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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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Kelly, John D. "Massive Rotator Cuff Tear." Orthopedics 36, no. 8 (August 1, 2013): 625–27. http://dx.doi.org/10.3928/01477447-20130724-08.
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Rhee, Yong Girl, Chang Hyun Cho, Moo Song Park, and Dae Woo Hwang. "Massive Rotator Cuff Tear." Journal of the Korean Orthopaedic Association 35, no. 5 (2000): 791. http://dx.doi.org/10.4055/jkoa.2000.35.5.791.
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&NA;. "Acute Rotator Cuff Tear." Ultrasound Quarterly 23, no. 2 (June 2007): 154–55. http://dx.doi.org/10.1097/01.ruq.0000277030.07759.fb.
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Jeong, Jin Young, and Hong Eun Cha. "Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear." Clinics in Shoulder and Elbow 17, no. 3 (January 1, 2014): 145–50. http://dx.doi.org/10.5397/cise.2014.17.3.145.
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In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.
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Kamath, Surendra Umesh, and Sunil Murthy. "DOES HYPERCHOLESTOLEMIA PREDISPOSE TO ROTATOR CUFF PATHOLOGIES?" Asian Journal of Pharmaceutical and Clinical Research 10, no. 4 (April 1, 2017): 373. http://dx.doi.org/10.22159/ajpcr.2017.v10i4.16883.
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Background: Rotator cuff tear are one of most common orthopedic musculoskeletal problem gaining importance due to large health scale expenditure. Causes of rotator cuff tears are multifactorial and unclear. Previous studies have suggested relation between elevated serum lipid profile and rotator cuff tear in western population. We therefore undertook study in our Indian population to correlate association of hypercholesterolemia with rotator cuff tear.Objective: To find association of rotator cuff pathology with hypercholesterolemia in Indian patients.Materials and methods: After obtaining clearance from institutional ethics committee. We prospectively collected fasting lipid samples of population who came to our hospitals with complaints of shoulder pain during our study period. 50 patients had rupture of rotator cuff which was confirmed by ultrasound of involved shoulder. 50 were seen for non-cuff related complaints. We followed strict inclusion and exclusion criteria.Results: Total cholesterol, Triglycerides and low density lipoprotein concentration of patients with rotator cuff tendon tear were on higher side than control group. High density lipoprotein trend showed being lower than control group. 21 of 50 (42%) had high cholesterol (total cholesterol greater than 240mg/dl) than compared to 18 of 50 (36%) in control group. however P value=0.539 and showed no statistical significance between groups.Conclusion: In Indian population there was no correlation between hypercholesterolemia and rotator cuff tear which is statistically significant.Key words Rotator cuff tear, Hypercholesterolemia, Indian population.
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Kim, Jung-Han, and Soo-Hwan Jung. "Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment." Clinics in Shoulder and Elbow 22, no. 3 (September 1, 2019): 159–70. http://dx.doi.org/10.5397/cise.2019.22.3.159.
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Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.
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Nakagawa, Shigeto, Minoru Yoneda, Kenji Hayashida, Shigeyuki Wakitani, and Kenji Okamura. "Greater Tuberosity Notch: An Important Indicator of Articular-Side Partial Rotator Cuff Tears in the Shoulders of Throwing Athletes." American Journal of Sports Medicine 29, no. 6 (November 2001): 762–70. http://dx.doi.org/10.1177/03635465010290061501.
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We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes.
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Jung, Sung-Weon, Jin-Woo Jin, Dong-Hee Kim, Hyeon-Soo Kim, Gwang-Eun Lee, Jin-Woo Kim, and Min-Jae Jang. "Diagnostic value of the axial view of magnetic resonance imaging to identify two-dimensional shapes of full-thickness rotator cuff tears." Acta Radiologica 61, no. 11 (February 20, 2020): 1545–52. http://dx.doi.org/10.1177/0284185120905098.
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Background Coronal and sagittal views of magnetic resonance imaging (MRI) were used to determine rotator cuff tear size and fatty infiltration, but these images were not enough to identify the tear shape. Purpose To correlate the preoperative axial MRI views and arthroscopic surgical findings to identify the two-dimensional shapes in rotator cuff tears. Material and Methods This study included 166 patients who underwent arthroscopic repair between 2015 and 2018. Preoperative coronal, sagittal, and axial MRI views were evaluated for tear size and geographic configuration in axial sections, and the length and the width were measured and were matched with arthroscopic surgical views by lateral portals. Results The agreement of axial MRI views with the arthroscopic view was 88.0% in crescent, 97.2% in longitudinal, 78.6% in massive, and 100% in rotator cuff tear arthropathy. The mean agreement rate of axial MRI views with arthroscopic view was 81.9%. Mean mediolateral and anteroposterior tear sizes on axial MRI were 16.68 mm and 19.33 mm, respectively. Mean mediolateral and anteroposterior tear sizes by arthroscopic view were 21.49 mm and 21.04 mm, respectively. Tear sizes by MRI axial images were 71.3% of arthroscopic view. SST/IST degenerative changes were noted in most patients with massive tears and rotator cuff arthropathy ( P = 0.001). Conclusion Rotator cuff tear shape on preoperative axial MRI view had close agreement (81.9%) with arthroscopic findings by lateral portal, and tear size by preoperative axial MRI views was 71.3% of that of arthroscopic view. Axial MRI views helped to predict the geometric tear shape of rotator cuff tears.
