Academic literature on the topic 'Rotator cuff tear'

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Journal articles on the topic "Rotator cuff tear"

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Mihata, Teruhisa, Rei Morikura, Akihiko Hasegawa, Kunimoto Fukunishi, Takeshi Kawakami, Yukitaka Fujisawa, Mutsumi Ohue, and Masashi Neo. "Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players." American Journal of Sports Medicine 47, no. 14 (October 14, 2019): 3476–82. http://dx.doi.org/10.1177/0363546519878141.

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Background: Partial-thickness rotator cuff tears are common shoulder injuries in baseball players. For some tears, the symptoms can be relieved through physical therapy or debridement without rotator cuff repair. Purpose: To assess whether partial-thickness rotator cuff tear by itself causes shoulder pain and muscle weakness in baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We studied 87 university baseball players (age, 19.5 ± 0.8 years; baseball career, 11.5 ± 1.6 years). All data were obtained during a full-participation annual medical check in 1 team. Rotator cuff tendons were examined ultrasonographically and allocated to 4 groups: (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, and (4) both supraspinatus and infraspinatus tendon tears. Current shoulder pain and shoulder muscle strength (dominant/nondominant) in abduction, external rotation, and internal rotation were compared by using chi-square and t tests. All players could play baseball with or without shoulder pain in this study. Results: Of the 87 players, 41 (47%) had articular-sided partial-thickness rotator cuff tears diagnosed on ultrasonography; the remaining 46 athletes were tear-free. Of the 41 affected patients, 19 had tears in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and infraspinatus tendons. Tear depth (mean ± SD) was 4.6 ± 2.3 mm in the supraspinatus and 6.2 ± 3.6 mm in the infraspinatus. Neither the rate of shoulder pain nor muscle strength differed significantly among the 4 groups ( P = .96 and P = .15-.70, respectively). Conclusion: Articular-sided partial-thickness rotator cuff tear—by itself—did not cause shoulder pain and muscle weakness in university baseball players. Most so-called articular-sided partial-thickness rotator cuff tears may not be pathologic tendon tears.
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Mihata, Teruhisa, Rei Morikura, Kunimoto Fukunishi, Yukitaka Fujisawa, Takeshi Kawakami, Akihiko Hasegawa, and Masashi Neo. "Partial-thickness Rotator Cuff Tear Itself Did Not Cause Shoulder Pain Or Muscle Weakness In Baseball Players." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0043. http://dx.doi.org/10.1177/2325967119s00430.

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Objectives: Rotator cuff tears are common shoulder injuries in baseball players. In some severe tears (i.e. through more than 50% of the cuff’s thickness), conservative treatment does not work well, and surgical treatment is sometimes chosen in an effort to ensure return to play. In contrast, some partial thickness rotator cuff tears do not cause shoulder symptoms, even during throwing motion. The objective of this study was to assess whether partial thickness rotator cuff tears cause shoulder pain and muscle weakness in baseball players. Methods: We studied 87 university baseball players (age: 19.5±0.8 years; baseball career: 11.5±1.6 years). Rotator cuff tendons were ultrasonographically examined (Fig 1), then divided into 4 groups; (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, (4) both supraspinatus and infraspinatus tendons tear. Current shoulder pain and shoulder muscle strength (Dominant/Non-dominant) in abduction, external rotation, and internal rotation were compared using Chi square test and t-test. Results: Forty-one (47%) players were diagnosed with articular-sided partial-thickness rotator cuff tears using ultrasonography. Nineteen tears were in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and the infraspinatus. Tear depth was 4.6±2.3 mm in the supraspinatus and 6.2±3.6 mm in the infraspinatus. There was no significant difference in rate of shoulder pain (p=0.96) and muscle strength among four groups (p=0.15 - 0.70). Conclusion: In this study, articular-sided partial-thickness rotator cuff tears did not cause shoulder pain and muscle weakness in university baseball players. Most of articular-sided partial-thickness rotator cuff tears are tears of the superior capsule but not the rotator cuff tendons, because the superior capsule is attached in the articular half of the greater tuberosity. Therefore, most so-called articular-sided partial-thickness rotator cuff tears may not be pathological tendon tear.
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Iwashita, Satoshi, Hiroshi Hashiguchi, Atsushi Okubo, Minoru Yoneda, and Shinro Takai. "Characteristics of the patients with delaminated rotator cuff tear." SICOT-J 4 (2018): 28. http://dx.doi.org/10.1051/sicotj/2018022.

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Purpose: The purpose of this study was to analyze factors relating to delamination in full-thickness rotator cuff tears. Methods: 126 patients with full-thickness rotator cuff tears treated by arthroscopic rotator cuff repair were the subjects of this study. There were 52 females and 74 males whose average age was 64.2 years. Fifty-three patients had history of trauma. The average duration of disorder was 29.5 weeks. Nineteen patients were diagnosed with diabetes. On types of the tears, small tear was observed in 59 patients, medium tear in 47 patients, large tear in 6 patients, and massive tear in 14 patients. The average size of tear was 1.98 cm. Delamination of the torn cuff was observed in 45 patients. Factors compared between the patients without delamination and those with delamination were as follows: gender and age of the patients, history of trauma, duration of disorder, diabetes, smoking, size and number of rotator cuff tears. Results: The delamination rate of the smoking patients was significantly higher than non-smoking patients. The delamination rate of patients with more than two tendon tears was significantly higher than those with only one tendon tear. The average size of tear with delamination was significantly larger than that of tear without delamination. The other factors were not related to delamination. Conclusions: This study suggests that smoking, size of tear and number of torn cuffs are associated with delamination. The progression of torn cuff, anatomical features and nicotine of smoking affect the causes of delaminated tear of rotator cuff.
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Urata, Setsuo, Hiroyuki Yonemitsu, Nobutake Nakane, Hidechika Nakashima, Shuichiro Takahashi, Tadashi Matsuda, Etsuo Nishikido, and Yasuhiro Araki. "Rotator cuff tear." Orthopedics & Traumatology 36, no. 4 (1988): 1109–13. http://dx.doi.org/10.5035/nishiseisai.36.1109.

