerve stimulation parameters such as current pulse width and pulse amplitude at many electrode contacts can be explored by employing optimization algorithms. Finite element nerve models with high density electrodes were constructed based on upper extremity cadaveric nerve cross sections. An objective function was developed to target specific groups of nerve fascicles and minimize overlap amongst these groups. By changing the objective function and using a genetic search algorithm, stimulation parameters can be optimized for many contacts.

  5. On the identification of sensory information from mixed nerves by using single-channel cuff electrodes

    Directory of Open Access Journals (Sweden)

    Udina Esther

    2010-04-01

    Full Text Available Abstract Background Several groups have shown that the performance of motor neuroprostheses can be significantly improved by detecting specific sensory events related to the ongoing motor task (e.g., the slippage of an object during grasping. Algorithms have been developed to achieve this goal by processing electroneurographic (ENG afferent signals recorded by using single-channel cuff electrodes. However, no efforts have been made so far to understand the number and type of detectable sensory events that can be differentiated from whole nerve recordings using this approach. Methods To this aim, ENG afferent signals, evoked by different sensory stimuli were recorded using single-channel cuff electrodes placed around the sciatic nerve of anesthetized rats. The ENG signals were digitally processed and several features were extracted and used as inputs for the classification. The work was performed on integral datasets, without eliminating any noisy parts, in order to be as close as possible to real application. Results The results obtained showed that single-channel cuff electrodes are able to provide information on two to three different afferent (proprioceptive, mechanical and nociceptive stimuli, with reasonably good discrimination ability. The classification performances are affected by the SNR of the signal, which in turn is related to the diameter of the fibers encoding a particular type of neurophysiological stimulus. Conclusions Our findings indicate that signals of acceptable SNR and corresponding to different physiological modalities (e.g. mediated by different types of nerve fibers may be distinguished.

  6. Intraoperative Atelectasis Due to Endotracheal Tube Cuff Herniation: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Madineh

    2012-09-01

    Full Text Available Endotracheal tube (ETT cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR for open reduction and internal fixation (ORIF of all fractures .The procedures were done under general anesthesia (G/A. The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

  7. [Fixation of a non-adjustable gastric band using an anterior gastric wall cuff (randomized study)].

    Science.gov (United States)

    Kasalický, M; Fried, M; Pesková, M; Bortlík, M; Votrubová, J

    2000-05-01

    We have been concerned with bariatric surgery at the First Surgical Clinic of th General Faculty Hospital, First Medical Faculty, Charles University Prague since 1983. In 1983-1986 vertical gastroplasties were made, between 1986 and 1993 non-adjustable gastric bands were provided by the laparotomic approach. Since 1993 when we were the first to implement a gastric band operation (GB) by the laparoscopic route, this method is used as the standard method. In 1993-1998 we made at the First Surgical Clinic 517 laparoscopic GB operation on account of morbid obesity in patients with a body mass index of 34-49 kg/m2. The group comprised 449 women and 59 men. The most frequent late complication in our group of morbidly obese patients who had a laparoscopically administered GB was in 5.1% enlargement of the proximal pouch above the GB by dilatation of its wall or slippage of the anterior wall proximally under the GB with a subsequent disorder of gastric evacuation and vomiting. We tried to reduce the incidence of this complication by fixing the GB by a cuff made from the anterior gastric wall. To test the effectiveness of the suggested fixation of the non-adjustable GB by a cuff we implemented in 1998-1999 a prospective randomized study in a group of 80 morbidly obese patients divided into experimental group n1-GB + C with the cuff and a control group n2-GB - C without a cuff. We investigated the incidence of the mentioned complication and the changed volume of the pouch above the GB after one year. Endoscopic assessment of the size of the pouch above the GB after surgery and after one year revealed that in group n1-GB + C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB - C the mean increase of the volume was 33.6 ml, i.e. 154.1% of the original size (p < 0.001). Based on the assembled results and aware of the fact that small groups were involved, we should like to express the assumption that the suggested modification

  8. Analysis of the quality of the manufacture of cuffs rubber reinforced with the use of the QFD method

    Directory of Open Access Journals (Sweden)

    N. O. Savchenko

    2016-01-01

    Full Text Available The use of cuffs rubber reinforced diverse, from pipe fittings to domestic plumbing. In this regard, relevant is the development of high-quality cuffs rubber reinforced on the basis of various fillers in order to prevent leakage of the working fluid and improve the reliability of cuffs in a wide range of loads. To improve the quality of cuffs rubber reinforced and meet the requirements of consumers a fundamentally new way to strengthen the rubber, which will improve the qualitative characteristics of cuffs rubber reinforced, consequently, increase their resistance to solvents is added to a polymer filler on the basis of nanocarbon. The purpose of this study is to plan quality cuffs rubber reinforced with the use of tolerancerange filler using tools monitoring and quality management the methodology of Quality Function Deployment (QFD. The relevance of QFD method is to determine the most important issues and related priorities, especially in the choice of positions that should be solved and improved when developing new products. To achieve this goal the following tasks: conducted market analysis of rubber products; carried out a consumer benchmarking and ranking of customer requirements; based on the analysis of customer requirements to cuffs rubber reinforced identified the most important requirements and via the SFC installed priority technical characteristics for further improvements; designed new product using the QFD. QFD method allowed a large amount of information in a compressed form and identify areas to improve specific technical specifications based on customer requirements.

  9. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  10. Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff: Implications for noninvasive blood pressure measurement

    Science.gov (United States)

    Deng, Zhipeng; Liang, Fuyou

    2016-07-01

    An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement. However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element (FE) models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

  11. Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff: Implications for noninvasive blood pressure measurement

    Science.gov (United States)

    Deng, Zhipeng; Liang, Fuyou

    2016-10-01

    An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement. However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element (FE) models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

  12. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2010-01-01

    Full Text Available Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7% and two patients had postoperative hoarseness of voice (5.4%. All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve ′just seal′, with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  13. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion.

    Science.gov (United States)

    Garg, Rakesh; Rath, Girija P; Bithal, Parmod K; Prabhakar, Hemanshu; Marda, Manish K

    2010-07-01

    Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values) and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7%) and two patients had postoperative hoarseness of voice (5.4%). All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve 'just seal', with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  14. Diagnostic Utility of US for Detecting Rotator Cuff Tears in Rheumatoid Arthritis Patients: Comparison with Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Der-Yuan Chen

    2014-12-01

    Conclusion: With a good agreement with MRI, US was shown to be a highly sensitive and accurate imaging modality in detecting full-thickness RCTs for patients with RA who have shoulder pain, but appeared to have lower sensitivity in detecting partial-thickness RCTs compared with MRI.

