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Acta Bio-medica : Atenei Parmensis Jan 2018Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the... (Review)
Review
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches.
Topics: Arthroscopy; Calcinosis; Conservative Treatment; Extracorporeal Shockwave Therapy; Humans; Rotator Cuff; Tendinopathy
PubMed: 29350647
DOI: 10.23750/abm.v89i1-S.7022 -
Clinics in Orthopedic Surgery Jun 2018Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older... (Review)
Review
Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.
Topics: Arthroscopy; Conservative Treatment; Debridement; Exercise Therapy; Humans; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 29854334
DOI: 10.4055/cios.2018.10.2.119 -
Journal of Rehabilitation Medicine Oct 2019To conduct a systematic review and meta-analysis to identify risk and associated factors for symptomatic rotator cuff tendinopathy. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To conduct a systematic review and meta-analysis to identify risk and associated factors for symptomatic rotator cuff tendinopathy.
DATA SOURCES
PubMed, CINAHL and Scopus were searched from inception to June 2017.
STUDY SELECTION
Participants presented with signs and symptoms suggestive of rotator cuff tendinopathy/tendinosis/tendinitis, shoulder impingement syndrome, or subacromial bursitis diagnosed by clinical tests and/or conventional imaging.
DATA EXTRACTION
Screening, quality assessment and data extraction were carried out by 2 reviewers.
DATA SYNTHESIS
Sixteen studies were included in this review. Overall, 22 factors were identified and 5 factors were explored using meta-analysis. Pooled analyses provided strong evidence that age above 50 years (odds ratio (OR)?=?3.31, 95% confidence interval (95% CI)?=?2.304.76, I2?=?0%, p<0.001) and diabetes (OR?=?2.24, 95% CI?=?1.373.65, I2?=?0%, p?=?0.001) were associated with increased risk of rotator cuff tendinopathy. In addition, moderate evidence showed that work with the shoulder above 90° was associated with increased risk of rotator cuff tendinopathy (OR?=?2.41, 95% CI?=?1.314.45, I2=?83%, p?=?0.005).
CONCLUSION
Age above 50 years, diabetes and overhead activities were associated with increased risk of rotator cuff tendinopathy.
Topics: Female; Humans; Male; Middle Aged; Risk Factors; Rotator Cuff; Tendinopathy
PubMed: 31489438
DOI: 10.2340/16501977-2598 -
Acta Bio-medica : Atenei Parmensis Jul 2021The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears.... (Review)
Review
The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and clinical outcomes for the management of massive rotator cuff tears.
Topics: Arthroscopy; Humans; Rotator Cuff; Rotator Cuff Injuries; Tendons; Tenodesis
PubMed: 34313657
DOI: 10.23750/abm.v92iS3.11766 -
The Journal of the American Academy of... Mar 2019Degenerative rotator cuff tears are the most common cause of shoulder pain and have a strong association with advanced aging. Considerable variation exists in surgeons'... (Review)
Review
Degenerative rotator cuff tears are the most common cause of shoulder pain and have a strong association with advanced aging. Considerable variation exists in surgeons' perceptions on the recommended treatment of patients with painful rotator cuff tears. Natural history studies have better outlined the risks of tear enlargement, progression of muscle degeneration, and decline in the function over time. This information combined with the known factors potentially influencing the rate of successful tendon healing such as age, tear size, and severity of muscle degenerative changes can be used to better refine appropriate surgical indications. Although conservative treatment can be successful in the management of many of these tears, risks to nonsurgical treatment also exist. The application of natural history data can stratify atraumatic degenerative tears according to the risk of nonsurgical treatment and better identify tears where early surgical intervention should be considered.
Topics: Aged; Aging; Disease Progression; Female; Humans; Male; Orthopedic Procedures; Rotator Cuff; Rotator Cuff Injuries; Shoulder Pain
PubMed: 30335631
DOI: 10.5435/JAAOS-D-17-00480 -
Medical Science Monitor : International... Oct 2020BACKGROUND The aim of this study was to assess the clinical effectiveness of scapula training exercises on shoulder function after surgery for rotator cuff injury.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND The aim of this study was to assess the clinical effectiveness of scapula training exercises on shoulder function after surgery for rotator cuff injury. MATERIAL AND METHODS Forty-six patients with rotator cuff injury after surgery were randomized into the experiment group or control group. Both groups were treated with conventional therapeutic exercise and physical therapy, and scapular training exercise was added to the experiment group. Patient status was evaluated by Constant-Murley scale (CMS), visual analogue scale (VAS), and the active range of motion (ROM) of the shoulder before and after 6 weeks and 12 weeks of treatment. RESULTS After 6 weeks and 12 weeks of treatment, all evaluations of the 2 groups were significantly improved as compared with those before treatment (P0.05). After 12 weeks of treatment, all items in the experimental group were significantly improved compared to the control group (P<0.05). CONCLUSIONS The combination of conventional rehabilitation interventions and scapular training exercise were an effective treatment of the shoulder dysfunction. Moreover, increased Scapula training exercise had better effect on the improvement of shoulder function.
