Defining the Relationship Between Rotator Cuff Injury and Proximal Humerus Fractures

Abstract

The purpose of our study was to correlate radiographic characteristics with rotator cuff tendon injury on magnetic resonance imaging after fractures of the proximal humerus. We prospectively obtained magnetic resonance imaging on 30 patients with proximal humerus fractures after classifying each fracture radiographically using Neer and AO systems and determining the displacement of the greater tuberosity. Twelve patients (40.0%) had either complete ruptures or avulsions of at least one of the rotator cuff muscles. No abnormality was identified in the rotator cuff musculature in nine patients (29%). Severity of injury to the rotator cuff tendons increased substantially with respect to increasing AO and Neer classes and 5 mm or greater displacement of the greater tuberosity fragment. Additional study is needed to determine the exact role of rotator cuff tendon injury in the ultimate function attained by patients with proximal humerus fractures.

Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients

“…If these main problems are avoided, patients may have a good outcome with these implants 23 . In the elderly patients suffering a proximal humeral fracture, however, the status of the rotator cuff frequently is poor [24][25][26] ; several other Authors also report unsatisfactory results with hemi-arthroplasty 27 : loss of ROM, non-union of tubercles in as many as 50% of the patients in some series and above all poor quality of the rotator cuff in functional outcome 27,28 . Moreover, it's proven that cuff tear and degeneration has a prevalence of almost 20% in a over 60 years old asymptomatic shoulders population 29,30 , reaching 31% of patients aged from 70 to 79 years old and 51% of patients more than 80 years old.…”

All-arthroscopic intramedullary nailing of 2- and 3-part proximal humeral fractures: a new arthroscopic technique and preliminary results

“…In a previous study, we analyzed acute proximal humeral fractures in the MRI and observed rotator cuff tears (with indication to treat) in seven of 30 patients (23%) [18]. Gallo et al [4] described in 12 of 30 patients (40%) complete rotator cuff tears or avulsions in the context of acute proximal humeral fractures as well. This confirms the relevance of a correct diagnosis and the treatment of concomitant injuries in patients with proximal humeral fractures for a better functional outcome.…”

Assessment of Rotator Cuff Tendons After Proximal Humerus Fractures: Is Preoperative Imaging Necessary?

“…The severity of injury to the rotator cuff tendons correlated with increasing Neer and AO classes and displacement of the greater tuberosity Ͼ5 mm. 21 In follow-up to this study, radiographic class, greater tuberosity displacement, and integrity of the rotator cuff tendons were reported to have some predictive value in outcome one year following initial injury. Specifically, patients consistently attained good or excellent functional scores (American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand) for the following factors: Neer one-or two-part fractures, AO type A fractures, greater tuberosity displacement Ͻ5 mm, lack of rotator cuff tear, or avulsion on magnetic resonance imaging.…”