  15. Application of Minimum Effective Cuff Inflating Volume for Laryngeal Mask Airway and its Impact on Postoperative Pharyngeal Complications

    Institute of Scientific and Technical Information of China (English)

    Bing-Bing Li; Jie Yan; Hong-Gang Zhou; Jing Hao; Ai-Jia Liu; Zheng-Liang Ma

    2015-01-01

    Background:High intracuffpressure can cause severe pharyngeal complications including sore throat or hoarseness after laryngeal mask airway (LMA) removal postoperatively.Though the application of minimum effective cuffinflating volume is suggested to maintain airway sealing and adequacy of ventilation for patients receiving general anesthesia with LMA at lower level of the intracuffpressure,it is currently not a standard care in most of the anesthetic departments.In this study,the minimum effective cuff inflating volume was determined for classic LMA Well LeadTM (Well Lead Medical Co.,Ltd.,China) and its impact on postoperative pharyngeal complications was also explored.Methods:Patients with American Society of Anesthesiologists physical status (Ⅰ-Ⅲ) undergoing the short-duration urological surgery were recruited in this trial.First,the minimum effective cuff inflating volume was determined for size 4 or 5 LMA Well LeadTM in the study 1.Immediately following placement and confirmation of ideal LMA position,the cuff was inflated with 5,7,10 ml of air and up to 30 ml at 5 ml increment.The intracuff pressure,oropharyngeal leak pressure (OLP),and inspiratory peak airway pressure under positive pressure ventilation at the corresponding cuff volume as indicated above were recorded.Second,the enrolled patients were randomly allocated into minimum effective cuff inflating volume group (MC) and routine care (RC) group in the study 2.The minimum effective cuff inflating volume was applied and maintained in MC group,whereas the cuff volume was inflated with half of the maximum cuff inflating volume recommended by manufacturer in RC group throughout the surgical procedure and stay in postanesthesia care unit prior to LMA removal.The incidence of pharyngeal complications at 0,2,24,and 48 h after removal of LMA and other intra-operative adverse events were also documented.Results:The intracuffpressure varied with the cuff inflating volume in a positive linear correlation

  16. Cuff pressure pain detection is associated with both sex and physical activity level in nonathletic healthy subjects

    DEFF Research Database (Denmark)

    Lemming, Dag; Börsbo, Björn; Sjörs, Anna

    2017-01-01

    PURPOSE : The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated. METHOD:  Normal physical activity level was defined as Godin Leisure...... is associated both with male sex and physical activity level.......-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual...

  17. Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia.

    Science.gov (United States)

    Jespersen, Anders; Dreyer, Lene; Kendall, Sally; Graven-Nielsen, Thomas; Arendt-Nielsen, Lars; Bliddal, Henning; Danneskiold-Samsoe, Bente

    2007-09-01

    The aim of this study was to evaluate the use of computerized cuff pressure algometry (CPA) in fibromyalgia (FM) and to correlate deep-tissue sensitivity assessed by CPA with other disease markers of FM. Forty-eight women with FM and 16 healthy age-matched women were included. A computer-controlled, pneumatic tourniquet cuff was placed over the gastrocnemius muscle. The cuff was inflated, and the subject rated the pain intensity continuously on an electronic Visual Analogue Scale (VAS). The subject stopped the inflation at the pressure-pain tolerance and the corresponding VAS-score was determined (pressure-pain limit). The pressure at which VAS firstly exceeded 0 was defined as the pressure-pain threshold. Other disease markers (FM only): Isokinetic knee muscle strength, tenderpoint-count, myalgic score, Beck Depression Inventory, and Fibromyalgia Impact Questionnaire. Student's T-test was used to compare pressure-pain threshold and pressure-pain tolerance and the Mann-Whitney test to compare pressure-pain limit. Pearson's correlation was used to detect linear relationships. Pressure-pain threshold and pressure-pain tolerance assessed by CPA were significantly lower in FM compared to healthy controls. There was no difference in pressure-pain limit. CPA-parameters were significantly correlated to isokinetic muscle strength where more hypersensitivity resulted in lower strength. Pressure-pain threshold and pressure-pain tolerance assessed by CPA were significantly lower in patients with FM indicating muscle hyperalgesia. CPA was associated with knee muscle strength but not with measures thought to be influenced by psychological distress and mood.

  18. Design, fabrication and evaluation of a conforming circumpolar peripheral nerve cuff electrode for acute experimental use.

    Science.gov (United States)

    Foldes, Emily L; Ackermann, D Michael; Bhadra, Niloy; Kilgore, Kevin L; Bhadra, Narendra

    2011-03-15

    Nerve cuff electrodes are a principle tool of basic and applied electro-neurophysiology studies and are championed for their ability to achieve good nerve recruitment with low thresholds. We describe the design and method of fabrication for a novel circumpolar peripheral nerve electrode for acute experimental use. This cylindrical cuff-style electrode provides approximately 270° of radial electrode contact with a nerve for each of an arbitrary number of contacts, has a profile that allows for simple placement and removal in an acute nerve preparation, and is designed for adjustment of the cylindrical diameter to ensure a close fit on the nerve. For each electrode, the electrical contacts were cut from 25 μm platinum foil as an array so as to maintain their positions relative to each other within the cuff. Lead wires were welded to each intended contact. The structure was then molded in silicone elastomer, after which the individual contacts were electrically isolated. The final electrode was curved into a cylindrical shape with an inner diameter corresponding to that of the intended target nerve. The positions of these contacts were well maintained during the molding and shaping process and failure rates during fabrication due to contact displacements were very low. Established electrochemical measurements were made on one electrode to confirm expected behavior for a platinum electrode and to measure the electrode impedance to applied voltages at different frequencies. These electrodes have been successfully used for nerve stimulation, recording, and conduction block in a number of different acute animal experiments by several investigators.

  19. Drinking citrus fruit juice inhibits vascular remodeling in cuff-induced vascular injury mouse model.

    Science.gov (United States)

    Ohnishi, Arika; Asayama, Rie; Mogi, Masaki; Nakaoka, Hirotomo; Kan-No, Harumi; Tsukuda, Kana; Chisaka, Toshiyuki; Wang, Xiao-Li; Bai, Hui-Yu; Shan, Bao-Shuai; Kukida, Masayoshi; Iwanami, Jun; Horiuchi, Masatsugu

    2015-01-01

    Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% Citrus unshiu (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% Citrus iyo (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI.

  20. Determinação do volume de ar no "cuff" de sondas endotraqueais

    Directory of Open Access Journals (Sweden)

    Pedro Marco Karan Barbosa

    1996-06-01

    Full Text Available O objetivo deste estudo foi determinar o melhor ajuste do volume de ar a ser insuflado no "cuff" de diferentes diâmetros de cânulas endotraqueais de alto volume residual e baixa pressão, mantendo a pressão exercida pelo balonete na mucosa da traquéia entre os limites preconizados de 20 a 30 mmHg (menor que a pressão capilar da traquéia. Para tanto, foram insuflados 10 ml de ar no "cuff" de cânulas de pacientes intubados com diferentes diâmetros internos (7,0 - 7,5 - 8,0 8,5 - 9,0, mensurando, uma a uma, a cada ml de ar insuflado, a pressão correspondente do "cuff " na mucosa da traquéia. A monitoração da pressão foi realizada através de um manómetro previamente calibrado. O procedimento foi realizado em 25 pacientes adultos, de ambos os sexos, agrupados em número de 5, para cada diâmetro interno de cânula. Os resultados obtidos foram analisados através da análise de regressão linear que demonstrou a relação aproximada entre ml/ar insuflado, pressão do "cuff", por diâmetro de cânula. Após análise dos resultados, o autor construiu um quadro com a indicação da quantidade de ar a ser insuflado no balonete e a respectiva pressão exercida sobre a mucosa da traquéia, por diâmetro de cânula, oferecendo uma contribuição para o pessoal que presta assistência a pacientes intubados no sentido de minimizar os possíveis danos e complicações e assegurar uma melhor ventilação respiratória.

  1. Improvements of Surgical Technique in Establishment of Rat Orthotopic Pulmonary Transplantation Model Using Cuffs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    In order to establish more simple and effective rat orthotopic lung transplantation models, 20 rats were divided into donor and recipient groups. Rat lung transplantation models were established by using improved cuff technique. All the 10 operations were accomplished successfully.The mean operative time of recipients was 45±4 min. The survival time was over 30 days after lung transplantation. The checks of X-ray were almost ncrmal. There was no significant difference in the blood gas analysis before and after clipping the right hilum (P>. 05). This method is more simple,applicable and requires less time.

