TENDINOPATIA DEL MANGUITO ROTADOR

http://www.ncbi.nlm.nih.gov/pubmed/19364757

Physiodynamic PD a través de Kiné Rehabilitación

JEREMY LEWIS: TENDINOPATIA DEL MANGUITO ROTADOR

Rotator cuff tendinopathy: a model for the c... [Br J Sports Med. 2010] - PubMed - NCBI

www.ncbi.nlm.nih.gov

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Br J Sports Med. 2010 Oct;44(13):918-23. doi: 10.1136/bjsm.2008.054817. Epub 2009 Apr 12.

Rotator cuff tendinopathy: a model for the continuum of pathology and related management.

Lewis JS.

Source

Therapy Department, Chelsea and Westminster NHS Healthcare, 369 Fulham Road, London SW10 9NH, UK. jeremy.lewis@chelwest.nhs.uk

Abstract

BACKGROUND:

Pathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are extremely common and are a principal cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the rotator cuff pathology from asymptomatic tendon through full thickness rotator cuff tears.

CONCLUSIONS:

The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Recently a new and generic model detailing the continuum of tendon pathology has been proposed. This model is relevant for the rotator cuff and provides a framework to stage the continuity of rotator cuff pathology. Furthermore, it provides a structure to identify the substantial deficiencies in our knowledge base and areas where research would improve our understanding of the pathological and repair process, together with assessment and management. The strength of this model adapted for the rotator cuff tendons and subacromial bursa will be tested in its ability to incorporate and adapt to emerging research.

PMID:

 

19364757

 

[PubMed - indexed for MEDLINE]

Which Patients Need Rotator Cuff Surgery?

http://icjr.net/article_48_rotator_cuff.htm#.Uim62cZyHsa

Which Patients Need Rotator Cuff Surgery?

Determining who is a candidate and when he or she needs surgery are as important as how to operate. Not all tears are symptomatic, and not all result in functional disability.

By Leesa Galatz - September 3, 2013

International Congress for Joint Reconstruction

Dr. Leesa Galatz shares her insights on determining which patients are candidates for rotator cuff surgery: http://goo.gl/UEoUKR

Author

Leesa M. Galatz, MD

Introduction
Rotator cuff repair is one of the most common procedures performed in the shoulder. Recent advances in techniques and instrumentation have made the procedure technically easier in many ways, yet no clear clinical differences result from any single repair configuration or device. [1-3] Choices in this regard depend entirely on surgeon preference.

The controversy, more often, is in regards to surgical indications. Determining who is a candidate and when he or she needs surgery are as important as how to operate.  The prevalence of rotator cuff tears is high, especially in the older population.  However, not all tears are symptomatic, and not all result in functional disability.

Factors Contributing to Treatment Guidelines

Natural History

Examining the natural history of rotator cuff disease illustrates the increasing prevalence and incidence of rotator cuff tears with age.  In a study of individuals with unilateral shoulder pain, the presence of rotator cuff disease was highly correlated with increasing age, such that the presence of a rotator cuff tear and the presence of bilateral cuff tears were seen in the sixth and seventh decades, respectively. [4]

Another study found that of 924 patients screened with ultrasound, 99 had a tear. [5] The average age in the tear group was a decade older than in the non-tear group: 60 versus 70 years old.  Although many patients were asymptomatic, the patients with tears had less shoulder function and more pain.

Understanding the natural history of rotator cuff tears helps form treatment guidelines:

• Asymptomatic degenerative tears in older people should be treated non-operatively.
• Patients who present with tears sooner than might be expected, such as in their 40s and early 50s, are at risk for tear size progression and concomitant development of degenerative muscle changes. 
• Given that smaller tears and tears in younger individuals heal more predictably, [6,7] early intervention may be indicated. 
• At the minimum, surveillance of known tears helps prevent progression to an irreparable state.

Functional and Structural OutcomeStudies reporting the functional and structural outcome after rotator cuff repair also contribute to treatment guidelines. [8-10] The literature clearly shows that rotator cuff tendon healing is less predictable after age 60 to 65 years. Tear size also has an impact on results. [11]

Therefore, factors to consider include:

• Patient age
• Tear size and reparability
• Pain level
• Functional disability
• Extent of non-operative treatment

Potential patient outcome should also be considered. Pain relief can occur in many patients in spite of poor healing after a rotator cuff repair. [8,12] The pain relief alone is a benefit, aside from structural restoration of tendon continuity. 

PAGES 123>

Leesa Galatz, MD

Leesa M. Galatz, MD, is Associate Professor, Shoulder and Elbow Service, Washington University Orthopedics, Barnes-Jewish Hospital, St. Louis, Missouri.

Researchers find 17% rotator cuff re-tear rate with predictive equation

http://ote.healio.com/i/140820/58

EFORT

Researchers find 17% rotator cuff re-tear rate with predictive equation - Source: OTE - Orthopaedics today Europe - http://ote.healio.com/i/140820/58

Researchers find 17% rotator cuff re-tear rate with predictive equation

ote.healio.com

Australian investigators identified predictors of rotator cuff re-tear and used them to create a formula that help them predict the chances of a re-tear, according to res…

Coracohumeral Distances and Correlation to Arm Rotation

http://ojs.sagepub.com/content/1/2/2325967113496059.full.pdf+html

Coracohumeral Distances and Correlation to Arm Rotation

An In Vivo 3-Dimensional Biplane Fluoroscopy Study

1. John P. Brunkhorst, MD*
2. J. Erik Giphart, PhD*
3. Robert F. LaPrade, MD, PhD*,†‡
4. Peter J. Millett, MD, MSc*,†

1. Investigation performed at the Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
2. ^*Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA.
3. ^†The Steadman Clinic, Vail, Colorado, USA.