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Watson, Scott, Benjamin Allen, Chris Robbins, Asheesh Bedi, Joel J. Gagnier, and Bruce Miller. "Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?" Orthopaedic Journal of Sports Medicine 6, no. 3 (March 1, 2018): 232596711876310. http://dx.doi.org/10.1177/2325967118763107.
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Background: Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. Purpose: To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. Results: A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Conclusion: Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.
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Kim, Sung Jae, Young Hwan Kim, and Yong Min Chun. "Arthroscopic Partial Repair of Massive Contracted Rotator Cuff Tears." Clinics in Shoulder and Elbow 17, no. 1 (January 1, 2014): 44–47. http://dx.doi.org/10.5397/cise.2014.17.1.44.
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Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.
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Oschman, Z., C. Janse van Rensburg, NGJ Maritz, H. Borain, and R. Owen. "Ultrasound study of the asymptomatic shoulder in patients with a confirmed rotator cuff tear in the opposite shoulder." South African Journal of Sports Medicine 19, no. 1 (March 5, 2007): 23. http://dx.doi.org/10.17159/2078-516x/2007/v19i1a272.
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Objective. To document the incidence of asymptomatic rotator cuff tears in patients with a confirmed symptomatic tear in the opposite shoulder, and to identify ultrasound findings that may distinguish symptomatic from asymptomatic tears. Design. When patients are referred for an ultrasound examination for the confirmation of symptomatic rotator cuff tear the opposite shoulder is often used for comparison. However, patients often have a similar tear on the asymptomatic side. Fifty patients with a confirmed symptomatic rotator cuff tear and an asymptomatic shoulder on the opposite side were chosen for inclusion. The patients were examined using a Siemens Sonoline Elegra 7.5 MHz linear multi-frequency probe. The appearance of the rotator cuff, long head of the biceps and the subacromial-subdeltoid bursa (SASD bursa) were documented. The antero-posterior (AP) dimension of the supraspinatus muscle and fat between the trapezius and supraspinatus muscles were measured, which indicated if a tear was acute or chronic. The width and length of the rotator cuff tear were measured. Setting. Division of Sports Medicine, University of Pretoria. Results. Fifty-four per cent of the asymptomatic shoulders had tears. We found that the symptomatic tears were larger, appeared more chronic and had an associated biceps tendinopathy and glenohumeral joint effusion. Conclusion. As other authors have found, the high incidence of asymptomatic tears indicates that rotator cuff tears can be regarded as a natural correlate of aging and that bilateral tears are common. Initial treatment should be conservative, but larger tears may benefit from early surgery before becoming chronic and causing glenohumeral dysfunction. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 23-28
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Kwon, Jieun, Ye Hyun Lee, Sae Hoon Kim, Jung Hoon Ko, Byung Kyu Park, and Joo Han Oh. "Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases." American Journal of Sports Medicine 47, no. 3 (January 10, 2019): 674–81. http://dx.doi.org/10.1177/0363546518817764.
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Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.
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Park, Jin Woo, Sung Hoon Moon, and Jun Hee Lee. "Comparison of Clinical and Anatomical Outcomes between Delaminated Rotator Cuff Tear and Single Layer Rotator Cuff Tear." Clinics in Shoulder and Elbow 21, no. 4 (December 1, 2018): 207–12. http://dx.doi.org/10.5397/cise.2018.21.4.207.
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BACKGROUND: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears.METHODS: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS).RESULTS: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be 15.46 ± 3.60 mm and 14.17 ± 3.16 mm (p=0.013), and muscle atrophy of SS (occupation ratio) was 60.54 ± 13.15 and 56.55 ± 12.88 (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups.CONCLUSIONS: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.
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Lacheta, Lucca, Alex Brady, Samuel I. Rosenberg, Travis J. Dekker, Ritesh Kashyap, Payam Zandiyeh, Grant J. Dornan, Matthew T. Provencher, and Peter J. Millett. "Superior Capsule Reconstruction With a 3 mm–Thick Dermal Allograft Partially Restores Glenohumeral Stability in Massive Posterosuperior Rotator Cuff Deficiency: A Dynamic Robotic Shoulder Model." American Journal of Sports Medicine 49, no. 8 (June 3, 2021): 2056–63. http://dx.doi.org/10.1177/03635465211013364.