  2. Rotating Cavitation Supression Project

    Data.gov (United States)

    National Aeronautics and Space Administration — FTT proposes development of a rotating cavitation (RC) suppressor for liquid rocket engine turbopump inducers. Cavitation instabilities, such as rotating...

  3. Measurements of endotracheal tube cuff contact pressure using fibre Bragg gratings

    Science.gov (United States)

    Hernandez, F. U.; Correia, R.; Korposh, S.; Morgan, S. P.; Hayes-Gill, B. R.; James, S. W.; Evans, D.; Norris, A.

    2015-09-01

    An optical fibre Bragg grating (FBG) was used to measure local strain (due to contact pressure) at the interface of a cuffed endotracheal tube (ETT) tested in a tracheal model. The tracheal model consisted of a corrugated tube. Two FBG sensors written in a single optical fibre were attached to the outside wall of the cuff of the ETT. Intracuff endotracheal pressure was measured using a digital manometer, while the contact pressure between the model trachea and the ETT was measured using Flexiforce sensors. Changes in the Bragg wavelengths in response to the inflation of the cuff of the ETT, and concomitant pressure increase, were observed to be dependent on the location of the FBGs at the corrugations, i.e., the annular peaks and troughs of the corrugated tube. The performance of both contact pressure sensors FBG and Flexiforce suggests that FBG technology is better suited to this application as it allows the measurement of contact pressures on non-uniform surfaces such as in the tracheal model.

  4. Cuff leak test and laryngeal survey for predicting post-extubation stridor

    Directory of Open Access Journals (Sweden)

    Anit B Patel

    2015-01-01

    Full Text Available Background and Aims: Evidence for the predictive value of the cuff leak test (CLT for post-extubation stridor (PES is conflicting. We evaluated the association and accuracy of CLT alone or combined with other laryngeal parameters with PES. Methods: Fifty-one mechanically ventilated adult patients in a medical-surgical intensive care unit were tested prior to extubation using; CLT, laryngeal ultrasound and indirect laryngoscopy. Biometric, laryngeal and endotracheal tube (ETT parameters were recorded. Results: PES incidence was 4%. CLT demonstrated ′no leak′ in 20% of patients. Laryngeal oedema was present in 10% of the patients on indirect laryngoscopy, and 71% of the patients had a Grades 1-3 indirect laryngoscopic view. Mean air column width on laryngeal ultrasound was 0.66 ± 0.15 cm (cuff deflated, mean ratio of ETT to laryngeal diameter was 0.48 ± 0.07, and the calculated CLT and laryngeal survey composite was 0.86 ± 1.25 (range 0-5. CLT and the CLT and Laryngeal survey composite measure were not associated with or predict PES. Age, sex, peri-extubation steroid use, intubation duration and body mass index were not associated with PES. Conclusion: Even including ultrasonographic and indirect laryngoscopic examination of the airway, no single aspect of the CLT or combination with laryngeal parameters accurately predicts PES.

  5. Mucosal cuff length to penile length ratio may affect the risk of premature ejaculation in circumcised males.

    Science.gov (United States)

    Yuruk, E; Temiz, M Z; Colakerol, A; Muslumanoglu, A Y

    2016-01-01

    Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.

  6. A comparison of the failure times of pulse oximeters during blood pressure cuff-induced hypoperfusion in volunteers.

    Science.gov (United States)

    Kawagishi, Toshiya; Kanaya, Noriaki; Nakayama, Masayasu; Kurosawa, Saori; Namiki, Akiyoshi

    2004-09-01

    Important information may not be obtained if the pulse oximetry signal is lost during inflation of a cuff for blood pressure measurement, particularly in patients with hemodynamic instability. In the present study, we compared the failure times of pulse oximeters during cuff-induced hypoperfusion in volunteers. A pulse oximeter sensor was attached to the index finger, and a blood pressure cuff was attached to the same arm of each volunteer. MasimoSET Radical (Masimo), Nellcor N-395 (N-395), Nellcor N-20PA, and Nellcor D-25 were tested. To evaluate the failure time of each pulse oximeter, time to peak of cuff pressure, time to loss of signal, time to recovery of signal, and failure interval were measured. All measurements were performed three times for each pulse oximeter and were averaged. There were no differences in hemodynamic measurements among the groups. Time to loss of signal was longer in Masimo than the other pulse oximeters. Masimo and N-395 showed significantly shorter times to recovery of signal than those of the other two pulse oximeters. Failure interval was in the order of Masimo Masimo did not lose a signal as rapidly as the other oximeters studied. Masimo was similar in performance to the N-395 at providing useful data sooner than conventional technology after a loss of the signal. These observations suggest that data will be more available with fewer false-positive alarms when using the Masimo oximeter followed by the N-395 when compared with conventional oximeters.

  7. Clinical outcomes of image guided radiation therapy (IGRT) with gold fiducial vaginal cuff markers for high-risk endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Monroe, Alan T.; Peddada, Anuj V. [Dept. of Radiation Oncology, Penrose Cancer Center, Colorado Springs (United States); Pikaart, Dirk [Dept. of Gynecologic Oncology, Penrose Cancer Center, Colorado Springs (United States)

    2013-06-15

    Objective. To report two year clinical outcomes of image guided radiation therapy (IGRT) to the vaginal cuff and pelvic lymph nodes in a series of high-risk endometrial cancer patients. Methods . Twenty-six consecutive high-risk endometrial cancer patients requiring adjuvant radiation to the vaginal cuff and regional lymph nodes were treated with vaginal cuff fiducial-based IGRT. Seventeen (65%) received sequential chemotherapy, most commonly with a sandwich technique. Brachytherapy followed external radiation in 11 patients to a median dose of 18 Gy in 3 fractions. The median external beam dose delivered was 47.5 Gy in 25 fractions. Results. All 656 fractions were successfully imaged and treated. The median overall translational shift required for correction was 9.1 mm (standard deviation, 5.2 mm) relative to clinical set-up with skin tattoos. Shifts of 1 cm, 1.5 cm, and 2 cm or greater were performed in 43%, 14%, and 4% of patients, respectively. Acute grade 2 gastrointestinal (GI) toxicity occurred in eight patients (30%) and grade 3 toxicity occurred in one. At two years, there have been no local or regional failures and actuarial overall survival is 95%. Conclusion. Daily image guidance for high-risk endometrial cancer results in a low incidence of acute GI/genitourinary (GU) toxicity with uncompromised tumor control at two years. Vaginal cuff translations can be substantial and may possibly result in underdosing if not properly considered.

  8. Use of a Yankauer suction tip combined with the Colpo-Pneumo Occluder balloon to suction the surgical field at the vaginal cuff during robotic hysterectomy.

    Science.gov (United States)

    Stitely, Michael L; Hashmi, Mahreen; Jain, Preiya; Hochberg, Charles

    2011-01-01

    A 39-year-old patient with complex endometrial hyperplasia without atypia underwent robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The procedure was technically challenging because of the patient's obesity (body mass index 50 kg/m(2)). Concomitant suction of pooled blood and retraction of bowel and omentum were necessary to close the vaginal cuff. An endoscopic retractor was used through the assistant's port, and a Yankauer suction tip was placed through an inflated Colpo-Pneumo Occluder balloon in the vagina to provide directed suction to the vagina cuff. This technique enabled efficient closure of the vaginal cuff.