Topics: Adult; Exercise Therapy; Female; Humans; Male; Middle Aged; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Scapula; Shoulder; Shoulder Joint; Treatment Outcome
PubMed: 33116073
DOI: 10.12659/MSM.925758 -
BMC Musculoskeletal Disorders Aug 2021Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing.
METHODS
A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ. The association between retear rate after surgery and patients' age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used.
RESULTS
Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3-6 months follow-up, 16% at 6-12 months follow-up, 21% at 12-24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures).
CONCLUSIONS
Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.
Topics: Arthroplasty; Arthroscopy; Humans; Magnetic Resonance Imaging; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 34465332
DOI: 10.1186/s12891-021-04634-6 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Two percent of the general population are wheelchair-dependent. The shoulder takes on the weight-bearing locomotor function, and tends with age to develop degenerative... (Review)
Review
Two percent of the general population are wheelchair-dependent. The shoulder takes on the weight-bearing locomotor function, and tends with age to develop degenerative pathologies, notably in the rotator cuff. The association between weight-bearing shoulder and rotator cuff tear raises several questions: what are the mechanisms by which wheelchair propulsion and transfer overload the shoulder, and what specificities do the lesions display? They occur in younger patients than in the rest of the population, after about 15 years' fairly constant wheelchair use. As well as the classical supraspinatus damage, an anterior cuff extension is the most frequent case. Is there a particular clinical presentation of cuff tear in this population? As the shoulder cannot be functionally protected, pain is constant and asymptomatic cuff tear is rare. Any pain after 12 years' wheelchair use requires morphologic exploration. How does treatment strategy differ for the weight-bearing shoulder? More than the classic quest for compensation, in the weight-bearing shoulder, the rotator cuff should be protected against any local aggression by systematic surgical recalibration of the subacromial space, and all lesions should be repaired, to avoid extension. Are functional results to be expected to be poorer in this population? On condition that the suture is protected by postponing any transfer beyond 4 months and that the shoulder is protected on a daily basis, analytic results and healing rates are comparable to those in the general population. However, general complications and skin complications are more frequent and require postoperative care in a specialized center.
Topics: Humans; Pain; Rotator Cuff; Rotator Cuff Injuries; Rupture; Shoulder; Shoulder Joint; Weight-Bearing
PubMed: 34890864
DOI: 10.1016/j.otsr.2021.103170 -
Clinical Orthopaedics and Related... Aug 2014
Topics: Biomechanical Phenomena; Disease Progression; Humans; Orthopedic Procedures; Recurrence; Rotator Cuff; Rotator Cuff Injuries; Tendon Injuries; Treatment Outcome; Wound Healing
PubMed: 24595814
DOI: 10.1007/s11999-014-3527-8 -
Annals of the New York Academy of... Apr 2021The high prevalence of rotator cuff tears poses challenges to individual patients and the healthcare system at large. This orthopedic injury is complicated further by... (Review)
Review
The high prevalence of rotator cuff tears poses challenges to individual patients and the healthcare system at large. This orthopedic injury is complicated further by high rates of retear after surgical repair. Outcomes following repair are highly dependent upon the quality of the injured rotator cuff muscles, and it is, therefore, crucial that the pathophysiology of rotator cuff degeneration continues to be explored. Fibro-adipogenic progenitors, a major population of resident muscle stem cells, have emerged as the main source of intramuscular fibrosis and fatty infiltration, both of which are key features of rotator cuff muscle degeneration. Improvements to rotator cuff repair outcomes will likely require addressing the muscle pathology produced by these cells. The aim of this review is to summarize the current rotator cuff degeneration assessment tools, the effects of poor muscle quality on patient outcomes, the role of fibro-adipogenic progenitors in mediating muscle pathology, and how these cells could be leveraged for potential therapeutics to augment current rotator cuff surgical and rehabilitative strategies.
Topics: Adipocytes; Adipogenesis; Adipose Tissue; Animals; Arthroplasty; Disease Models, Animal; Fibroblasts; Fibrosis; Humans; Mice; Muscular Atrophy; Rotator Cuff; Rotator Cuff Injuries; Stem Cells
PubMed: 32725671
DOI: 10.1111/nyas.14437