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Graham, Patrick. "Rotator Cuff Tear." Orthopaedic Nursing 37, no. 2 (2018): 154–56. http://dx.doi.org/10.1097/nor.0000000000000441.

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Auethavekiat, Paranee, and Clement J. Michet. "Rotator-Cuff Tear." New England Journal of Medicine 354, no. 19 (May 11, 2006): e20. http://dx.doi.org/10.1056/nejmicm040011.

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Lungren, Matthew P., David Smith, James E. Carpenter, and Richard E. Hughes. "FALL-RELATED ROTATOR CUFF TEARS." Journal of Musculoskeletal Research 10, no. 02 (June 2006): 75–81. http://dx.doi.org/10.1142/s0218957706001728.

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Tears of the rotator cuff tendons may occur as a result of tendon degeneration or from a single traumatic event but commonly a combination of these factors are in play. Rotator cuff tendon degeneration and accidental falls are both known to increase in incidence with increasing age. No study to date has sought to investigate the characteristic of accidental falls as a significant cause of injury in the rotator cuff tear population. We developed a 25 multi-step item questionnaire to investigate the source of injury in sixty rotator cuff tear patients. The majority, 32/60 (53.3%), reported a fall associated with their rotator cuff tear. The tears nearly always occurred on the same side as the fall. Most falls resulting in cuff tears were to the side and front rather than backwards. Our findings highlight that falls are the leading cause of injury in the rotator cuff tear patient population and describe characteristics of the previously under-recognized fall-related rotator cuff tear population.
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Muto, Tomoyuki, Hiroaki Inui, Hiroki Ninomiya, Hiroshi Tanaka, and Katsuya Nobuhara. "Characteristics and Clinical Outcomes in Overhead Sports Athletes after Rotator Cuff Repair." Journal of Sports Medicine 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/5476293.

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Rotator cuff tears in young overhead sports athletes are rare. The pathomechanism causing rotator cuff tears in young overhead athletes is different from that in aged patients. The purpose of this study was to investigate rotator cuff tear characteristics in young overhead sports athletes to reveal the pathomechanism causing these injuries. This study included 25 overhead sports athletes less than 30 years old with atraumatic rotator cuff tears necessitating repair. Rotator cuff tear characteristics were evaluated intraoperatively, including rotator cuff tear shape and injured rotator cuff tendon. Clinical outcome measures were assessed before surgery and at the final follow-up. In this study, 22 patients reported minimal to no shoulder pain and returned to sports without significant complaints at last follow-up. The isolated infraspinatus tendon was most often injured; the incidence rate of the tear at this site was 32% (8 cases). In the deceleration phase of overhead motion, the eccentric contraction force of the ISP (infraspinatus) tendon peaks and the increased load leads to injury at the ISP tendon. The pathomechanism of rotator cuff injuries in young overhead athletes might be not only internal or subacromial impingement, but also these mechanisms.
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Scibek, Jason S., James E. Carpenter, and Richard E. Hughes. "Rotator Cuff Tear Pain and Tear Size and Scapulohumeral Rhythm." Journal of Athletic Training 44, no. 2 (March 1, 2009): 148–59. http://dx.doi.org/10.4085/1062-6050-44.2.148.

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Abstract Context: The body of knowledge concerning shoulder kinematics in patients with rotator cuff tears is increasing. However, the level of understanding regarding how pain and tear size affect these kinematic patterns is minimal. Objective: To identify relationships between pain associated with a full-thickness rotator cuff tear, tear size, and scapulohumeral rhythm (SHR) and to determine whether pain and tear size serve as predictors of SHR. Design: A test-retest design was used to quantify pain and SHR before and after a subacromial lidocaine injection. Correlation and multivariate analyses were used to identify relationships among pain, tear size, and SHR. Setting: Orthopaedic biomechanics research laboratory. Patients or Other Participants: Fifteen patients (age range, 40–75 years) with diagnosed full-thickness rotator cuff tears participated. They were experiencing pain at the time of testing. Intervention(s): Shoulder kinematic data were collected with an electromagnetic tracking system before and after the patient received a lidocaine injection. Main Outcome Measure(s): Pain was rated using a visual analog scale. Three-dimensional scapular kinematics and glenohumeral elevation were assessed. Scapular kinematics included anterior-posterior tilt, medial-lateral tilt, and upward-downward rotation. A regression model was used to calculate SHR (scapular kinematics to glenohumeral elevation) for phases of humeral elevation and lowering. Results: Linear relationships were identified between initial pain scores and SHR and between tear size and SHR, representing an increased reliance on scapular motion with increasing pain and tear size. Pain was identified as an independent predictor of SHR, whereas significant findings for the effect of tear size on SHR and the interaction between pain and tear size were limited. Conclusions: We noted an increased reliance on scapular contributions to overall humeral elevation with increasing levels of pain and rotator cuff tear size. Pain associated with a rotator cuff tear serves as a primary contributor to the kinematic patterns exhibited in patients with rotator cuff tears.
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Ecklund, Kier J., Thay Q. Lee, James Tibone, and Ranjan Gupta. "Rotator Cuff Tear Arthropathy." Journal of the American Academy of Orthopaedic Surgeons 15, no. 6 (June 2007): 340–49. http://dx.doi.org/10.5435/00124635-200706000-00003.

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Dissertations / Theses on the topic "Rotator cuff tear"

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Björnsson, Hallgren Hanna Cecilia. "Treatment of subacromial pain and rotator cuff tears." Doctoral thesis, Linköpings universitet, Ortopedi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-82094.