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Background: Superior capsule reconstruction (SCR) has been shown to improve shoulder function and reduce pain in patients with isolated irreparable supraspinatus tendon tears. However, the effects of SCR on biomechanics in a shoulder with an extensive posterosuperior rotator cuff tear pattern remain unknown. Purpose/Hypothesis: The purpose was to (1) establish a dynamic robotic shoulder model, (2) assess the influence of rotator cuff tear patterns, and (3) assess the effects of SCR on superior humeral head translation after a posterosuperior rotator cuff tear. It was hypothesized that a posterosuperior rotator cuff tear would increase superior humeral head translation when compared with the intact and supraspinatus tendon–deficient state and that SCR would reduce superior humeral head translation in shoulders with massive rotator cuff tears involving the supraspinatus and infraspinatus tendons. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders were tested using a robotic arm. Kinematic testing was performed in 4 conditions: (1) intact, (2) simulated irreparable supraspinatus tendon tear, (3) simulated irreparable supra- and infraspinatus tendon tear, and (4) SCR using a 3 mm–thick dermal allograft (DA). Kinematic testing consisted of static 40-N superior force tests at 0°, 30°, 60°, and 90° of abduction and dynamic flexion, abduction, and scaption motions. In each test, the superior translation of the humeral head was reported. Results: In static testing, SCR significantly reduced humeral superior translation compared with rotator cuff tear at all abduction angles. SCR restored the superior stability back to native at 60° and 90° of abduction, but the humeral head remained significantly and superiorly translated at neutral position and at 30° of abduction. The results of dynamic testing showed a significantly increased superior translation in the injured state at lower elevation angles, which diminished at higher elevation, becoming nonsignificant at elevation >75°. SCR reduced the magnitude of superior translation across all elevation angles, but translation remained significantly different from the intact state up to 60° of elevation. Conclusion: Massive posterosuperior rotator cuff tears increased superior glenohumeral translation when compared with the intact and supraspinatus tendon–insufficient rotator cuff states. SCR using a 3-mm DA partially restored the superior stability of the glenohumeral joint even in the presence of a simulated massive posterosuperior rotator cuff tear in a static and dynamic robotic shoulder model. Clinical Relevance: The biomechanical performance concerning glenohumeral stability after SCR in shoulders with large posterosuperior rotator cuff tears is unclear and may affect clinical outcomes in daily practice.
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Shin, Sang-Jin. "Massive Rotator Cuff Tear Repair." Journal of the Korean Shoulder and Elbow Society 13, no. 1 (June 15, 2010): 167–74. http://dx.doi.org/10.5397/cise.2010.13.1.167.
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Lee, Yong-Geol. "Rotator Cuff Tear: Decision Making." Clinics in Shoulder and Elbow 8, no. 2 (December 1, 2005): 57–62. http://dx.doi.org/10.5397/cise.2005.8.2.057.
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Boezaart, André P., Joe F. De Beer, and Karin van Rooyen. "Technical Note: Rotator cuff tear." Arthroscopy: The Journal of Arthroscopic & Related Surgery 16, no. 7 (October 2000): 1–5. http://dx.doi.org/10.1053/jars.2000.16288.
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ESSMAN, JAMES A., ROBERT H. BELL, and MICHAEL ASKEW. "Full-Thickness Rotator-Cuff Tear." Clinical Orthopaedics and Related Research &NA;, no. 265 (April 1991): 170???177. http://dx.doi.org/10.1097/00003086-199104000-00018.
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Goodwin, David Steven, Daniel James Kaplan, David Fralinger, Soterios Gyftopoulos, Robert J. Meislin, and Laith M. Jazrawi. "Rotator Cuff Tear Shape Characterization." Orthopaedic Journal of Sports Medicine 4, no. 7_suppl4 (July 18, 2016): 2325967116S0010. http://dx.doi.org/10.1177/2325967116s00107.
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Haritinian, Emil George, Bogdan Sendrea, and Laurent Nove Josserand. "The Challenges of Arthroscopic Diagnosis of Subscapularis Tears." Revista de Chimie 69, no. 9 (October 15, 2018): 2508–10. http://dx.doi.org/10.37358/rc.18.9.6564.
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Visualisation of subscapularis lesions is difficult during open surgery. Introduction of arthroscopic procedures for rotator cuff surgery improved the diagnosis of subscapularis tears, but it still can be more challenging than for other rotator cuff tendon tears. The SFA classification of subscapularis tears is reproducible and correlates well with the arthroscopic findings. The arthroscopic diagnosis of subscapularis tear is made easier by: shoulder internal rotation, biceps tenodesis, dissection of the rotator interval, recognition of the sentinel and comma signs.
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Takase, Fumiaki, Atsuyuki Inui, Yutaka Mifune, Tomoyuki Muto, Yoshifumi Harada, Takeshi Kokubu, and Masahiro Kurosaka. "Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad”." Case Reports in Orthopedics 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/312968.
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We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture—a “terrible tetrad.” A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.
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Itoigawa, Yoshiaki, Keiichi Yoshida, Hidetoshi Nojiri, Daichi Morikawa, Takayuki Kawasaki, Tomoki Wada, Akihisa Koga, Yuichiro Maruyama, and Muneaki Ishijima. "Association of Recurrent Tear After Arthroscopic Rotator Cuff Repair and Superoxide-Induced Oxidative Stress." American Journal of Sports Medicine 49, no. 8 (May 20, 2021): 2048–55. http://dx.doi.org/10.1177/03635465211014856.
