Rotator cuff tears: pathology and repair

Yadav, Hemang; Nho, Shane J.; Romeo, Anthony A.; MacGillivray, John D.

doi:10.1007/s00167-008-0686-8

Cited by 61 publications

(44 citation statements)

References 101 publications

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“…Acromial morphology in particular contributes to bursal sided cuff tears. 19 More commonly, cuff tears are thought to begin on the articular side in the context of age-related degeneration and microtrauma. 19 Inflammatory changes, oxidative stress, tissue remodeling and apoptosis are all important parts of this pathological process.…”

Section: Discussionmentioning

confidence: 99%

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

Gille¹,

Suehwold

Schulz

et al. 2009

Orthop Rev

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The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.

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Section: Discussionmentioning

confidence: 99%

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

Gille¹,

Suehwold

Schulz

et al. 2009

Orthop Rev

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show abstract

“…Extrinsic factors include repetitive impingement under the acromion, whereas intrinsic factors are defined by a degeneration-microtrauma model. 27 The degeneration-microtrauma model likely explains GTPS pain because abnormalities around the greater trochanter, such as osteophytes or calcifications, are seen in 40% of patients. 5 Changes within the gluteal tendons have been confirmed by several recent studies.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Greater Trochanteric Pain Syndrome in Active Duty US Military Servicemembers

Blank¹,

Owens²,

Burks³

et al. 2012

Orthopedics

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Although greater trochanteric pain syndrome is thought to be a common musculoskeletal disorder, little has been reported on the incidence rates of the disorder. The purpose of this study was to determine the incidence and demographic risk factors of greater trochanteric pain syndrome in a United States military population. Multivariate Poisson regression analysis was used to estimate the rate of greater trochanteric pain syndrome per 1000 person-years, controlling for sex, race, age, rank, and branch of service. The overall unadjusted incidence rate of greater trochanteric pain syndrome was 2.03 per 1000 person-years. Women had a significantly increased adjusted incidence rate ratio for greater trochanteric pain syndrome of 5.03 (95% confidence interval [CI], 4.91–5.16). The adjusted incidence rate ratio for White servicemembers compared with Black servicemembers was 1.36 (95% CI, 1.32–1.40). The adjusted incidence rate ratio for the 40+ age group compared with the 25 to 29 age group was 2.81 (95% CI, 2.68–2.95). Compared with junior officers, junior and senior enlisted ranks had an increased adjusted incidence rate ratio of 1.94 (95% CI, 1.84–2.04) and 1.17 (95% CI, 1.12–1.23), respectively. Compared with the Navy, each branch of service had an increased adjusted incidence rate ratio, with the Army at 2.90 (95% CI, 2.80–3.01), the Marines at 1.96 (95% CI, 1.87–2.07), and the Air Force at 1.33 (95% CI, 1.27–1.38). Female servicemembers had a five-fold greater incidence of greater trochanteric pain syndrome. Increasing age, enlisted rank groups, and service in the Army, Marines, or Air Force were also significant risk factors.

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“…49 The increased prevalence of tears over time, the common finding of an increase in tear size, and the worsening of the muscle functional capacity with progressive atrophy and fatty infiltration have led some surgeons to believe that rotator cuff tears should be repaired early in their course. 24,66 Ellman et al 22 showed poorer results with surgery with increased preoperative weakness of the shoulder, less active range of motion, and narrowing of the acromiohumeral distance suggestive of a larger tear. Burkhart et al, 11 while finding that patients with advanced fatty infiltration of the cuff muscles can often benefit from rotator cuff repair, also found that the improvement was not nearly as good in the patients with more advanced fatty infiltration.…”

Section: Anatomymentioning

confidence: 97%