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Shoulder pain is very common, affecting 14-21 % of the population at some time during their lifetime. The aims of this thesis were to improve the understanding of various aspects concerning the pathogenesis and treatment of subacromial pain and rotator cuff tears. Patients and healthy individuals were examined and compared in five studies: Study I) Seventy patients were retrospectively examined, clinically and with ultrasound, 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at surgery. Ultrasound showed significantly fewer rotator cuff tears compared to the prevalence of asymptomatic tears reported in the literature for the same age group. This indicates that arthroscopic subacromial decompression might protect the rotator cuff. Study II) Forty-two patients were retrospectively examined, clinically and with ultrasound, 39 months (mean) after an acute rotator cuff repair. All patients had pseudoparalysis after trauma, a full thickness tear and no previous history of shoulder symptoms. A delay in surgical treatment of three months and the number of tendons injured did not affect the outcome. Age affected outcome negatively. Study III) Plasma samples from 17 patients with cuff tears and 16 plasma samples from healthy age- and gender-matched controls were collected and analysed regarding the levels of matrix metalloproteinases and their inhibitors, TIMP1-4. Elevated levels of TIMP-1 were found in the patients with cuff tears compared to controls. Higher levels of TIMP-1, TIMP-3 and MMP-9 were found in patients with full-thickness tears compared to patients with partial-thickness tears. Study IV) Ninety-seven patients with longstanding subacromial pain, on the waiting-list for arthroscopic subacromial decompression, were prospectively randomised to specific shoulder exercises or control exercises for three months. Thereafter they were clinically examined and asked if they still wanted surgery. The specific shoulder exercises focusing on eccentric exercise for the rotator cuff and scapula stabilisers were found to be effective in reducing subacromial pain and improving shoulder function, thereby reducing the need for surgery. Study V) All patients including those operated, in Study IV were re-examined after one year using clinical assessment scores. The option of surgery was continuously available up to the one-year follow-up. Ultrasound and radiological examinations performed at inclusion were analysed in relation to the choice of surgery. The positive effects of the specific exercise programme were maintained after one year and significantly fewer patients in this group chose surgery. Surgery was significantly more often chosen by patients who had a low baseline shoulder score, and/or a full thickness rotator cuff tear.  All patients showed significant improvement in the clinical scores one year after inclusion or one year after surgery. These results support the concept that subacromial pain has a multifactorial aetiology and that the first line of treatment should be specific shoulder exercises. When conservative treatment fails, an acceptable result can be achieved with arthroscopic subacromial decompression. The rotator cuff status is important to consider when treating and studying these patients.
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Meyer, Dominik. "Changes in the muscles of the rotator cuff following tendon tear /." Zürich, 2005. http://opac.nebis.ch/cgi-bin/showAbstract.pl?sys=000254621.

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Braun, Cordula. "Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears." Thesis, Teesside University, 2016. http://hdl.handle.net/10149/621790.

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Rotator cuff disorders encompass a range of impairments from tendinopathy to partialor full-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain. Rotator cuff tears, most of which are atraumatic, are common in adults with shoulder pain and are strongly associated with increasing age. Conservative treatment including physiotherapy is the first-line treatment, but some patients do not respond, and ultimately require surgery. Early predictions of response could allow individuals’ care pathways to be optimised, preventing unnecessary delays and suffering and benefiting patients and healthcare providers alike. My primary aim was to develop a prognostic model for the outcome of physiotherapy in adults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This was addressed by a prospective prognostic model study. The study was underpinned by a systematic review of prognostic models in adults undergoing physiotherapy for painful rotator cuff disorders and was further informed and complemented by the following work: the development and validation of the physiotherapy protocol for the prognostic study; the identification, selection and definition of the candidate prognostic factors for the prognostic study; the estimation of the Minimal Important Difference (MID) of the study’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC); and an exploratory responder analysis of the WORC outcome scores. The prognostic systematic review, prognostic study, MID analysis and responder analysis are original contributions to knowledge. The prognostic systematic review revealed important methodological deficiencies in the five included studies, and no clinically usable model. No study addressed a distinct PTT population. The process of identifying factors for my own prognostic model study revealed a lack of knowledge about the prognostic relevance of factors. All of the candidate models I explored in my prognostic study (n sample = 65, n analysed = 61) had low performance and precision. The estimated MID of the WORC was -300. The responder analysis resulted in different proportions of responders to treatment depending on the responder definition. My results highlight the difficulties involved in predicting outcomes in the field of shoulder pain and rotator cuff disorders, and the need for methodologically sound prognosis research.
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MacIntyre-Newell, Meaghan. "Vascular Changes in the Supraspinatus Muscle and Association with Intramuscular Fat Accumulation: An Experimental Study in Rabbits." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37835.

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Supraspinatus (SSP) tendon tear leads to intramuscular fat accumulation in the SSP muscle and the mechanisms are currently unknown. The purpose of this study was to investigate changes in vascularization of the SSP muscle and the relationship to intramuscular fat accumulation following SSP tendon detachment with or without reattachment. One hundred and six rabbits underwent SSP tendon detachment. In groups of ten, thirty rabbits were sacrificed 4, 8, and 12 weeks following detachment. Forty rabbits underwent detachment and immediate reattachment and were sacrificed in groups of ten following 0, 1, 2, and 6 weeks of healing. In groups of twelve, the remaining thirty-six rabbits underwent SSP tendon reattachment 4, 8, and 12 weeks after detachment and were sacrificed 12 weeks later. Vascularization was quantified in each specimen using CD31 immunohistochemistry. Four weeks after SSP tendon detachment, there was an increase in vascularization of the distal SSP muscle that reached significance after 12 weeks of detachment (p=0.024). We found that vascularization was positively correlated with intramuscular fat accumulation after detachment only (r=0.29; p=0.008). After SSP tendon reattachment, immediate or delayed, the correlation between vascularization and intramuscular fat accumulation was not observed. Microscopically, some SSP muscle vascular structures in the reattachment group had thicker vascular walls which were further quantified using αSMA immunohistochemistry. The delayed reattachment group showed an increase in vascular wall thickness in the distal portion of the SSP muscle at 4+12 (p=0.012) and 12+12 (p=0.012) weeks and in the proximal portion at 4+12 (p=0.024) weeks. Further investigation is required to demonstrate a cause/effect relationship between increased vascularization and intramuscular fat accumulation in the context of rotator cuff tear and success of surgical repair.
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Canducci, Martina. "Gestione Chirurgica e Gestione Conservativa a confronto nella Lesione di Cuffia dei Rotatori: Revisione Sistematica della Letteratura." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2020. http://amslaurea.unibo.it/21907/.