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Background: Recurrent tears after arthroscopic rotator cuff repair (ARCR) remain a significant clinical problem. Oxidative stress contributes to the degeneration of the rotator cuff, and a degenerative rotator cuff can lead to recurrent tear after ARCR. However, the correlation between oxidative stress and retear after ARCR is unclear. Purpose: To investigate the correlation between superoxide-induced oxidative stress and recurrent tear after ARCR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 68 patients who underwent ARCR using a suture-bridge technique participated in this study. Specimens were collected from the edge of the torn tendon during surgery. The modified Bonar score was used to evaluate degeneration of the rotator cuff on histological specimens, and fluorescence intensity on dihydroethidium (DHE) staining was used to detect oxidative stress. Superoxide dismutase (SOD) enzyme activity was also measured. The following were used for clinical evaluation: age, tear size on magnetic resonance imaging (MRI) before surgery, Goutallier classification on MRI before surgery, and Japanese Orthopaedic Association score before and 6 months after surgery. After the repaired rotator cuffs were evaluated on MRI 6 months after surgery, the patients were divided into groups: those with a healed rotator cuff (healed group; n = 46) and those with a recurrent tear (retear group; n = 22). The significant differences between the groups were determined with regard to clinical evaluation, modified Bonar score, DHE intensity, and SOD activity. In addition, multivariate logistic regression analysis was performed to investigate risk factors for recurrent tear. Results: Age, tear size, Goutallier classification, modified Bonar score, DHE intensity, and SOD activity were significantly greater in the retear group than in the healed group, although the Japanese Orthopaedic Association score was not significantly different. Multiple logistic regression analysis demonstrated that age, tear size, and SOD activity were significantly correlated with recurrent tear. Conclusion: In addition to tear size and age, superoxide-induced oxidative stress may be an exacerbating factor for retear after ARCR.
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Chun, Yong-Min. "Irreparable Massive Rotator Cuff Tear: How do I address." Orthopaedic Journal of Sports Medicine 7, no. 11_suppl6 (November 1, 2019): 2325967119S0045. http://dx.doi.org/10.1177/2325967119s00456.
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Despite advances in arthroscopic techniques and devices, symptomatic massive contracted rotator cuff tear is still a challenging to most shoulder surgeons. This rotator cuff tissue has all of the following characteristics; inelastic and friable tendon quality, adhesion and scarring to severely retracted tendon, muscle atrophy and fatty infiltration. All these factors preclude optimal repair without tension1-3. In case of irreparable massive cuff tears, reverse total shoulder arthroplasty has emerged as an appropriate treatment modality for elderly, however the treatment options for younger patients vary from conservative care, simple debridement with biceps tenotomy/tenodesis, tuberoplasty, partial repair, tendon transfer, to biologic augmentation1-7. Moreover, there is no clear guidance yet. Recently, reverse arthroplasty has extended its indication to irreparable massive tears without arthritis in relatively young patients. However, complication rate is relatively high and there is the issue of undetermined longevity6. Particularly, there are not a few cases of internal rotation deficit postoperatively, which is related with personal hygiene8. For that reason, many surgeons prefer to preserve the native joint as long as possible. Regardless of tear size or arthritis, we can often experience cases of relatively good function with tolerable pain in daily living activities. Levy et al reported satisfactory result after reconditioning of the deltoid to compensate for a deficient rotator cuff, however there is a debate of how long it will last. There are many other modalities of conservative treatment such as NSAID medication, corticosteroid injection, physical therapy, strengthening of remaining components of the rotator cuff or deltoid, which can be attempted initial period8. If there is no effect for a long time, surgical options should be considered. Arthroscopic debridement is well suited for older patients with low physical demands and sometimes can be done in combination with tenotomy/tenodesis of long head of biceps6, 9. Lesions of the long head of the biceps tendon is often associated with massive rotator cuff tear, and also not uncommonly responsible for shoulder pain and dysfunction due to its large network of sensory and sympathetic nerve fibers9. Arthroscopic debridement has advantages of short operation time, uncomplicated rehabilitation and low risk of complication. On the other hand, it has only short-term benefit for clinical outcome, and do not improve strength of rotator cuff muscles, moreover cannot decelerate the progression of arthritic change6. Though some researchers investigated that isolated arthroscopic biceps tenotomy/tenodesis improved symptoms in patients with massive irreparable rotator cuff tears9, there is some debate for doing debridement or biceps tenotomy/tenodesis for its own sake. Arthroscopic tuberoplasty, trimming of the greater tuberosity of humerus provides better articulation in coracoacrmomial arch which is important passive stabilizer against anterior and superior humeral head subluxation10, 11. Rhee et al10 reported satisfactory result of arthroscopic tuberoplasty during the minimum follow-up (24 months). They concluded that arthroscopic tuberoplasty can be an option for diminishing pain and improving active forward flexion for irreparable massive rotator cuff tears. Recently, Park et al showed11 8-year follow up study, which supports previous results. It