  9. High molecular weight hyaluronan for treatment of chronic shoulder pain associated with glenohumeral arthritis

    Directory of Open Access Journals (Sweden)

    Weil AJ

    2011-07-01

    Full Text Available Arnold J WeilNon-Surgical Orthopedics PC, Marietta, GA, USABackground: There is insufficient evidence to determine whether intra-articular injections may be effective for treatment of glenohumeral osteoarthritis. Euflexxa® (high molecular weight hyaluronate, a bioengineered high molecular weight hyaluronan, has been shown to be a safe and effective treatment for patients with knee osteoarthritis. There is also support for the use of hyaluronate injection for the treatment of chronic shoulder pain associated with osteoarthritis or rotator cuff damage. This small-scale exploratory study was conducted to evaluate the safety and efficacy of high molecular weight hyaluronate for the treatment of chronic shoulder pain associated with osteoarthritis.Methods: Subjects with glenohumeral osteoarthritis and chronic pain (n = 27 received one injection per week for 3 weeks of high molecular weight hyaluronate and were assessed for changes in pain (100 mm visual analog scale [VAS], range of motion, and the subject’s and physician’s global assessment over 26 weeks. Subjects were also assessed for pain, stiffness, and physical functioning using the Western Ontario and McMaster Universities Arthritis Index (WOMAC. Finally, responses were evaluated using modified Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT-Osteoarthritis Research Society International (OARSI Proposition D criteria. Safety was assessed by recording adverse events.Results: High molecular weight hyaluronate significantly improved pain (VAS, WOMAC, range of motion, stiffness, and physical functioning scores; 77.8% of subjects were rated as having an OMERACT-OARSI Proposition D high response. There were no serious adverse events, and none were considered to be related to treatment.Conclusion: Treatment with high molecular weight hyaluronate improves pain, stiffness, and range of motion, and may have an acceptable safety and tolerability profile. A randomized, double

  10. Assessment of central haemomodynamics from a brachial cuff in a community setting

    Directory of Open Access Journals (Sweden)

    Nunan David

    2012-06-01

    Full Text Available Abstract Background Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed. Methods One-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP and pulse pressure and wave reflection parameters (augmentation pressure (AP and index, AIx were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from 80 years in the whole population and a subset with a systolic BP  Results We obtained 1,793 measures of peripheral and central BP, PP and augmentation parameters. Age and gender associations with central haemodynamic and augmentation parameters reflected those previously established from reference standard non-invasive techniques under specialised settings. Findings were the same for patients with a systolic BP below 140 mmHg (i.e. normotensive. Lower values for AIx in the current study are possibly due to differences in sampling rates, detection frequency and/or averaging procedures and to lower numbers of volunteers in younger age groups. Conclusion A novel transfer-function like algorithm, using brachial cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings.

  11. Fibre-selective recording from the peripheral nerves of frogs using a multi-electrode cuff

    Science.gov (United States)

    Schuettler, Martin; Donaldson, Nick; Seetohul, Vipin; Taylor, John

    2013-06-01

    Objective. We investigate the ability of the method of velocity selective recording (VSR) to determine the fibre types that contribute to a compound action potential (CAP) propagating along a peripheral nerve. Real-time identification of the active fibre types by determining the direction of action potential propagation (afferent or efferent) and velocity might allow future neural prostheses to make better use of biological sensor signals and provide a new and simple tool for use in fundamental neuroscience. Approach. Fibre activity was recorded from explanted Xenopus Laevis frog sciatic nerve using a single multi-electrode cuff that records whole nerve activity with 11 equidistant ring-shaped electrodes. The recorded signals were amplified, delayed against each other with variable delay times, added and band-pass filtered. Finally, the resulting amplitudes were measured. Main Result. Our experiments showed that electrically evoked frog CAP was dominated by two fibre populations, propagating at around 20 and 40 m/s, respectively. The velocity selectivity, i.e. the ability of the system to discriminate between individual populations was increased by applying band-pass filtering. The method extracted an entire velocity spectrum from a 10 ms CAP recording sample in real time. Significance. Unlike the techniques introduced in the 1970s and subsequently, VSR requires only a single nerve cuff and does not require averaging to provide velocity spectral information. This makes it potentially suitable for the generation of highly-selective real-time control-signals for future neural prostheses. In our study, electrically evoked CAPs were analysed and it remains to be proven whether the method can reliably classify physiological nerve traffic. The work presented here was carried out at the laboratories of the Implanted Devices Group, Department of Medical Physics and Bioengineering, University College London, UK.

  12. On Averaging Rotations

    DEFF Research Database (Denmark)

    Gramkow, Claus

    1999-01-01

    In this article two common approaches to averaging rotations are compared to a more advanced approach based on a Riemannian metric. Very offten the barycenter of the quaternions or matrices that represent the rotations are used as an estimate of the mean. These methods neglect that rotations belong...... approximations to the Riemannian metric, and that the subsequent corrections are inherient in the least squares estimation. Keywords: averaging rotations, Riemannian metric, matrix, quaternion...

  13. Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes.

    Science.gov (United States)

    Niederbracht, Yvonne; Shim, Andrew L; Sloniger, Mark A; Paternostro-Bayles, Madeline; Short, Thomas H

    2008-01-01

    Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes.

  14. Rotations with Rodrigues' Vector

    Science.gov (United States)

    Pina, E.

    2011-01-01

    The rotational dynamics was studied from the point of view of Rodrigues' vector. This vector is defined here by its connection with other forms of parametrization of the rotation matrix. The rotation matrix was expressed in terms of this vector. The angular velocity was computed using the components of Rodrigues' vector as coordinates. It appears…

  15. On Averaging Rotations

    DEFF Research Database (Denmark)

    Gramkow, Claus

    2001-01-01

    In this paper two common approaches to averaging rotations are compared to a more advanced approach based on a Riemannian metric. Very often the barycenter of the quaternions or matrices that represent the rotations are used as an estimate of the mean. These methods neglect that rotations belong...

  16. Safety and reliability of the sealing cuff pressure of the Microcuff pediatric tracheal tube for prevention of post-extubation morbidity in children: A comparative study

    Directory of Open Access Journals (Sweden)

    Roshdi Roshdi Al-Metwalli

    2014-01-01

    Full Text Available Objectives: The objective of this study is to evaluate the efficacy and safety of sealing pressure as an inflation technique of the Microcuff pediatric tracheal cuffed tube. Materials and Methods: A total of 60 children were enrolled in this study. After induction of anesthesia and intubation with Microcuff pediatric tracheal tube, patients were randomly assigned, to one of the three groups. Control group (n = 20 the cuff was inflated to a cuff pressure of 20 cm H 2 O; sealing group (n = 20 the cuff was inflated to prevent the air leak at peak airway pressure of 20 cm H 2 O and the finger group (n = 20 the cuff was inflated to a suitable pressure using the finger estimation. Tracheal leak, incidence and severity of post-extubation cough, stridor, sore throat and hoarseness were recorded. Results: The cuff pressure as well as the volume of air to fill the cuff was significantly low in the sealing group when compared with the control group (P < 0.001; however, their values were significantly high in the finger group compared with both the control and the sealing group (P < 0.001. The incidence and severity of sore throat were significantly high in the finger group compared with both the control and the sealing group (P = 0.0009 and P = 0.0026. Three patients in the control group developed air leak around the endotracheal tube cuff. The incidence and severity of other complications were similar in the three groups. Conclusion: In pediatric N 2 O, free general anesthesia using Microcuff pediatric tracheal tub, sealing cuff pressure is safer than finger palpation technique regarding post-extubation morbidities and more reliable than recommended safe pressure in prevention of the air leak.