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Background: la lesione di cuffia dei rotatori è la seconda patologia muscoloscheletrica più comune dopo la lombalgia ed è il disturbo di spalla più comune per il quale i pazienti necessitano di terapia. Per lesione o rottura di cuffia si intende lo strappo del tessuto tendineo con la parziale o totale disinserzione dalla superficie ossea che causa dolore alla spalla, perdita di movimento, debolezza e limitazioni nello svolgimento delle ADL. Il trattamento include la riparazione chirurgica e la fisioterapia, ma non è ancora presente un’opinione dominante su quale sia il trattamento più efficace per la risoluzione di questo quadro patologico. Obiettivo: analizzare studi di ricerca primaria che comparano l'efficacia della gestione chirurgica rispetto alla conservativa nel trattamento delle lesioni di cuffia degenerative, efficacia valutata in termini di miglioramento della sintomatologia dolorosa e disabilità (CMS). Disegno dello Studio: Revisione Sistematica costruita seguendo la traduzione italiana del PRISMA Statement (Fondazione GIMBE). Criteri di Eleggibilità: Studi Controllati Randomizzati (RCTs) con partecipanti affetti da lesione di cuffia degenerativa che indagano il miglioramento di dolore e disabilità rispettivamente nelle due tipologie di intervento. Fonti di ricerca: Gli studi primari sono stati reperiti nelle seguenti banche dati: PubMed, PEDro e Cochrane Library, cercando dall'incipit fino ad aprile 2020. Risultati: sono stati inclusi 3 studi. A tutti è stata applicata la PEDro Scale per la valutazione della validità interna. Tutti gli studi hanno riportato un punteggio ≥ 6, che riflette un’alta qualità metodologica. Conclusioni: gli studi inclusi non hanno dimostrato un chiaro beneficio in favore della chirurgia soprattutto nel breve termine dove si riscontrano minime differenze fra i due tipi di intervento. Sono dunque necessari ulteriori studi che determinino l’efficacia comparativa dei due interventi principalmente nel lungo termine.
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Kisieliūtė, Eglė. "Peties sąnario mobilizacijos ir pratimų efektyvumas gydant peties sąnario sukamosios manžetės plyšimus." Bachelor's thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130910_083134-69331.

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Tyrimo objektas: Peties sąnario judesių amplitudės, raumenų jėgos, skausmo ir funkcinio pajėgumo pokyčiai taikant pratimus ir peties sąnario mobilizaciją po peties sąnario sukamosios manžetės plyšimo operacijos. Temos aktualumas. Peties sąnario sukamosios manžetės plyšimai dažnai lemia peties sąnario skausmus ir įvairaus pobūdžio negalią vyresniame amžiuje (Khair & Gulotta, 2011). Šią traumą patiria apie 25,0 proc. vyresnių nei 60 m žmonių ir apie 20,0 proc. vyresnių nei 20 m žmonių (Itoj, 2013). Lietuvoje yra atlikta nedaug tyrimų apie peties sąnario sukamosios manžetės plyšimus. Užsienio autoriai daugiau tyrinėja peties sąnario mobilizacijos ir pasyvių techninkų efektyvumą sergant peties ankšumo sindromu, artritu, artroze ir kitomis ligomis. Ypač trūksta informacijos apie gydymą, kuris leistų pacientams išvengti operacijos. Daugelis autorių nurodo, jog reikalingi išsamesni tyrimai šioje srityje. Tyrimo tikslas: įvertinti peties sąnario mobilizacijos ir pratimų efektyvumą gydant peties sąnario sukamosios manžetės plyšimus. Tyrimo uždaviniai: 1. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos paties sąnario judesių amplitudę, raumenų jėgą, skausmą ir funkcinį pajėgumą prieš kineziterapiją. 2. Įvertinti peties sąnario mobilizacijos ir gydomųjų pratimų poveikį pacientų peties sąnario judesių amplitudei, raumenų jėgai, skausmui ir funkciniam pajėgumui po sukamosios manžetės plyšimo operacijos. 3. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos judesių... [toliau žr. visą tekstą]
Object: The change of shoulder range of motion, muscle strength, pain and functional capacity after taking exercises and shoulder joint mobilization for patients after rotator cuff tear reconstruction surgery. Relevance of the topic. In elder age shoulder pain and various disabilities often occur because of the rotator cuff tears (Khair & Gulotta, 2011). 25,0 percent of population over 60 years and 20,0 percent of population over 20 years suffer from this injury (Itoj, 2013). Foreigner scientists more often make studies about the effectiveness of shoulder joint mobilization and other passive physical therapy techniques in curing other shoulder illnesses such as impingement syndrome, arthritis and ect. Especially there is lack of information about treatment that would prevent patients from surgery. Many scientists indicate that more studies are necessary about this topic. Task. The aim of this study was to evaluate the effectiveness of shoulder joint mobilization and therapeutic exercises curing rotator cuff tears. The main goals of this study were: 1. To evaluate range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear arthroscopic reconstruction surgery. 2. To evaluate effectiveness of shoulder joint mobilization and therapeutic exercises for range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear reconstruction surgery. 3. To evaluate how shoulder... [to full text]
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Simon, Dominic William Neil. "A comparison of the behaviour of cultured osteoblastic cells derived from the humeral tuberosity and the acromion after chronic rotator cuff tear." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.504977.

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Khoschnau, Shwan. "Soft Tissue Aspects of the Shoulder Joint." Doctoral thesis, Uppsala universitet, Ortopedi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-168236.