seems to be a good option for those who have significant pain despite of the possible active motion with irreparable massive rotator cuff tears. The conversion of the massive or irreparable rotator cuff tear to a functional rotator cuff tear by means of arthroscopic partial repair has produced satisfactory clinical outcomes by some. Even though the partial repair and margin convergence of the torn rotator cuff tear cannot cover the humeral head completely, the transverse force couple of the rotator cuff can be restored and play an important role as a stable fulcrum for the glenohumeral joint1, 2. Recently, Kim et al. 1 compared the functional outcomes and structural integrity after arthroscopic partial versus complete repair of massive contracted rotator cuff tears. In their study, the complete repair was achieved by anterior and posterior interval slide and side to side repair of the interval slide edge (22 patients); the partial repair was achieved by anterior interval slide and margin convergence (19 patients) and the residual defect was about 11 mm at the time of surgery. At two-year followup, the functional outcomes were not different significantly between groups. Even though the preoperative tear sizes on magnetic resonance arthrography (MRA) images were not different significantly between groups, follow-up MRA identified a retear in 91% in complete repair group and the re-tear size of the complete repair group was significantly greater than that of the partial repair group. They concluded that the complete repair through aggressive release did not have better clinical and structural outcomes, compared with the partial repair without aggressive release for massive contracted rotator cuff tears. Kim et al2. also reported satisfactory outcomes after arthroscopic partial repair with margin convergence (Fig. 1) for irreparable large to massive rotator cuff tears. Although there was a residual defect ranging from 5 mm to 32 mm (anterior to posterior width, mean 12 mm) at the time of surgery, and the mean acromiohumeral distance was decreased from 6.5 mm to 5.9 mm at the final follow-up, all shoulder scores improved significantly. Although the strength of the active forward flexion or abduction of the affected side significantly improved after surgery, it was not restored to the same level as the contralateral side. Although partial repair without aggressive release showed similar clinical result comparing to complete repair following it, radiologic outcome was better. Recently, in the case of supraspinatus and infraspinatus were completely absent, but subscapularis could be repaired, isolated subscapularis repair showed satisfactory results in patients with young age for arthroplasty. Kim et al12 also reported Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears. They found satisfactory short-term outcomes and structural integrity in patients in their 50 s and 60 s without arthritis for average 3 year follow up. However, there was unsatisfactory result in the case of poor teres minor quality12,13. The repair of anterior L-shaped tears is usually difficult because of the lack of anterior rotator cuff tendon to cover the footprint. The biceps tendon is usually exposed from the retracted anterolateral corner of the torn tendon and can be easily used to augment rotator cuff repair. Jeon et al14 compared partial repair between complete repair due to biceps augmentation. And there was no difference in clinical outcomes and re-tear rate. They concluded only that partial tendon repair for reducing the footprint exposure without undue tension may be considered as one of the treatment options for large anterior L-shaped rotator cuff tears. Yoon15 et al also tried biologic augmentation, they tried arthroscopic rotator cuff repair with bone marrow stimulation and patch augmentation in patients with massive rotator cuff tears. They found that concomitant bone marrow stimulation and patch augmentation significantly reduced retear and medial-row failure rates in the arthroscopic repair of massive rotator cuff tears Recently, another treatment option was introduced for irreparable rotator cuff tears. Mihata et al4,5,16 reported that superior capsule reconstruction could restore superior stability of the glenohumeral joint in irreparable rotator cuff tears. According to their report, the reconstructed superior capsule restored superior stability better than did conventional patch graft, due to the suture anchor creating additional fixation at the superior glenoid in the superior capsule reconstruction. In a subsequent case-series clinical study, they reported satisfactory outcomes of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. In conclusion, if surgery was indicated due to severe intractable pain, one can choose arthroplasty rather than other surgical options in the case of preoperative pseudoparalysis, arthropathy, or failed repair for massive rotator cuff tear in elderly. On the other hand, if patients had good range of motion without osteoarthritis, one can choose preserving the native joint as possible; if partial repair can recreate robust force couple, repair with or without biologic augmentation. Reference Kim SJ, Kim SH, Lee SK, Seo JW, Chun YM. Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am. 2013;95(16):14828. Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy. 2012;28(6):761-8 Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop Relat Res. 1991;(267):45-56 Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40:2248-2255. Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459-470. Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89:747-757.
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Bashir, Adil, Suleiman Seth, Iftikhar H. Wani, Munir Farooq, Naseem ul Gani, and Berjina Farooq Naqshi. "Mini-Open Rotator Cuff Tear Repair: An Institutional Experience with a Midterm Follow-up." Ortopedia Traumatologia Rehabilitacja 20, no. 5 (October 31, 2018): 383–87. http://dx.doi.org/10.5604/01.3001.0012.8274.