  17. The spatial rotator

    DEFF Research Database (Denmark)

    Rasmusson, Allan; Hahn, Ute; Larsen, Jytte Overgaard

    2013-01-01

    the spatial rotator fast to use. Since a 3D probe is involved, it is expected that the spatial rotator will be more efficient than the the nucleator and the planar rotator, which are based on measurements in a single plane. An extensive simulation study shows that the spatial rotator may be more efficient...... to identify the specific tissue region under study. In order to use the spatial rotator in practice, however, it is necessary to be able to identify intersection points between cell boundaries and test rays in a series of parallel focal planes, also at the peripheral parts of the cell boundaries. In cases...

  18. Predictors of human rotation.

    Science.gov (United States)

    Stochl, Jan; Croudace, Tim

    2013-01-01

    Why some humans prefer to rotate clockwise rather than anticlockwise is not well understood. This study aims to identify the predictors of the preferred rotation direction in humans. The variables hypothesised to influence rotation preference include handedness, footedness, sex, brain hemisphere lateralisation, and the Coriolis effect (which results from geospatial location on the Earth). An online questionnaire allowed us to analyse data from 1526 respondents in 97 countries. Factor analysis showed that the direction of rotation should be studied separately for local and global movements. Handedness, footedness, and the item hypothesised to measure brain hemisphere lateralisation are predictors of rotation direction for both global and local movements. Sex is a predictor of the direction of global rotation movements but not local ones, and both sexes tend to rotate clockwise. Geospatial location does not predict the preferred direction of rotation. Our study confirms previous findings concerning the influence of handedness, footedness, and sex on human rotation; our study also provides new insight into the underlying structure of human rotation movements and excludes the Coriolis effect as a predictor of rotation.

  19. USASOC Injury Prevention/Performance Optimization Musculoskeletal Screening Initiative

    Science.gov (United States)

    2012-11-01

    Anatomic Location Specific Injuries Probable Causes Knee Patellar Tendinitis Overuse places chronic stress on patella tendon Lack of lower...climbing activities too quickly Rotator cuff becomes fatigued during long climbs Biceps tendinitis Scapulohumeral rhythm becomes compromised

  20. Luxatio erecta--en sjaelden form for skulderluksation

    DEFF Research Database (Denmark)

    Al-Saadi, Sammer Kadhum; Olsen, Bo Sanderhoff

    2009-01-01

    resonance scan showed supraspinatus tendon rupture. Such type of shoulder dislocation is associated with significant complications (such as rotator cuff tears) and also late complications (including instability, chronic pain and reduced motion). A brief description of presentation, diagnosis and management...

  1. Galaxy cluster's rotation

    CERN Document Server

    Manolopoulou, Maria

    2016-01-01

    We study the possible rotation of cluster galaxies, developing, testing and applying a novel algorithm which identifies rotation, if such does exits, as well as its rotational centre, its axis orientation, rotational velocity amplitude and, finally, the clockwise or counterclockwise direction of rotation on the plane of the sky. To validate our algorithms we construct realistic Monte-Carlo mock rotating clusters and confirm that our method provides robust indications of rotation. We then apply our methodology on a sample of Abell clusters with z<~0.1 with member galaxies selected from the SDSS DR10 spectroscopic database. We find that ~35% of our clusters are rotating when using a set of strict criteria, while loosening the criteria we find this fraction increasing to ~48%. We correlate our rotation indicators with the cluster dynamical state, provided either by their Bautz-Morgan type or by their X-ray isophotal shape and find for those clusters showing rotation that the significance and strength of their...

  2. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain

    Science.gov (United States)

    Hauser, Ross A.; Lackner, Johanna B.; Steilen-Matias, Danielle; Harris, David K.

    2016-01-01

    OBJECTIVE The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated. DATA SYNTHESIS Fourteen RCTs, 1 case–control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood–Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive

  3. Chronic myelogenous leukemia (CML)

    Science.gov (United States)

    CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... Chronic myelogenous leukemia is grouped into phases: Chronic Accelerated Blast crisis The chronic phase can last for ...

  4. Relativistic Rotating Vector Model

    CERN Document Server

    Lyutikov, Maxim

    2016-01-01

    The direction of polarization produced by a moving source rotates with the respect to the rest frame. We show that this effect, induced by pulsar rotation, leads to an important correction to polarization swings within the framework of rotating vector model (RVM); this effect has been missed by previous works. We construct relativistic RVM taking into account finite heights of the emission region that lead to aberration, time-of-travel effects and relativistic rotation of polarization. Polarizations swings at different frequencies can be used, within the assumption of the radius-to-frequency mapping, to infer emission radii and geometry of pulsars.

  5. Highly sensitive contact pressure measurements using FBG patch in endotracheal tube cuff

    Science.gov (United States)

    Correia, R.; Blackman, O. R.; Hernandez, F. U.; Korposh, S.; Morgan, S. P.; Hayes-Gill, B. R.; James, S. W.; Evans, D.; Norris, A.

    2016-05-01

    A method for measuring the contact pressure between an endotracheal tube cuff and the trachea was designed and developed by using a fibre Bragg grating (FBG) based optical fibre sensor. The FBG sensor is encased in an epoxy based UV-cured cuboid patch and transduces the transversely loaded pressure into an axial strain that induces wavelength shift of the Bragg reflection. The polymer patch was created by using a PTFE based mould and increases tensile strength and sensitivity of the bare fibre FBG to pressure to 2.10×10-2 nm/kPa. The characteristics of the FBG patch allow for continuous measurement of contact pressure. The measurement of contact pressure was demonstrated by the use of a 3D printed model of a human trachea. The influence of temperature on the measurements is reduced significantly by the use of a second FBG sensor patch that is not in contact with the trachea. Intracuff pressure measurements performed using a commercial manometer agreed well with the FBG contact pressure measurements.

  6. Faraday rotation measure synthesis

    NARCIS (Netherlands)

    Brentjens, MA; de Bruyn, AG

    2005-01-01

    We extend the rotation measure work of Burn ( 1966, MNRAS, 133, 67) to the cases of limited sampling of lambda(2) space and non-constant emission spectra. We introduce the rotation measure transfer function (RMTF), which is an excellent predictor of n pi ambiguity problems with the lambda(2) coverag

  7. SMAP Faraday Rotation

    Science.gov (United States)

    Le Vine, David

    2016-01-01

    Faraday rotation is a change in the polarization as signal propagates through the ionosphere. At L-band it is necessary to correct for this change and measurements are made on the spacecraft of the rotation angle. These figures show that there is good agreement between the SMAP measurements (blue) and predictions based on models (red).

  8. A Rotating Quantum Vacuum

    CERN Document Server

    De Lorenci, V A

    1996-01-01

    We investigate which mapping we have to use to compare measurements made in a rotating frame to those made in an inertial frame. Using a "Lorentz-like" coordinate transformation we obtain that creation-anihilation operators of a massless scalar field in the rotating frame are not the same as those of an inertial observer. This leads to a new vacuum state (a rotating vacuum) which is a superposition of positive and negative frequency Minkowski particles. After this, introducing an apparatus device coupled linearly with the field we obtain that there is a strong correlation between number of rotating particles (in a given state) obtained via canonical quantization and via response function of the rotating detector. Finally, we analyse polarization effects in circular accelerators in the proper frame of the electron making a connection with the inertial frame point of view.