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The aim of this thesis was to study different aspects of the soft tissues of the shoulder joint. The variation in the quality of the tendons and ligaments can be explained by genetic factors. To test the hypothesis that collagen 1 α1 Sp1 polymorphism is related to the occurrence of cruciate ligament ruptures and shoulder dislocations, a total of 358 patients (233 patients with cruciate ligament ruptures and 126 with shoulder dislocations) were included in the study. We found a decreased risk of these injuries associated with collagen type 1 α1 Sp1 polymorphism. To study the mechanical properties of a better type of fixation of soft tissue to bone, 10 skeletally mature New Zealand white rabbits were operated bilaterally on the knees. The medial collateral ligaments were fixed by two types of plates one with a flat undersurface and the other with a pegged undersurface. After 4 weeks the force at failure, stiffness and energy uptake was almost double in the knees operated with the pegged plates. The prevalence and dysfunction of rotator cuff tears was investigated in 106 subjects who had never sought for their shoulder complaints, using Constant score, ultrasound and plain x-ray. The prevalence of full-thickness cuff tears was 30% (21% of all shoulders). The Constant score was lower in subjects with full-thickness tears. Partial-thickness tears and acromioclavicular joint osteoarthritis had no impact on shoulder complaints or Constant score. The subacromial index was lower for shoulders with full-thickness tears. Forty-eight patients with median age 56 years underwent subacromial decompression with or without acromioclavicular joint resection, investigated with MRI pre- and 3 months postoperatively. The Constant score and subjective shoulder value were measured preoperatively and at 3 and 6 months after surgery and even 2 years for subjective shoulder value. Two raters investigated the MRI. The results showed poor inter-rater reliability for MRI. However, both Constant score and subjective shoulder value improved over time. MRI is not a reliable method to study the capsular reaction after subacromial decompression due to high subjectivity of the radiologists.
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Wang, Fang St George Clinical school UNSW. "Oxidative stress induced C-Jun N-terminal Kinase (JNK) activation in tendon cells upregulates MMP1 mRNA and protein expression." Awarded by:University of New South Wales. St George Clinical school, 2006. http://handle.unsw.edu.au/1959.4/28815.

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To explore the potential mechanisms of tendon degeneration, we investigated the role of c-Jun N-terminal Kinase (JNK) activation and the regulation of matrix metalloproteinase 1 (MMP1) in tendon matrix degradation under oxidative stress. JNK and MMP1 activity in samples from normal and ruptured human supraspinatus tendons were evaluated by immunohistochemistry. Real-time quantitative PCR was utilized to evaluate MMP1 mRNA expression and western blotting for MMP1 and JNK protein detection. JNK activation and increased MMP1 activity were found in the torn human supraspinatus tendon tissue, as well as in human tendon cells under in vitro oxidative stress. Inhibition of JNK prevented MMP1 over-expression in oxidative stressed human tendon cells. Results from the current study indicated that stress activated JNK plays an important role in tendon matrix degradation, possibly through upregulating of MMP1.
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Popp, Ariane Gerber. "Management of irreparable subscapularis tendon tears." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2005. http://dx.doi.org/10.18452/13956.

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Zur Zeit gibt es keinen optimalen Sehnentransfer zur Behandlung von irreparablen Ruptur der Subscapularissehne. Obwohl der Pectoralis major Transfer als Therapie der Wahl gilt, bleibt der Kraftvektor der verlagerten Sehne-Muskeleinheit sehr unterschiedlich zum Kraftvektor des Subscapularismuskels. Das Ziel dieser Arbeit war, ein neues Konzept zur Behandlung von irreparablen Subscapularisrupturen zu definieren, bei dem die Subscapulariseinheit selektiv mittels Teres major(TM) und Pectoralis major (PM) wiederhergestellt wird. In den Kadaverstudien dieser Arbeit konnte gezeigt werden, dass sich der M. Teres major anatomisch-chirurgisch als Sehnentransfer zur Rekonstruktion der unteren Hälfte des M. Subscapularis eignet. Darüberhinaus wurde in einer dreidimensionalen Vektoranalyse gezeigt, dass der Kraftvektoren vom verlagerten Teres major sich nicht signifikant vom Kraftvektoir des unteren Anteils des Musculus subscapularis unterscheidet. Es wurde weiterhin gezeigt, dass Modifikationen des Pectoralis major transfer durch Reroutingmassnahmen zu einer deutlichen Verbesserung seines Kraftvektors im Vergleich zum oberen Amteil des Musculussubscapularis führt. Basierend auf den neuen anatomischen und biomechanischen Erkenntnissen wurde im letzten Teil dieser Schrift das neue Konzept klinisch angewandt. Dabei wurde bei 7 Patienten mit einer irreparablen Subscapularisruptur nach multiplen Voreingriffen eine selektive Rekonstruktion mittels kombinierten TM-PM Transfer durchgeführt. Es traten keine Komplikationen auf und alle Patienten hatten eine deutliche Linderung Ihrer Schmerzen und eine Verbesserung der Funktion. Somit erscheint diese neue Transferoperation eine sichere und effiziente Option zur Behandlung irreparabler Subscapularisrupturen darzustellen.
Currently there is no optimal tendon transfer procedure for the management of irreparable subscapularis lesions. Although the pectoralis major transfer is considered as the gold standard in the treatment of irreparable subscapularis tears, the force vector orientation of this transfer may not be optimal in comparision to the situation at the subscapularis muscle. Objective of this monograph was to establish the anatomical and biomechanical basis for a new concept of selective subscapularis reconstruction combining a teres major transfer to the pectoralis major transfer. In the cadaveric part of this work, it could be demonstrated that the teres major is a safe and biomechanically logical transfer for reconstruction of the lower part of the subscapularis. The analysis was carried on to define the optimal transfer for reconstruction of the upper part of the subscapularis. It was possible to determine the biomechanical effect of rerouting procedures of the pectoralis major transfer. Passing the tendon underneath the conjoined tendon appeared to be the most effective way to improve the direction of the pectoralis major transfer for subscapularis reconstruction. However this technique is demanding when the plane underneath the conjoined tendon is scarred and the pectoralis major is bulky. In such cases there is a risk to injure the musculocutaneous nerve. Therefore, rerouting the sternal part of the pectoralis major underneath its clavicular part (sPM tansfer) may be a safer option. Finally, based on the acquired anatomical and biomechanical data, early clinical experience in a series of 7 patients was reported. Although the clinical series was small, the combined TM-sPM transfer appeared to be a valuable and a safe alternative to treat irreparable subscapularis tears. An interesting observation in this study was that the transfer was able to recenter the statically subluxed humeral head in two cases. This could be attributed to the dynamic hammock built by the transferred teres major. The early promising subjective and objective results presented here encourage for further investigation.
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Books on the topic "Rotator cuff tear"

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Rotator cuff tear. Basel: Karger, 2011.