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Background. Rotator cuff tears have long been recognised as a cause of pain and disability. Over the past decades the treatment of rotator cuff tears has evolved from an open procedure to a mini-open procedure to an all-arthroscopic one. The indications and benefits of each of the procedures are still debated. The purpose of this study was to observe the results of “Mini-open repair rotator cuff tear”. Material and methods. This was a prospective study conducted in the postgraduate department of Orthopaedics Government Medical College, Srinagar, from March 2013 to January 2018 with cases followed up for a minimum of 3 years. This study included 50 patients of either sex with non-massive full thickness tears of rotator cuff. Results. The mean UCLA score improved from 10.96 preoperatively to 30.68 at final follow-up. Overall, 88% of the patients achieved excellent or good results and 92% were satisfied. No significant difference was noted in functional outcomes between traumatic and degenerative tears. Size of tear seems to be a determining factor in the functional outcome. Stiffness as a complication occurred in two patients. Conclusion. 1. Mini-open rotator cuff tear repair eliminated symptomatic full thickness rotator cuff tears with significant improvement in functional scores. 2. There were no major complications of the surgical procedure adopted or the fixation method used. 3. Mini-open rotator cuff repair remains a useful technique despite advances in arthroscopy.
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Turman, Kimberly A., Mark W. Anderson, and Mark D. Miller. "Massive Rotator Cuff Tear in an Adolescent Athlete: A Case Report." Sports Health: A Multidisciplinary Approach 2, no. 1 (December 30, 2009): 51–55. http://dx.doi.org/10.1177/1941738109350404.
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Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia (“stinger” or “burner”). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.
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Yeo, Daniel Y. T., Judie R. Walton, Patrick Lam, and George A. C. Murrell. "The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs." American Journal of Sports Medicine 45, no. 4 (December 19, 2016): 788–93. http://dx.doi.org/10.1177/0363546516675168.
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Background: Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L’Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Results: Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm2 but reached 44% in tears >8 cm2. Conclusion: There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.
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Carbonel, Ignacio, Angel A. Martínez, Elisa Aldea, Jorge Ripalda, and Antonio Herrera. "Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup." Advances in Orthopedics 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/914148.
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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.
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Park, Jin-Young, Kyung-Tae Chung, and Moon-Jib Yoo. "Arthroscopic Rotator Cuff Repair: Serial comparison of outcomes between full-thickness rotator cuff tear and partial-thickness rotator cuff tear." Clinics in Shoulder and Elbow 6, no. 1 (June 1, 2003): 72–79. http://dx.doi.org/10.5397/cise.2003.6.1.072.
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Lee, Sung Hyun, Dae Jin Nam, Se Jin Kim, and Jeong Woo Kim. "Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear." American Journal of Sports Medicine 45, no. 11 (August 8, 2017): 2555–62. http://dx.doi.org/10.1177/0363546517721187.
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Background: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. Purpose: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. Results: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Conclusion: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.
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Kumar, Nishikant, and Anil Mehtani. "IRREPARABLE ROTATOR CUFF TEAR; A SURGICAL DILEMMA." Journal of Musculoskeletal Research 16, no. 02 (June 2013): 1330001. http://dx.doi.org/10.1142/s0218957713300019.
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Rotator cuff tear are common injuries in modern day orthopedic practice. Irreparable rotator cuff tear are those massive tear which cannot be repaired primarily. Their management depends on several factors like symptoms, age of patient, location of tear and examination findings. However, most chronic rotator cuff tear especially in older age group can be treated conservatively, when shoulder has reasonably good range of movement.
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Kim, Kyung Cheon, Woo Yong Lee, Hyun Dae Shin, Young Mo Kim, and Sun Cheol Han. "Repair Integrity and Functional Outcomes after Arthroscopic Repair of Transtendinous Full-thickness Rotator Cuff Tears Minimum Two-year Follow-up." Clinics in Shoulder and Elbow 20, no. 4 (December 1, 2017): 183–88. http://dx.doi.org/10.5397/cise.2017.20.4.183.
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BACKGROUND: To evaluate the clinical outcomes and associated repair integrity in patients treated with arthroscopic repair for a transtendinous rotator cuff tear followed by resection of the remnant rotator cuff tendon.METHODS: Between July 2007 and July 2011, we retrospectively reviewed patients who were treated for transtendinous full-thickness tears in the tendinous portion of the rotator cuff by arthroscopic repair. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score, a visual analogue scale (VAS) pain score, and range of motion (ROM). The repair integrity was determined by magnetic resonance imaging or ultrasonography.RESULTS: There were 19 shoulders with transtendinous full-thickness tears in the tendinous portion of the rotator cuff. The ASES, UCLA, Constant-Murley, and VAS pain scores showed significant improvements in function and symptoms (all p<0.001). The active ROM for forward flexion and abduction was also significantly improved (p=0.002 and p<0.001, respectively). The postoperative radiological examination showed cuff integrity without a re-tear in 68.4% of patients. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and re-torn group (p=0.530, p=0.885, and p=0.262, respectively).CONCLUSIONS: Although repair of transtendinous rotator cuff tears followed by resection of the remnant rotator cuff tendon in the footprint has a relatively high re-tear rate, no significant difference was observed in the short-term clinical results between the re-tear and healed groups.
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Reilly, P., I. Macleod, R. Macfarlane, J. Windley, and RJH Emery. "Dead Men and Radiologists Don't Lie: A Review of Cadaveric and Radiological Studies of Rotator Cuff Tear Prevalence." Annals of The Royal College of Surgeons of England 88, no. 2 (March 2006): 116–21. http://dx.doi.org/10.1308/003588406x94968.