1. ↵‡Robert F. LaPrade, MD, PhD, Steadman Philippon Research Institute, Complex Knee and Sports Medicine Orthopaedic Surgery, The Steadman Clinic, 181 West Meadow Drive, Vail, CO 81657 USA (e-mail: drlaprade@sprivail.org).

Abstract

Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.

Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.

Study Design: Descriptive laboratory study.

Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.

Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index.

Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.

Clinical Relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 29, Issue 2 , Pages 343-348, February 2013

Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair: A Meta-analysis of the Randomized Clinical Trials

• Shahin Sheibani-Rad, M.D.
, 
• M. Russell Giveans, Ph.D.
, 
• Steven Paul Arnoczky, D.V.M.
, 
• Asheesh Bedi, M.D.

Purpose

The purpose of this meta-analysis was to critically assess whether there are differences in clinical outcomes between single-row and double-row rotator cuff repair in prospective randomized Level I studies.

Methods

Using Medline, Scopus, Scirus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library, as well as a hand search, we searched for randomized prospective trials comparing single-row and double-row rotator cuff repair. The functional outcome scores included the American Shoulder and Elbow Surgeons shoulder scale, the Constant shoulder score, and the University of California, Los Angeles shoulder rating scale. A test of heterogeneity was performed to determine whether there was a difference across the included studies.

Results

Five studies met our inclusion criteria. A test of heterogeneity showed no difference across these studies. The functional American Shoulder and Elbow Surgeons; Constant; and University of California, Los Angeles outcomes scores showed no difference between single- and double-row rotator cuff repair.

Conclusions

We found no significant differences in clinical outcomes between single-row and double-row rotator cuff repair in a meta-analysis of Level I studies.

Level of Evidence

Level I, meta-analysis of Level I randomized controlled studies.

• 
  

Partial Rotator Cuff Tears in Adolescents: Factors Affecting Outcomes

Partial Rotator Cuff Tears in Adolescents: Factors Affecting Outcomes

Eric A. Eisner, MD, Joanna  H. Roocroft, MA, MD, Molly A. Moor, MPH, and Eric W. Edmonds, MD

Introduction: In the adult population, rotator cuff tears are common and established treatment methods yield satisfactory results. In adolescents, however, these injuries are uncommon and few treatment methods and outcome reports exist. The purpose of this study was to examine a series of adolescent ro- tator cuff tears, identify associated pathology, and report treatment outcomes.

Methods: A retrospective comparative analysis of adolescent patients treated for rotator cuff tears diagnosed by magnetic resonance imaging (MRI) or arthroscopy between 2008 and

2010 was performed. Patients were divided by treatment ren- dered: nonoperative or operative. Demographic and diagnostic variables were compared between the 2 groups. After release to full activity, 3 patient outcome measures were obtained: QuickDASH (Disability of the Arm, Shoulder, and Hand), QuickDASH Sports module, and the Single Assessment Nu- merical Evaluation (SANE).

Results: Fifty-three adolescents (38 boys and 15 girls) with a mean age of 15.8 years (8.8 to 18.8 y) met the inclusion criteria. All rotator cuff tears were partial articular-sided tendon avul- sions, and surgical treatment (when required) consisted of de- bridement to stable edges. All patients underwent a trial of at least 6 weeks of physical therapy, with 57% failing to improve and requiring subsequent surgery. In the patients that were treated nonoperatively, 39% were diagnosed with associated pathology based on MRI findings, whereas operative patients exhibited an associated pathology rate of 70%. Patients with MRI-diagnosed associated pathology were 1.8 times more likely (95% confidence interval, 1.02-3.13, P = 0.025) to require surgery compared with those without MRI-identified associated pathol- ogy. Nineteen patients (13 operative, 6 nonoperative) completed the outcome questionnaires at a mean 16.9 months after treat- ment. QuickDASH, SANE, and QuickDASH Sports module scores were not statistically different between nonoperative and operative treatment groups (7.5 vs. 8.1, P = 0.90; 85.3 vs. 80.6, P = 0.47; and 5.2 vs. 19.5, P = 0.39, respectively). All outcome measures exhibited significant correlations with one another, with the strongest correlation being a negative association between SANE and Sports module scores (r = - 0.76, P = 0.001). Discussion: Isolated partial articular-sided tendon avulsion in- juries may be successfully treated with physical therapy, with return to sports expected; however, if associated pathology was present then nonoperative treatment was less successful. Im- provement in pain and activities of daily living can be achieved with surgery after failed conservative management for rotator cuff injuries; however, the adolescent athlete will often have residual shoulder complaints during sports participation.

Level of Evidence: Level III—retrospective cohort study.

Key Words: rotator cuff, outcomes, sports, adolescents

(J Pediatr Orthop 2013;33:2–7)

artículo a texto completo. pdf

Dr Michell Ruiz /AMECRA

El dr Michell Ruiz durante su participación en el pasado congreso de la AMECRA celebrado en los cabos Baja California, México, 2013