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Gumina, Stefano, ed. Rotator Cuff Tear. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-33355-7.

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Gulotta, Lawrence V., and Edward V. Craig, eds. Massive Rotator Cuff Tears. Boston, MA: Springer US, 2015. http://dx.doi.org/10.1007/978-1-4899-7494-5.

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Sampaio Gomes, Nuno, Ladislav Kovačič, Frank Martetschläger, and Giuseppe Milano, eds. Massive and Irreparable Rotator Cuff Tears. Berlin, Heidelberg: Springer Berlin Heidelberg, 2020. http://dx.doi.org/10.1007/978-3-662-61162-3.

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Hamil, Douglas P. Effectiveness of nonoperative and operative treatments for rotator cuff tears. Hauppauge, N.Y: Nova Science Publishers, 2011.

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Maffulli, N., ed. Rotator Cuff Tear. S. Karger AG, 2011. http://dx.doi.org/10.1159/isbn.978-3-8055-9815-6.

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Gumina, Stefano. Rotator Cuff Tear: Pathogenesis, Evaluation and Treatment. Springer, 2016.

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Gumina, Stefano. Rotator Cuff Tear: Pathogenesis, Evaluation and Treatment. Springer, 2018.

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Tumber, Paul Singh, and Philip W. H. Peng. Peripheral Nerve Blocks in Chronic Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0037.

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Ultrasound-guided nerve blockade for chronic pain offers advantages over blind landmark-based and fluoroscopic techniques. It allows visualization of soft-tissue structures and spread of the injectate while limiting ionizing radiation exposure. Interventionalists must have both a clear understanding of the anatomy that is being visualized on the ultrasound image and the ability to safely place a needle to the desired target site. Neural blockade of the suprascapular nerve can be useful in the management of chronic shoulder pain such as adhesive capsulitis, frozen shoulder, rotator cuff tear, and glenohumeral arthritis. Intercostal nerve blocks can be helpful for painful conditions that affect the thorax or upper abdomen. The lateral femoral cutaneous nerve local anesthetic block may provide analgesia for procedures involving the region, such as skin harvesting. The pudendal nerve block may be useful for diagnostic or therapeutic purposes in certain cases of chronic pelvic pain involving pudendal neuralgia.
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Reilly, Peter. Pathology of cuff tears. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.004002.

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♦ Rotator cuff tears are common♦ Aetiology complex and multifactorial♦ Tendons deteriorate with age♦ Posterosuperior tears are more common♦ They evolve in a typical fashion♦ Anterosuperior tears are less common.
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Book chapters on the topic "Rotator cuff tear"

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Carbone, Stefano, and Stefano Gumina. "Rotator Cuff Biomechanics." In Rotator Cuff Tear, 45–51. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-33355-7_3.

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Longo, Umile Giuseppe, Alessandra Berton, Nicola Papapietro, Nicola Maffulli, and Vincenzo Denaro. "Epidemiology, Genetics and Biological Factors of Rotator Cuff Tears." In Rotator Cuff Tear, 1–9. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328868.

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Longo, Umile Giuseppe, Alessandra Berton, Nicola Papapietro, Nicola Maffulli, and Vincenzo Denaro. "Biomechanics of the Rotator Cuff: European Perspective." In Rotator Cuff Tear, 10–17. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328870.

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Karas, Vasili, Brian J. Cole, and Vincent M. Wang. "Role of Biomechanics in Rotator Cuff Pathology: North American Perspective." In Rotator Cuff Tear, 18–26. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328871.

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Porcellini, Giuseppe, Francesco Caranzano, Fabrizio Campi, and Paolo Paladini. "Instability and Rotator Cuff Tear." In Rotator Cuff Tear, 41–52. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328876.

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Kibler, W. Ben. "The Scapula in Rotator Cuff Disease." In Rotator Cuff Tear, 27–40. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328877.

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Oliva, Francesco, Stefano Gatti, Giuseppe Porcellini, Nicholas R. Forsyth, and Nicola Maffulli. "Growth Factors and Tendon Healing." In Rotator Cuff Tear, 53–64. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328878.

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Snyder, Garrett M., Scott D. Mair, and Christian Lattermann. "Tendinopathy of the Long Head of the Biceps." In Rotator Cuff Tear, 76–89. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328880.

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Longo, Umile Giuseppe, Alessandra Berton, Andrea Marinozzi, Nicola Maffulli, and Vincenzo Denaro. "Subscapularis Tears." In Rotator Cuff Tear, 114–21. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328886.

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Franceschi, Francesco, Rocco Papalia, Alessio Palumbo, Angelo Del Buono, Nicola Maffulli, and Vincenzo Denaro. "Operative Management of Partial- and Full-Thickness Rotator Cuff Tears." In Rotator Cuff Tear, 100–113. Basel: KARGER, 2011. http://dx.doi.org/10.1159/000328888.

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Conference papers on the topic "Rotator cuff tear"

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Oh, Joo Han, Bong-Jae Jun, Michelle H. McGarry, and Thay Q. Lee. "Biomechanical Evaluation of Rotator Cuff Tear Progression and the Influence of Parascapular Muscle Loading." In ASME 2009 4th Frontiers in Biomedical Devices Conference. ASMEDC, 2009. http://dx.doi.org/10.1115/biomed2009-83138.