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INTRODUCTION Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.
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Kim, Jung-Han, and Hyeong-Won Seo. "Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear." Clinics in Shoulder and Elbow 22, no. 3 (September 1, 2019): 121–27. http://dx.doi.org/10.5397/cise.2019.22.3.121.
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Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients’ shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear.Methods: We assessed patients’ rotator cuff tear humeral head positions based on humeral?scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated.Results: One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (<i>p</i><0.001, <i>p</i><0.001, <i>p</i><0.001).Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.
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Park, In, Hyo-Jin Lee, Sang-Ki Kim, Min-Sik Park, and Yang-Soo Kim. "Factors Related to Preoperative Shoulder Pain in Patients with Atraumatic Painful Rotator Cuff Tears." Clinics in Shoulder and Elbow 22, no. 3 (September 1, 2019): 128–34. http://dx.doi.org/10.5397/cise.2019.22.3.128.
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Background: Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma.Methods: We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors.Results: Shoulder pain was associated with young age (<i>p</i>=0.01), male sex (<i>p</i>=0.01) and the presence of diabetes mellitus (<i>p</i><0.001). Measurements of rotator cuff tear characteristics including tear size (<i>p</i>=0.53), muscle atrophy (<i>p</i>=0.16) and the number of torn tendons (<i>p</i>=0.34) did not correlate with shoulder pain. Symptom duration (<i>p</i>=0.60) and range of motion (<i>p</i>>0.05) also showed no correlation with VAS for pain.Conclusions: Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.
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Tashjian, Robert Z., Ian Lock, Erin K. Granger, Yangliang Wang, Younghee Lee, Peter N. Chalmers, and Kevin B. Jones. "Gene Expression in Torn Rotator Cuff Tendons Determined by RNA Sequencing." Orthopaedic Journal of Sports Medicine 8, no. 6 (June 1, 2020): 232596712092748. http://dx.doi.org/10.1177/2325967120927480.
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Background: Although the cause of rotator cuff tearing is likely multifactorial and a genetic predisposition has been proposed, the biochemical basis remains unknown. Purpose: To determine gene expression profiles in torn rotator cuff tendon tissue through use of RNA sequencing. Study Design: Controlled laboratory study. Methods: The supraspinatus tendon edge was biopsied in 24 patients undergoing arthroscopic rotator cuff repair for full-thickness supraspinatus rotator cuff tears. The supraspinatus tendon was also biopsied in 9 patients undergoing open reduction and internal fixation for a proximal humeral fracture (controls). Total RNA was extracted and sequenced. Differential gene expression was analyzed between the tear and control groups, and a secondary analysis was conducted between groups defined by an unbiased clustering. Results: Tear and control transcriptomes demonstrated significant differential expression in more than 3000 genes. The identified differential genes were highlighted in pathways involved in inflammation in control patients and extracellular matrix generation in patients with tears. Secondary analysis using unsupervised and thus unbiased hierarchical clustering revealed 2 clusters (c2 and c3). Cluster c3 contained smaller ( P < .001) and less retracted ( P = .018) tears (ie, tears earlier in the progression of rotator cuff disease) with increased expression of hypoxia target genes. Cluster c2 contained larger, more retracted tears (ie, tears further in the progression of rotator cuff disease) with increased expression of endothelial cell markers and chronic inflammation target genes. Tears in c2 had significantly worse healing rates compared with tears in c3 (0% vs 89%; P = .007). Conclusion: Smaller, less retracted tears had increased expression of hypoxia target genes and improved healing, whereas larger, more retracted tears were associated with endothelial cell markers and worse healing. Thus, hypoxia may be the inciting event for tear development, whereas with tear enlargement, a chronic, inflammatory, angiogenic process may predominate. Clinical Relevance: Identification of differential gene expression in rotator cuff tears may be a reliable tool to predict repair healing in the future.
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Tang, Jin, and Jinzhong Zhao. "Rooting Rotator Cuff Reconstruction for Irreparable Posterior-Superior Rotator Cuff Tear." Arthroscopy Techniques 10, no. 3 (March 2021): e727-e737. http://dx.doi.org/10.1016/j.eats.2020.10.061.
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Nyffeler, Richard W., Nicholas Schenk, and Philipp Bissig. "Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations." International Orthopaedics 45, no. 6 (March 27, 2021): 1573–82. http://dx.doi.org/10.1007/s00264-021-05012-6.
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Abstract Purpose A simple fall on the shoulder is often referred to as minor trauma that cannot cause a tendon tear but at best reveal a pre-existing rotator cuff pathology. We wanted to know whether this statement was true. The purpose of our study was therefore to summarize the causes of acute rotator cuff tears reported in the literature and provide a biomechanical explanation for tendon tears diagnosed after a fall. Method We searched PubMed and included studies reporting rotator cuff tears occurring due to a trauma. The number of cases, the tendons involved, the age of the patients, and the nature of trauma were summarized. In addition, we noted any information provided by the authors on the pathogenesis of acute tendon ruptures. Results Sixty-seven articles with a total of 4061 traumatic rotator cuff tears met the inclusion criteria. A simple fall was the most common cause (725 cases) and the supraspinatus tendon was most frequently affected. The postulated pathomechanism is a sudden stretch of the tendon-muscle unit while contracting (eccentric loading). Conclusion A simple fall can cause an acute rotator cuff tear and fall-related tears are not restricted to young individuals. They can affect patients of any age. The stresses occurring within the rotator cuff during an attempt to cushion a fall may locally exceed the tensile strength of the tendon fibers and cause a partial or full-thickness tear.