  9. Uniformly rotating neutron stars

    CERN Document Server

    Boshkayev, Kuantay

    2016-01-01

    In this chapter we review the recent results on the equilibrium configurations of static and uniformly rotating neutron stars within the Hartle formalism. We start from the Einstein-Maxwell-Thomas-Fermi equations formulated and extended by Belvedere et al. (2012, 2014). We demonstrate how to conduct numerical integration of these equations for different central densities ${\\it \\rho}_c$ and angular velocities $\\Omega$ and compute the static $M^{stat}$ and rotating $M^{rot}$ masses, polar $R_p$ and equatorial $R_{\\rm eq}$ radii, eccentricity $\\epsilon$, moment of inertia $I$, angular momentum $J$, as well as the quadrupole moment $Q$ of the rotating configurations. In order to fulfill the stability criteria of rotating neutron stars we take into considerations the Keplerian mass-shedding limit and the axisymmetric secular instability. Furthermore, we construct the novel mass-radius relations, calculate the maximum mass and minimum rotation periods (maximum frequencies) of neutron stars. Eventually, we compare a...

  10. Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff:Implications for noninvasive blood pressure measurement

    Institute of Scientific and Technical Information of China (English)

    Zhipeng Deng; Fuyou Liang

    2016-01-01

    An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement. However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element (FE) mod-els were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evi-dence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm sur-face and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In par-ticular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pres-sure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

  11. Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Sandeep Kumar Mishra

    2015-01-01

    Full Text Available Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left. The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation, lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

  12. A rotating quantum vacuum

    Energy Technology Data Exchange (ETDEWEB)

    Lorenci, V.A. de; Svaiter, N.F. [Centro Brasileiro de Pesquisas Fisicas (CBPF), Rio de Janeiro, RJ (Brazil)

    1996-11-01

    It was investigated which mapping has to be used to compare measurements made in a rotating frame to those made in an inertial frame. Using a non-Galilean coordinate transformation, the creation-annihilation operators of a massive scalar field in the rotating frame are not the same as those of an inertial observer. This leads to a new vacuum state(a rotating vacuum) which is a superposition of positive and negative frequency Minkowski particles. Polarization effects in circular accelerators in the proper frame of the electron making a connection with the inertial frame point of view were analysed. 65 refs.

  13. Chaotic rotation of Hyperion?

    Science.gov (United States)

    Binzel, R. P.; Green, J. R.; Opal, C. B.

    1986-01-01

    Thomas et al. (1984) analyzed 14 Voyager 2 images of Saturn's satellite Hyperion and interpreted them to be consistent with a coherent (nonchaotic) rotation period of 13.1 days. This interpretation was criticized by Peale and Wisdom (1984), who argued that the low sampling frequency of Voyager data does not allow chaotic or nonchaotic rotation to be distinguished. New observations obtained with a higher sampling frequency are reported here which conclusively show that the 13.1 day period found by Thomas et al. was not due to coherent rotation.

  14. [Variations in the internal pressure of the pneumatic cuffs of endotracheal tubes according to their contents and the anesthetic mixtures used. Experimental study].

    Science.gov (United States)

    de Santos, P; Castillo, J; Bogdanovich, A; Nalda, M A

    1989-01-01

    With the purpose of measuring pressure changes in the pneumatic cuffs of endotracheal tubes when the composition of the mixture of gases used for ventilation had to change for the same content, we designed a model of artificial respiration that consisted of a tube with a low pressure pneumatic cuff measuring 8.5 mm in inner diameter introduced in a replica of a human trachea, adjusted to two anesthetic bags. The cuff valve was connected to a pressure transducer by a three-ended stopcock and, after aspiration of its content, it was inflated with air, saline or nitrous oxide and oxygen at 60% up to a basal pressure of 20 mmHg. The tube was connected to a respirator adjusted to inflate 10 l/min at a rate of 15 insufflations/min of: oxygen 100% for 5 minutes, then nitrous oxide and oxygen at 60% for 30 minutes and oxygen 100% again for 15 minutes. When inflating the pneumatic cuff with air and ventilating with nitrous oxide and oxygen at 60%, its pressure reached a maximum mean value of 58 mmHg (190% with respect to base values). When insufflating with saline and ventilating in the same conditions, pressure reached a maximum mean value of 33 mmHg (65% with respect to base values). When the pneumatic cuff was inflated with nitrous oxide and oxygen at 60%, important changes in pressure were observed when the characteristics of the inspired gases were modified. We conclude that some method for monitoring pneumatic cuff pressure should be systematized.

  15. Fractal Aggregation Under Rotation

    Institute of Scientific and Technical Information of China (English)

    WU Feng-Min; WU Li-Li; LU Hang-Jun; LI Qiao-Wen; YE Gao-Xiang

    2004-01-01

    By means of the Monte Carlo simulation, a fractal growth model is introduced to describe diffusion-limited aggregation (DLA) under rotation. Patterns which are different from the classical DLA model are observed and the fractal dimension of such clusters is calculated. It is found that the pattern of the clusters and their fractal dimension depend strongly on the rotation velocity of the diffusing particle. Our results indicate the transition from fractal to non-fractal behavior of growing cluster with increasing rotation velocity, i.e. for small enough angular velocity ω the fractal dimension decreases with increasing ω, but then, with increasing rotation velocity, the fractal dimension increases and the cluster becomes compact and tends to non-fractal.

  16. Fractal Aggregation Under Rotation

    Institute of Scientific and Technical Information of China (English)

    WUFeng-Min; WULi-Li; LUHang-Jun; LIQiao-Wen; YEGao-Xiang

    2004-01-01

    By means of the Monte Carlo simulation, a fractal growth model is introduced to describe diffusion-limited aggregation (DLA) under rotation. Patterns which are different from the classical DLA model are observed and the fractal dimension of such clusters is calculated. It is found that the pattern of the clusters and their fractal dimension depend strongly on the rotation velocity of the diffusing particle. Our results indicate the transition from fractal to non-fractal behavior of growing cluster with increasing rotation velocity, i.e. for small enough angular velocity ω; thefractal dimension decreases with increasing ω;, but then, with increasing rotation velocity, the fractal dimension increases and the cluster becomes compact and tends to non-fractal.

  17. Earth rotation and geodynamics

    OpenAIRE

    Bogusz Janusz; Brzezinski Aleksander; Kosek Wieslaw; Nastula Jolanta

    2015-01-01

    This paper presents the summary of research activities carried out in Poland in 2011-2014 in the field of Earth rotation and geodynamics by several Polish research institutions. It contains a summary of works on Earth rotation, including evaluation and prediction of its parameters and analysis of the related excitation data as well as research on associated geodynamic phenomena such as geocentre motion, global sea level change and hydrological processes. The second part of the paper deals wit...

  18. Rotational spectrum of phenylglycinol

    Science.gov (United States)

    Simão, Alcides; Peña, Isabel; Cabezas, Carlos; Alonso, José L.

    2014-11-01

    Solid samples of phenylglycinol were vaporized by laser ablation and investigated through rotational spectroscopy in a supersonic expansion using two different techniques: chirped pulse Fourier transform microwave spectroscopy and narrow band molecular beam Fourier transform microwave spectroscopy. One conformer, bearing an O-H···N and an N-H···π intramolecular hydrogen bonds, could be successfully identified by comparison of the experimental rotational and 14N nuclear quadruple coupling constants with those predicted theoretically.