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Rotator cuff tears (RCT) commonly start at the anterior insertion of the supraspinatus and have been shown to propagate posteriorly. Early detection and repair of small or medium size tears has been shown to result in better clinical outcome and structural integrity than that of large or massive tears. However, it is unknown at which stage of rotator cuff tear propagation the biomechanical environment becomes altered. Previous biomechanical studies have not considered rotator cuff propagation based on the footprint anatomy, rotational glenohumeral joint kinematics, and the influence of anatomy-based muscle loading including pectoralis major and latissmus dorsi. Therefore, the purpose of this study was to determine the relationship between progressive rotator cuff tear and glenohumeral joint biomechanics using a rotator cuff tear progression model and anatomically based muscle loading including the influence of the pectoralis major and latissmus dorsi. Our hypotheses were 1) cuff tear progression will lead to abnormal glenohumeral joint biomechanics, specifically in kinematics (rotational range of motion and the path of humeral head apex) and abduction capability and 2) the pectoralis major and latissmus dorsi muscles will act as a stabilizer of the humeral head in large or massive tear.
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McGarry, Michelle H., Jennifer L. Bissell, Bruce Y. Yang, Ranjan Gupta, and Thay Q. Lee. "Effects of Supraspinatus Tear and Repair on Glenohumeral Joint Biomechanics." In ASME 2002 International Mechanical Engineering Congress and Exposition. ASMEDC, 2002. http://dx.doi.org/10.1115/imece2002-33024.

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Rotator cuff tears are common injuries seen by orthopaedic surgeons. Management may vary depending on patient factors, size and location of tear, and severity of symptoms. Treatment for symptomatic rotator cuff tear often includes subacromial decompression, debridement, and/or repair. The objective of this study was to determine the change in glenohumeral joint (GHJ) forces after repair of pathologic supraspinatus tears.
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Derwin, Kathleen A., and Joseph P. Iannotti. "Augmentation Devices for Rotator Cuff Repair." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53610.

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Rotator cuff tears affect 40% or more of those over age 60 and are a common cause of pain and disability. Surgical repairs have high failure rates that range from 20 to 90%. Currently, scaffolds derived from various natural and synthetic biomaterials are being marketed as augmentation devices for rotator cuff repairs at the time of surgery 1–3. The US Food and Drug Administration (FDA) has cleared these devices “to support soft tissues where weakness exists” but not “to provide the full mechanical strength for the tendon repair”. Based on the mechanical connotation of their intended use, it is commonly believed that when applied appropriately, these devices may provide some degree of load sharing of forces across the tendon repair site and thus decrease the likelihood of tendon re-tear.
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Reuther, Katherine E., Stephen J. Thomas, Joseph J. Sarver, Jennica J. Tucker, Chang-Soo Lee, Chancellor F. Gray, David L. Glaser, and Louis J. Soslowsky. "Massive Cuff Tears Alter Joint Function and Decrease Cartilage Mechanics Following Return to Overuse Activity in a Rat Model." In ASME 2012 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/sbc2012-80072.

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Rotator cuff tendon tears are common conditions which can alter shoulder joint function and over time, cause secondary damage to the surrounding tissues, including the cartilage and other remaining tendons. Glenohumeral joint stability is dependent on a dynamic balance between rotator cuff forces, in particular the subscapularis anteriorly and the infraspinatus posteriorly. An intact rotator cuff stabilizes the joint, allowing for concentric rotation of the humeral head on the glenoid. However, a massive rotator cuff tear involving the supraspinatus and infraspinatus may disrupt the normal balance of forces at the joint, resulting in abnormal joint loading. This is of particular concern in populations who perform activities requiring repeated overhead activity (e.g., laborers, athletes). Our lab has previously demonstrated that restoration of the subscapularis-infraspinatus anterior-posterior force balance improves shoulder function by providing a stable fulcrum for concentric rotation of the humeral head on the glenoid [1]. However, the long term consequences caused by disruption of the anterior-posterior force balance (supraspinatus and infraspinatus tear) on the glenoid cartilage and adjacent (intact) tendons, particularly in the case of an overuse population, remains unknown. Therefore, the objective of this study was to investigate the effect of disrupting the anterior-posterior force balance on joint function and joint damage using a clinically relevant overuse model system. We hypothesized that a disrupted anterior-posterior force balance (supraspinatus and infraspinatus tear) would result in H1) decreased joint function and H2) inferior adjacent tissue (glenoid cartilage, biceps and subscapularis tendon) properties compared to an intact anterior-posterior force balance (supraspinatus only tear).
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Thomas, Stephen J., Joseph J. Sarver, Jennica Tucker, Katherine Reuther, Lena Edelstein, Sarah Ilkhani-Pour, Chancellor Gray, Chang Soo Lee, David L. Glaser, and Louis J. Soslowsky. "The Effect of Return to Overuse Activity After a Supraspinatus Tear on Joint Function and Biceps Mechanical Properties in a Rat Model." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53660.

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Rotator cuff tendon tears are one of the most common shoulder injuries and are most prevalent in populations performing repetitive overhead activities [1]. In addition, long head of the biceps (LHB) tendon injuries occur secondary to cuff tears and may or may not lead to functional deficits [2]. Previous animal model studies have found that in the presence of a cuff tear, the biceps has decreased mechanical properties at 8 weeks [3]. Such studies, however, did not examine the effect of repetitive overhead activity on biceps properties and shoulder function in the presence of a cuff tear. Therefore, the objective of this study was to evaluate the effect of returning to overuse activity after a supraspinatus tendon tear on shoulder function and biceps structural and mechanical properties. We hypothesized that overuse activity following a supraspinatus tendon tear would not alter shoulder function, when compared to cage activity, but would decrease biceps structural and mechanical properties, particularly at the insertion site.
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Park, Maxwell C. "Arthroscopic Challenges in Treating Rotator Cuff Tears of the Shoulder." In ASME 2009 4th Frontiers in Biomedical Devices Conference. ASMEDC, 2009. http://dx.doi.org/10.1115/biomed2009-83056.