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Lin, Chen Chiang, Hsin Hui Chan, Chen Yuan Huang, and Nang Shu Yang. "Predictive Models for Pre-Operative Diagnosis of Rotator Cuff Tear: A Comparison Study of Two Methods between Logistic Regression and Artificial Neural Network." Applied Mechanics and Materials 595 (July 2014): 263–68. http://dx.doi.org/10.4028/www.scientific.net/amm.595.263.
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Rotator cuff tears are the most common disorder of the shoulders.agnetic resonance Image (MRI) is the diagnostic gold standard of rotator cuff tears. However, there are some dilemmas in the rotator cuff tears treatment. Clinically, surgical results of rotator cuff tears are sometimes different from MRI results of rotator cuff tears. The main purpose of this study is to build up predicative models for pre-operative diagnosis of rotator cuff tears There are two models of this study are proposed: logistic regression model and artificial neural network model. Patients are divided into two sets: Set1 is patients with full thickness rotators cuff tears. Set 2 is patients with partial thickness rotators cuff tears. The charts of 158 patients are completely reviewed and the collected data were analyzed. The results showed that the predictive accuracy of artificial neural networks model is higher than the predictive accuracy of logistic model. The application of this study can assist doctors to increase the accuracy rate of pre-operative diagnosis and to decrease the legal problems.
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Donovan, Andrea, Mark Schweitzer, Jenny Bencardino, Catherine Petchprapa, Jodi Cohen, and Gina Ciavarra. "Correlation between Rotator Cuff Tears and Systemic Atherosclerotic Disease." Radiology Research and Practice 2011 (2011): 1–7. http://dx.doi.org/10.1155/2011/128353.
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The purpose of this study was to investigate the association of aortic arch calcification, a surrogate marker of atherosclerosis, with rotator cuff tendinosis and tears given the hypothesis that decreased tendon vascularity is a contributing factor in the etiology of tendon degeneration. A retrospective review was performed to identify patients ages 50 to 90 years who had a shoulder MRI and a chest radiograph performed within 6 months of each other. Chest radiographs and shoulder MRIs from 120 patients were reviewed by two sets of observers blinded to the others' conclusions. Rotator cuff disease was classified as tendinosis, partial thickness tear, and full thickness tear. The presence or absence of aortic arch calcification was graded and compared with the MRI appearance of the rotator cuff. The tendon tear grading was positively correlated with patient age. However, the tendon tear grading on MRI was not significantly correlated with the aorta calcification scores on chest radiographs. Furthermore, there was no significant correlation between aorta calcification severity and tendon tear grading. In conclusion, rotator cuff tears did not significantly correlate with aortic calcification severity. This suggests that tendon ischemia may not be associated with the degree of macrovascular disease.
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Lee, Yong-Soo, Ja-Yeon Kim, Hyo-Nam Kim, Dhong-Won Lee, and Seok Won Chung. "Gene Expression Patterns Analysis in the Supraspinatus Muscle after a Rotator Cuff Tear in a Mouse Model." BioMed Research International 2018 (December 23, 2018): 1–18. http://dx.doi.org/10.1155/2018/5859013.
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Rotator cuff tear is a muscle-tendinous injury representative of various musculoskeletal disorders. In general, rotator cuff tear occurs in the tendon, but it causes unloading of the muscle resulting in muscle degeneration including fatty infiltration. These muscle degenerations lead to muscle weakness, pain, and loss of shoulder function and are well known as important factors for poor functional outcome after rotator cuff repair. Given that rotator cuff tear in various animal species results in similar pathological changes seen in humans, the animal model can be considered a good approach to understand the many aspects of the molecular changes in injured muscle. To comprehensively analyze changes in gene expression with time following a rotator cuff tear, we established a rotator cuff tear in mouse supraspinatus tendon of shoulder. At weeks 1 and 4 after the tear, the injured muscles were harvested for RNA isolation, and microarray analysis was performed. Expression patterns of genes belonging to 10 muscle physiology-related categories, including aging, apoptosis, atrophy, and fatty acid transport, were analyzed and further validated using real-time PCR. A total of 39,429 genes were analyzed, and significant changes in expression were observed for 12,178 genes at 1 week and 2,370 genes at 4 weeks after the tear. From the list of top 10 significantly up- and downregulated genes at the 2 time periods and the network evaluation of relevant genes according to the 10 categories, several important genes in each category were observed. In this study, we found that various genes are significantly altered after rotator cuff tear, and these genes may play key roles in controlling muscle degeneration after a rotator cuff tear.