Biomechanics of Massive Rotator Cuff Tears

Hansen, Matthew; Otis, James C.; Johnson, Jared; Cordasco, Frank A.; Craig, Edward V.; Warren, Russell F.

doi:10.2106/jbjs.f.00880

Cited by 153 publications

(100 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, cuff repair should be performed before AHI narrowing. The results of our study are consistent with the concepts of massive cuff tear pathomechanics previously proposed by Burkhart [1], Hansen et al [15], and von Eisenhart-Rothe et al [24]. Nevertheless, isolated glenohumeral arthritis as described by Walch et al [25] (Grade 4A) may be related to increased glenohumeral reaction forces without a total loss of ''stable fulcrum kinematics.…”

Section: Discussionsupporting

confidence: 92%

“…These results suggest that such ruptures may be the result of grade progression rather than a specific cause. The active flexion angles did not decrease even after grade progression in our study (Table 4), which could be the result of compensation, including a stable glenohumeral fulcrum [1] and increased reaction force at the glenohumeral joint in abduction [15]. As risk factors for the progression of the modified Hamada classification grade after biceps tenotomy of massive rotator cuff tears, Walch et al [25] reported teres minor atrophy in patients with severe fatty infiltration of the infraspinatus muscle and fatty infiltration of the subscapularis.…”

Section: Discussionmentioning

confidence: 54%

See 1 more Smart Citation

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Hamada

Yamanaka²,

Uchiyama

et al. 2011

Clinical Orthopaedics &Amp; Related Research

248

131

View full text Add to dashboard Cite

Background In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4. Questions/purposes We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively. Patients and Methods We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 54%

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Hamada

Yamanaka²,

Uchiyama

et al. 2011

Clinical Orthopaedics &Amp; Related Research

248

131

View full text Add to dashboard Cite

show abstract

“…Inman 28) reported that the elevating force generated by the deltoid reaches a peak at 90° abduction; similarly, the humeral head restraining force generated by the rotator cuff reaches a peak at 60° abduction. Moreover, a biomechanical analysis of cadaver shoulders by Hansen et al 29) indicated that, for large rotator cuff tears (> 6 cm), up to 45% more deltoid force was required to elevate the arm to 90°. Stabilizing the humeral head within the glenoid cavity is most important at low-to mid-range elevations.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional Scapular Kinematics During Arm Elevation in Massive Rotator Cuff Tear Patients

Miura

Kai

Morihara

et al. 2017

PRM

View full text Add to dashboard Cite

Objective: Rotator cuff tears can influence shoulder kinematics and severely impair function. However, there have been no studies on three-dimensional (3D) shoulder kinematics in massive rotator cuff tear (MRCT) patients. Hypothesizing that MRCT patients could demonstrate significantly changed scapular kinematics during arm elevation in the scapular plane, we compared 3D scapular kinematics in the scapular plane between MRCT patients and healthy elderly subjects. Methods:We assessed 15 shoulders of 11 MRCT patients and 16 shoulders of 16 healthy subjects. With the subjects seated, we used an electromagnetic tracking system to calculate the upward rotation, posterior tilt, and internal rotation of the scapula at 10° increments from 30° to 120° with respect to the thorax. We performed two-way analysis of covariance with the initial position of the scapular motion as the covariate and performed multiple comparisons using the Bonferroni method. Results: MRCT patients exhibited significantly higher scapular upward rotation than did the healthy subjects (P < 0.05). There were no significant differences between groups with regard to posterior tilt and internal rotation. Conclusions: This study indicated that when MRCT patients elevated their arms, they exhibited a significantly higher scapular upward rotation at low-to mid-range elevations compared with that of healthy subjects. This difference may have resulted from a compensatory effect in response to the decreased elevation torque caused by the loss of rotator cuff function. These results may assist rehabilitation strategies to improve active arm elevation in MRCT patients.

show abstract

“…Hansen et al, utilising a cadaveric shoulder model, concluded that for 6-8cm rotator cuff tears a 22-45% increase in deltoid force was necessary to elevate the arm [Hansen et al, 2008]. McCully et al…”

Section: Discussionmentioning

confidence: 99%

“…However, despite this anatomical deficit, some patients with a MRCT are able to maintain function. This has led to the hypothesis that alternative muscle activation strategies can compensate for the deficient rotator cuff to establish a stable glenohumeral fulcrum for arm movement [Hansen et al, 2008;Steenbrink et al, 2006;Steenbrink et al, 2009]. …”

Section: Introductionmentioning

confidence: 99%

Electromyographic assessment of muscle fatigue in massive rotator cuff tear

Hawkes

Alizadehkhaiyat

Kemp

et al. 2015

Journal of Electromyography and Kinesiology

View full text Add to dashboard Cite

Shoulder muscle fatigue has not been assessed in massive rotator cuff tear (MRCT). This study used EMG to measure fatigability of 13 shoulder muscles in 14 healthy controls and 11 patients with MRCT. A hand grip protocol was applied to minimise artifacts due to pain experience during measurement. The fatigue index (median frequency slope) was significantly non-zero (negative) for anterior, middle, and posterior parts of deltoid, supraspinatus and subscapularis muscles in the controls, and for anterior, middle, and posterior parts of deltoid, and pectoralis major in patients (p ≤ 0.001). Fatigue was significantly greater in patients compared to the controls for anterior and middle parts of deltoid and pectoralis major (p ≤ 0.001). A submaximal grip task provided a feasible way to assess shoulder muscle fatigue in MRCT patients, however with some limitations. The results suggest increased activation of deltoid is required to compensate for lost supraspinatus abduction torque. Increased pectoralis major fatigue in patients (adduction torque) likely reflected strategy to stabilise the humeral head against superior subluxing force of the deltoid. Considering physiotherapy as a primary or adjunct intervention for the management of MRCT, the findings of this study generate a base for future clinical studies aiming at the development of evidence-based protocol

show abstract

Biomechanics of Massive Rotator Cuff Tears

Cited by 153 publications

References 38 publications

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Three-dimensional Scapular Kinematics During Arm Elevation in Massive Rotator Cuff Tear Patients

Electromyographic assessment of muscle fatigue in massive rotator cuff tear

Contact Info

Product

Resources

About