Diagnosis and treatment of anterosuperior rotator cuff tears

Warner, Jon J.P.; Higgins, Laurence D.; Parsons, Moby; Dowdy, Paul A.

doi:10.1067/mse.2001.112022

Cited by 340 publications

(222 citation statements)

References 36 publications

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“…Rotator cuff muscle area, a measure of atrophy, was also documented in two ways: percent muscle area was computed and the Warner atrophy grade was determined [26]. Computed supraspinatus muscle area was determined as an occupation area percentage (Fig.…”

Section: Outcome Variablesmentioning

confidence: 99%

“…It was not possible to perform a similar calculation for the infraspinatus given that the outer boundaries of infraspinatus extramuscular fat are not well defined in the literature. The Warner atrophy grade is a four-category scale describing atrophy as none, mild, moderate, or severe [26]. ''None'' indicates supraspinatus muscle extending superior to a line extending between the superior tip of the coracoid and the superior tip of the scapular spine; ''mild'' indicates that the supraspinatus muscle extends to, but not beyond, this line; ''moderate'' and ''severe'' indicate higher degrees of muscle atrophy.…”

Section: Outcome Variablesmentioning

confidence: 99%

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Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Lapner

Jiang

Zhang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Shoulder arthroplasty provides reliable pain relief and restoration of function. However, the effects of fatty infiltration and atrophy in the supraspinatus and infraspinatus muscles on functional outcomes are not well understood. Questions/purposes The purposes of this study were to (1) compare preoperative with postoperative fatty infiltration and atrophy of the supraspinatus and infraspinatus muscles after primary shoulder arthroplasty; and (2) identify any associations between these variables and outcome measures.Methods A retrospective analysis was undertaken of 62 patients with a mean age of 67 years (range, 34-90 years) who underwent shoulder arthroplasty. CT scans were conducted preoperatively and at 12 months postoperatively. Outcome variables included the degree of supraspinatus and infraspinatus fatty infiltration (percent fatty infiltration and Goutallier grade), muscle area (percent muscle area and Warner atrophy grade), shoulder strength, and the Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score, and Constant outcome score. Results Preoperatively, the mean percent fatty infiltration (FI) within the supraspinatus and infraspinatus was identical at 14%. One year after shoulder arthroplasty, both muscles had less fatty infiltration (6% and 7%, respectively; p \ 0.001). Similarly, the Goutallier grade significantly improved postoperatively for the supraspinatus (p = 0.0037) and infraspinatus (p = 0.0007). Conversely, measures of muscle atrophy remained unchanged postoperatively (p [ 0.251). Preoperatively, greater supraspinatus percent FI was negatively associated with preoperative shoulder strength (r = 0.37, p = 0.001) and Constant score (r = 0.38, p = 0.001). Postoperative infraspinatus percent FI was negatively associated with postoperative strength (r = 0.3, p = 0.021) and Constant score (r = 0.3, p = 0.04). Multivariable regression One of the authors (GSA) received research funding support from

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Section: Outcome Variablesmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Lapner

Jiang

Zhang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Anterior extension of a full-thickness rotator cuff tear to the subscapularis tendon has been identified as a negative factor for global shoulder function, notably after surgical repair [11,12,27,36]. However, the influence of the anatomic location of the tear on the postoperative longterm function and structural characteristics of the rotator cuff is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Although preserved shoulder function can be observed in patients with irreparable rotator cuff tears [3,11,12], the disruption of natural force balance between the anterior subscapularis muscle and posterior infraspinatus muscle reportedly leads to substantial disability [27,30,36]. Therefore, closure of the rotator interval and restoration of the AP force balance appear critical [38].…”

Section: Introductionmentioning

confidence: 99%

“…Pain relief and restoration of internal rotation strength can be expected after surgical repair of isolated tears of the subscapularis tendon [6,14,24]. Several authors [2,36] reported a minimum of 30% increase in the average Constant-Murley scores 2 years after either arthroscopic or surgical technique repair of a combined tear of the supraspinatus and subscapularis tendons. In addition, Flury et al [8] found rerupture was more likely to occur with severe preoperative fatty degeneration, but did not show whether healing of the repair ultimately influenced postoperative atrophy and fatty muscle infiltration.…”

Section: Introductionmentioning

confidence: 99%

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Does Open Repair of Anterosuperior Rotator Cuff Tear Prevent Muscular Atrophy and Fatty Infiltration?

Schino

Augereau

Nich

2012

Clinical Orthopaedics &Amp; Related Research

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BackgroundRepair of cuff tears involving rotator interval reportedly improves function. However, it is unclear whether successful repair prevents shoulder degenerative changes. Questions/purposes Therefore, we (1) documented the minimal 4-year function of patients who underwent open surgical repair for rotator interval tears; (2) evaluated repaired tendon healing with postoperative MRI; and (3) sought to determine the influence of tendon healing on muscular and glenohumeral joint changes. Methods We retrospectively analyzed 22 patients (23 shoulders) treated by open transosseous reinsertion of supraspinatus and subscapularis tendons. The mean age of the patients was 53 years (range, 37-64 years). The tear was traumatic in four cases. Repair healing and muscular changes were assessed using MRI. The minimum followup was 46 months (mean, 75 months; range, 46-103 months).Results We observed an improvement in the absolute Constant-Murley score from 63 points preoperatively to 76 points postoperatively. With the last followup MRI, the supraspinatus tendon repair had failed in two of the 23 shoulders, whereas the subscapularis tendon repair had healed in all cases.

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Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: Results from 58 sonographic examinations with surgical correlation

Moosmayer

Heir

Smith

2006

J of Clinical Ultrasound

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Purpose. To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears.Methods. Preoperative sonographic examination was performed on 58 shoulders. Key biases on sonographic interpretation such as history-taking, physical examination, or concurrent imaging examinations were excluded by way of blinding. Tears of the rotator cuff were the positive findings of interest. Assessment of tear size and localization was done sonographically, and the results were compared with operative findings.Results. All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than 61 cm.Conclusions. Blinded sonographic examination is effective in the detection and quantification of fullthickness tears of the rotator cuff but lacks sensitivity in the detection of partial-thickness tears.

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Diagnosis and treatment of anterosuperior rotator cuff tears

Cited by 340 publications

References 36 publications

Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Does Open Repair of Anterosuperior Rotator Cuff Tear Prevent Muscular Atrophy and Fatty Infiltration?

Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: Results from 58 sonographic examinations with surgical correlation

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