  19. Electromagnetic rotational actuation.

    Energy Technology Data Exchange (ETDEWEB)

    Hogan, Alexander Lee

    2010-08-01

    There are many applications that need a meso-scale rotational actuator. These applications have been left by the wayside because of the lack of actuation at this scale. Sandia National Laboratories has many unique fabrication technologies that could be used to create an electromagnetic actuator at this scale. There are also many designs to be explored. In this internship exploration of the designs and fabrications technologies to find an inexpensive design that can be used for prototyping the electromagnetic rotational actuator.

  20. Chronic cholecystitis

    Science.gov (United States)

    Cholecystitis - chronic ... Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. Most of these attacks are caused by gallstones in the gallbladder. These ...

  1. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  2. Chronic Pain

    Science.gov (United States)

    ... a problem you need to take care of. Chronic pain is different. The pain signals go on ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis ...

  3. Chronic prostatitis

    OpenAIRE

    Le, Brian; Schaeffer, Anthony J.

    2011-01-01

    Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.

  4. Chronic prostatitis

    OpenAIRE

    Erickson, Bradley A.; Schaeffer, Anthony J.; Le, Brian

    2008-01-01

    Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome, CP/CPPS). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.

  5. Rotating superconductor magnet for producing rotating lobed magnetic field lines

    Science.gov (United States)

    Hilal, Sadek K.; Sampson, William B.; Leonard, Edward F.

    1978-01-01

    This invention provides a rotating superconductor magnet for producing a rotating lobed magnetic field, comprising a cryostat; a superconducting magnet in the cryostat having a collar for producing a lobed magnetic field having oppositely directed adjacent field lines; rotatable support means for selectively rotating the superconductor magnet; and means for energizing the superconductor magnet.

  6. Continuous cuff-less blood pressure monitoring based on the pulse arrival time approach: the impact of posture.

    Science.gov (United States)

    Muehlsteff, J; Aubert, X A; Morren, G

    2008-01-01

    There is an unmet need for cuff-less blood pressure (BP) monitoring especially, in personal healthcare applications. The pulse arrival time (PAT) approach might offer a suitable solution to enable comfortable BP monitoring even at beat-level. However, the methodology is based on hemodynamic surrogate measures, which are sensitive to patient activities such as posture changes, not necessarily related to blood pressure variations. In this paper, we analyze the impact of posture on the PAT measure and related hemodynamic parameters such as the pre-ejection period in well-defined procedures. Additionally, the PAT of a monitored subject is investigated in an unsupervised scenario illustrating the complexity of such a measurement. Our results show the failure of blood pressure inference based on simple calibration strategies using the PAT measure only. We discuss opportunities to compensate for the observed effects towards the realization of wearable cuff-less blood pressure monitoring. These findings emphasize the importance of accessing context information in personal healthcare applications, where vital sign monitoring is typically unsupervised.

  7. Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion

    Science.gov (United States)

    Kyriacou, P. A.; Shafqat, K.; Pal, S. K.

    2007-10-01

    Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO2) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO2) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO2 sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures. Both pulse

  8. Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Kyriacou, P A [School of Engineering and Mathematical Sciences, City University, London EC1V 0HB (United Kingdom); Shafqat, K [School of Engineering and Mathematical Sciences, City University, London EC1V 0HB (United Kingdom); Pal, S K [St Andrew' s Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, CM1 7ET (United Kingdom)

    2007-10-15

    Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO{sub 2}) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO{sub 2}) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO{sub 2} sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures

  9. Rapidly rotating red giants

    CERN Document Server

    Gehan, Charlotte; Michel, Eric

    2016-01-01

    Stellar oscillations give seismic information on the internal properties of stars. Red giants are targets of interest since they present mixed modes, which behave as pressure modes in the convective envelope and as gravity modes in the radiative core. Mixed modes thus directly probe red giant cores, and allow in particular the study of their mean core rotation. The high-quality data obtained by CoRoT and Kepler satellites represent an unprecedented perspective to obtain thousands of measurements of red giant core rotation, in order to improve our understanding of stellar physics in deep stellar interiors. We developed an automated method to obtain such core rotation measurements and validated it for stars on the red giant branch. In this work, we particularly focus on the specific application of this method to red giants having a rapid core rotation. They show complex spectra where it is tricky to disentangle rotational splittings from mixed-mode period spacings. We demonstrate that the method based on the id...

  10. Chiral rotational spectroscopy

    Science.gov (United States)

    Cameron, Robert P.; Götte, Jörg B.; Barnett, Stephen M.

    2016-09-01

    We introduce chiral rotational spectroscopy, a technique that enables the determination of the orientated optical activity pseudotensor components BX X, BY Y, and BZ Z of chiral molecules, in a manner that reveals the enantiomeric constitution of a sample and provides an incisive signal even for a racemate. Chiral rotational spectroscopy could find particular use in the analysis of molecules that are chiral solely by virtue of their isotopic constitution and molecules with multiple chiral centers. A basic design for a chiral rotational spectrometer together with a model of its functionality is given. Our proposed technique offers the more familiar polarizability components αX X, αY Y, and αZ Z as by-products, which could see it find use even for achiral molecules.

  11. The optical rotator

    DEFF Research Database (Denmark)

    Tandrup, T; Gundersen, Hans Jørgen Gottlieb; Jensen, Eva B. Vedel

    1997-01-01

    The optical rotator is an unbiased, local stereological principle for estimation of cell volume and cell surface area in thick, transparent slabs, The underlying principle was first described in 1993 by Kieu Jensen (T. Microsc. 170, 45-51) who also derived an estimator of length, In this study we...... further discuss the methods derived from this principle and present two new local volume estimators. The optical rotator benefits from information obtained in all three dimensions in thick sections but avoids over-/ underprojection problems at the extremes of the cell. Using computer-assisted microscopes...... the extra measurements demand minimal extra effort and make this estimator even more efficient when it comes to estimation of individual cell size than many of the previous local estimators, We demonstrate the principle of the optical rotator in an example (the cells in the dorsal root ganglion of the rat...

  12. Chiral Rotational Spectroscopy

    CERN Document Server

    Cameron, Robert P; Barnett, Stephen M

    2015-01-01

    We introduce chiral rotational spectroscopy: a new technique that enables the determination of the individual optical activity polarisability components $G_{XX}'$, $G_{YY}'$, $G_{ZZ}'$, $A_{X,YZ}$, $A_{Y,ZX}$ and $A_{Z,XY}$ of chiral molecules, in a manner that reveals the enantiomeric constitution of a sample whilst yielding an incisive signal even for a racemate. Chiral rotational spectroscopy could find particular use in the analysis of molecules that are chiral by virtue of their isotopic constitution and molecules with multiple chiral centres. The principles that underpin chiral rotational spectroscopy can also be exploited in the search for molecular chirality in space, which, if found, may add weight to hypotheses that biological homochirality and indeed life itself are of cosmic origin.

  13. Rotation of cometary meteoroids

    CERN Document Server

    Capek, David

    2014-01-01

    The aim of this study is to estimate the rotational characteristics of meteoroids after their release from a comet during normal activity. The results can serve as initial conditions for further analyses of subsequent evolution of rotation in the interplanetary space. A sophisticated numerical model was applied to meteoroids ejected from 2P/Encke comet. The meteoroid shapes were approximated by polyhedrons with several thousands of surface elements, which have been determined by 3D laser scanning method of 36 terrestrial rock samples. These samples came from three distinct sets with different origin and shape characteristics. Two types of gas-meteoroid interactions (diffuse and specular reflection of gas molecules from the surface of meteoroid) and three gas ejection models (leading to very different ejection velocities) were assumed. The rotational characteristics of ejected meteoroid population were obtained by numerical integration of equations of motion with random initial conditions and random shape sele...