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Rotator cuff tears can be the source of significant morbidity. Impingement syndrome involving repetitive and prolonged mechanical irritation of the rotator cuff against the roof of the shoulder creates a progression of disease. Chronic tendon inflammation can lead to structural loss of integrity, leading to partial tears, and if left unchecked, full-thickness tears. Currently, the surgeon has the ability to repair full-thickness tears using minimally invasive techniques. However, the persistent tear rate after repair is remarkably high, more than 50% in some studies. One surgical goal is to alter progression of disease, and repair partial-thickness tears, for example. Another goal is to optimize the healing environment with the repair construct itself, accounting for biomechanical considerations. When using an arthroscopic approach, the challenges for treating partial- versus full-thickness tears varies significantly given anatomic restrictions—particularly, during repair of partial-thickness tears, the surgeon is “blind” for portions of the procedure as the arthroscope is typically placed intra-articularly, while instruments are passed from above the tendon, extra-articularly. Ideally, new technologies can be developed to optimize rotator cuff repair and healing in this setting.
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Jun, Bong Jae, Joo Han Oh, Michelle H. McGarry, Akash Gupta, Kyung Chil Chung, James Hwang, and Thay Q. Lee. "Restoration of Shoulder Biomechanics in the Massive Rotator Cuff Tear According to Degree of Repair Completion." In ASME 2010 5th Frontiers in Biomedical Devices Conference. American Society of Mechanical Engineers, 2010. http://dx.doi.org/10.1115/biomed2010-32049.

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The development of new instruments and surgical techniques has improved the outcome of rotator cuff repair even with massive tears. Based on cuff integrity or amount of retraction with massive cuff tears a complete repair may not be possible allowing for only partial repair. The ability to mobilize the cuff to the footprint can affect the degree of partial repair that can be performed. Partial repair may lead to abnormal biomechanics that may predispose patients to limited function and subsequent pathology following rotator cuff repair. Therefore, the purpose of this study is to compare the biomechanical characteristics of massive rotator cuff repair according to the degree of repair completion and to determine a minimum degree of repair required to restore normal biomechanics.
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Adams, Corinne R., Mark A. Baldwin, Peter J. Laz, Paul J. Rullkoetter, and Joseph E. Langenderfer. "Development of a Computational Model to Study Effects of Rotator Cuff Tear Size and Location on Muscle Moment Arms." In ASME 2007 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2007. http://dx.doi.org/10.1115/sbc2007-176401.

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Rotator cuff tendon tear causes alterations to cuff muscle architecture and tendons including muscle fascicle contracture and increased tendon length, fatty infiltration of the muscle fibers, muscle fiber pennation angle changes, asymmetric muscle atrophy, and altered muscle fiber type composition, e.g. [1]. These changes ultimately result in a reduction in muscle force, and frequently lead to a reduction of shoulder strength and a loss of functionality. Recently, division of the cuff tendons in a manner related to cuff tear has been shown to alter tendon excursions and cause muscle moment arms reductions in a cadaver experiment [2] and a computational study [3]. Evaluations of the effects of cuff tear size and location on cuff muscle moment arms have not been conducted. Consequently, the mechanisms by which the muscle force and moment arm changes affect joint strength are not well understood. An improved understanding of these relationships would increase potential for rehabilitation of joint strength following cuff repair. Models for evaluating rotator cuff tear are non-existent since subject-specific models have focused on healthy normal shoulders. Consequently, models have not been used to quantify the effects of clinically observed changes in muscle and tendon architecture on muscle moment arm and force generating capacity.
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Aurora, Amit, Jorge E. Gatica, Antonie J. van den Bogert, Jesse A. McCarron, and Kathleen A. Derwin. "A Biomechanical Model for Augmented Human Rotator Cuff Repairs." In ASME 2010 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2010. http://dx.doi.org/10.1115/sbc2010-19248.

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Rotator cuff tears affect 40% or more of those over age 60 and are a common cause of pain and disability. Surgical repairs have high failure rates that range from 20 to 90%. Hence, natural and synthetic scaffolds are being developed to mechanically augment tendon repairs and to biologically enhance the intrinsic healing potential of the patient. When used as an augmentation device, scaffolds are believed to provide some degree of load sharing in a manner that decreases the likelihood of tendon re-tear. While significant advances are being made in the development of scaffolds, no studies have investigated the degree of load sharing provided by a scaffold used for rotator cuff repair augmentation. Furthermore, the manner in which loads on an augmented rotator cuff repair are distributed amongst the various components of the repair is not known, nor is the relative biomechanical importance of the various components of the repair. To answer these questions, the objectives of this study are to (1) develop quasi-static analytical models of simplified rotator cuff repairs, (2) validate the models by comparing the predicted model force to experimental measurements of force for human rotator cuff repairs, and (3) use the models to predict the degree of load sharing provided by a scaffold used for rotator cuff repair augmentation.
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Muto, Tomoyuki, Hiroaki Inui, Hiroshi Tanaka, Kazuki Ishiro, Kento Morita, Hiroki Ninomiya, Masahiko Komai, et al. "MRI-based 3D-shape model improves diagnosis of rotator cuff tear." In 2017 6th International Conference on Informatics, Electronics and Vision & 2017 7th International Symposium in Computational Medical and Health Technology (ICIEV-ISCMHT). IEEE, 2017. http://dx.doi.org/10.1109/iciev.2017.8338514.

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Reports on the topic "Rotator cuff tear"

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Xiang, Xiao-Na. Platelet-Rich Plasma as a conservative treatment for partial-thickness rotator cuff tear and tendinopathy: A Systematic Review and Meta-analysis. INPLASY - International Platform of Registered Systematic Review Protocols, April 2020. http://dx.doi.org/10.37766/inplasy2020.4.0144.

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Little to choose between open and keyhole surgery as options for repairing shoulder rotator cuff tears. National Institute for Health Research, December 2015. http://dx.doi.org/10.3310/signal-000155.

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