  14. Effect of rotation on a rotating hot-wire sensor

    Science.gov (United States)

    Hah, C.; Lakshminarayana, B.

    1978-01-01

    An investigation was conducted to discern the effects of centrifugal and Coriolis forces on a rotating hot-wire. The probe was calibrated in a wind tunnel as well as in a rotating mode. The effect of rotation was found to be negligibly small. A small change in cold resistance (1.5%) was observed in the rotating wire. The rotation seems to have a negligible effect on the fluid mechanics, heat transfer and material characteristics of the wire. This is a significant conclusion in view of the potential application of the hot-wire probe in a rotating passage (such as turbomachinery).

  15. The rotating quantum vacuum

    CERN Document Server

    Davies, Paul Charles William; Manogue, C A; Davies, Paul C W; Dray, Tevian; Manogue, Corinne A

    1996-01-01

    We derive conditions for rotating particle detectors to respond in a variety of bounded spacetimes and compare the results with the folklore that particle detectors do not respond in the vacuum state appropriate to their motion. Applications involving possible violations of the second law of thermodynamics are briefly addressed.

  16. Compact rotating cup anemometer

    Science.gov (United States)

    Wellman, J. B.

    1968-01-01

    Compact, collapsible rotating cup anemometer is used in remote locations where portability and durability are factors in the choice of equipment. This lightweight instrument has a low wind-velocity threshold, is capable of withstanding large mechanical shocks while in its stowed configuration, and has fast response to wind fluctuations.

  17. Rotationally Actuated Prosthetic Hand

    Science.gov (United States)

    Norton, William E.; Belcher, Jewell G., Jr.; Carden, James R.; Vest, Thomas W.

    1991-01-01

    Prosthetic hand attached to end of remaining part of forearm and to upper arm just above elbow. Pincerlike fingers pushed apart to degree depending on rotation of forearm. Simpler in design, simpler to operate, weighs less, and takes up less space.

  18. Tratamento conservador das lesões parciais e completas do manguito rotador Conservative treatment of partial and complete tears of the rotator cuff

    OpenAIRE

    Osvandré Lech; Cézar Valenzuela Neto; Antônio Severo

    2000-01-01

    A lesão do manguito rotador é a mais freqüente patologia do ombro. Cerca de 180 pacientes foram tratados conservadoramente nos dois Serviços nos anos de 1996 e 1997. Este grupo recebeu uma ampla gama de tratamentos (apenas medicação, exercícios caseiros, infiltração, fisioterapia, etc.). Este estudo avaliou os resultados do tratamento conservador em 26 pacientes com rupturas parcial e total do manguito rotador. O protocolo consistiu de um programa com 6 meses de duração que incluiu terapia mi...

  19. 肩关节镜辅助下小切口肩峰成形及肩袖修补%Arthroscopically assisted mini-approach rotator cuff repairs

    Institute of Scientific and Technical Information of China (English)

    韦民; MinolaRiccardo; 等

    2003-01-01

    目的探讨肩关节镜辅助下小切口肩袖修补手术的临床应用价值. 方法本组26例患者,在关节镜下完成肩峰成形,然后在小切口内对肩袖完全破裂的18例患者行肌腱-骨隧道缝合,对部分破裂的8例患者行肌腱-肌腱缝合. 结果术后随访21~48个月(平均37.5个月),所有患者均无术后感染及肩关节粘连发生,肩关节疼痛,特别是夜间痛明显改善,手术疗效满意.UCLA评分由术前平均20.1分改善至术后31.6分. 结论本术式可确定肩关节面一侧肩袖破裂的部位及深度,且不破坏三角肌的连续性.手术效果好,患者可较早进行功能煅练,功能恢复快.适合在我国许多刚开展肩关节镜手术的医院推广.

  20. The treatment of calcifying rotator cuff tendinitis%肩袖钙化性肌腱炎的治疗体会

    Institute of Scientific and Technical Information of China (English)

    滕海; 陈北北; 朴成哲

    2010-01-01

    @@ 肩袖钙化性肌腱炎病因不明,以往认为是由于肌腱组织退变后出现的钙化表现.目前认为退变性的肌腱炎是逐渐恶化的,而钙化性肌腱炎作为炎症的一种,有着急性发作的特点并有自愈倾向[1].

  1. Quantification of early fatty infiltration of the rotator cuff muscles: comparison of multi-echo Dixon with single-voxel MR spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Agten, Christoph A.; Rosskopf, Andrea B.; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Gerber, Christian [Balgrist University Hospital, Orthopaedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2016-10-15

    To evaluate quantification of early fatty infiltration in supraspinatus muscles with magnetic resonance (MR) imaging using a T2*-corrected multi-echo 3D-gradient-echo Dixon-based sequence (multi-echo Dixon) and compare it to proton-MR-spectroscopy. Sixty subjects (mean age 46 years, 41 men) with good supraspinatus muscle quality on 1.5 T MR imaging were included. Fat percentage (FP) in the supraspinatus muscle was quantified using a multi-echo Dixon compared to single-voxel MR spectroscopy as reference standard. In 18 subjects the multi-echo Dixon was repeated to assess test-retest reliability. Measurements based on multi-echo Dixon were performed by two independent readers by placing regions-of-interest (ROIs) in the supraspinatus muscle corresponding to the MR-spectroscopy voxel. Intraclass and concordance correlation coefficients (ICC/CCC) were used for statistical analysis. Test-retest reliability was substantial for reader 1 (ICC = 0.757) and almost perfect for reader 2 (ICC = 0.873). Inter-reader reliability for multi-echo Dixon was almost perfect (ICC = 0.893, P <.0005). Mean FP in all 60 subjects with multi-echo Dixon was 3.5 ± 1.6 for reader 1, 3.7 ± 1.8 for reader 2, and 2.8 ± 1.4 with MR spectroscopy. Correlation between multi-echo Dixon and MR spectroscopy was moderate (CCC = 0.641). The multi-echo Dixon sequence is a reliable method and comparable to MR-spectroscopy for quantification of low levels of fatty infiltration in the supraspinatus muscle. (orig.)

  2. [Chronicity, chronicization, systematization of delusions].

    Science.gov (United States)

    Trapet, P; Fernandez, C; Galtier, M C; Gisselmann, A

    1984-05-01

    Chronicity in psychopathology is indicative of a term, a decay. Chronicization only leads the way to this term. Here, chronicization is taken literally as an inscription in the time course of delusions. The mechanism of systematization seems to be a central mark in the approach to chronic delusions. It is not an alienation or an irreversible closing but an attempted accommodation with reality in the life of psychotic subjects, irrespective of the delusional structure. The role of therapy and drug treatment as a follow-up may in that case assume another meaning.

  3. Wave-driven Rotation in Supersonically Rotating Mirrors

    Energy Technology Data Exchange (ETDEWEB)

    A. Fetterman and N.J. Fisch

    2010-02-15

    Supersonic rotation in mirrors may be produced by radio frequency waves. The waves produce coupled diffusion in ion kinetic and potential energy. A population inversion along the diffusion path then produces rotation. Waves may be designed to exploit a natural kinetic energy source or may provide the rotation energy on their own. Centrifugal traps for fusion and isotope separation may benefit from this wave-driven rotation.