Examination of the Shoulder

Ronquillo, Jonathan C.; Szomor, Zoltan L.; Murrell, George A. C.

doi:10.1097/bte.0b013e31823a10c6

Cited by 31 publications

(29 citation statements)

References 40 publications

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“…5 The answers of the patients in the questionnaire were converted to numerical figures for statistical analysis as follows: overall rating (very bad = 0, bad = 1, poor = 2, fair = 3, good = 4); frequency of pain (never = 0, monthly = 1, weekly = 2, daily = 3, always = 4); level of pain and difficulty reaching behind the back and the overhead (none = 0, mild = 1, moderate = 2, severe = 3, very severe = 4); stiffness (not at all = 0, a little = 1, moderately = 2, quite = 3, very stiff = 4); current level of work/ activity (none = 0, light activity = 1, moderate activity = 2, strenuous labor = 3); and level of sport (none = 0, hobby sport = 1, club sport = 2, national sport = 3). This questionnaire included domains of global assessment, pain, daily, recreational and athletic activities, and work.…”

Section: Assessment Of Painmentioning

confidence: 99%

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Arthroscopic ePTFE Patch Repair for Irreparable Rotator Cuff Tears

Ronquillo

Fpoa

Lam

et al. 2013

Techniques in Shoulder &Amp; Elbow Surgery

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Introduction: Massive rotator cuff tears are difficult to manage. A treatment option is the use of a synthetic patch as an interpositional bridge to restore the continuity of the cuff defect. The aim of this paper was to evaluate the early clinical results of these techniques compared with the standard direct tendon to bone repair. Methods:A retrospective case-controlled study was performed on patients with massive (Z15 cm 2 ) rotator cuff tears who underwent an arthroscopic direct tendon to bone repair and patients with irreparable rotator cuff tears who underwent arthroscopic patch interposition using multiple mattress technique or a novel weave technique at the patch to tendon interface. Results:Of the 801 arthroscopic rotator cuff repairs, 37 patients met the inclusion criteria. Of these, 21 underwent direct tendon to bone repair without interpositional patches and 16 underwent interpositional expanded polytetrafluoroethylene (ePTFE) patch repairs (8 with multiple mattress sutures and 8 with a weave repair at the patch to tendon interface). No differences were noted between the 3 groups in terms of patient age (66 ± 3, 64 ± 3, and 63 ± 5 y, respectively), rotator cuff tears sizes (25 ± 3, 25 ± 6, and 19 ± 4 cm 2 ), preoperative subjective pain and function, and strength and range of motion. Overall subjective pain and function improved in all 3 repair groups at 6 months postoperatively (P < 0.05). Supraspinatus strength was superior in the weave technique when compared with the direct tendon to bone (P < 0.001) and the multiple mattress technique (P < 0.001). External rotation strength was better with the weave technique over the direct tendon to bone repair at 6 months (P = 0.01). There was more range of motion in external rotation in the weave technique over the direct tendon to bone repair (P < 0.001) and the multiple mattress technique (P = 0.04). Operative times with the ePTFE reconstructions (64 ± 7 min with the multiple mattress repair and 46 ± 3 min with the weave repair) were longer than the direct tendon to bone repair (33 ± 3 min). At 6 months, ultrasound showed that 10/21 repairs were intact in the direct tendon to bone repair group, whereas all (16/16) repairs with the ePTFE grafts were intact (P = 0.01). Conclusions:The weave arthroscopic method for attaching a synthetic patch to the torn edges of an irreparable rotator cuff tear was faster to perform and gave better supraspinatus and external rotation strength when compared with the multiple mattress repair at 6 months after repair. Tendons repaired with an ePTFE patch were much less likely to retear when compared with tendons repaired directly to the bone.

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Section: Assessment Of Painmentioning

confidence: 99%

“…5 Visual estimation as a measure of range of motion was recorded in degrees. Forward flexion and abduction were performed with the ipsilateral hand of the examiner moving the arm, with the other hand stabilizing the scapula.…”

Section: Assessment Of Passive Range Of Motionmentioning

confidence: 99%

Arthroscopic ePTFE Patch Repair for Irreparable Rotator Cuff Tears

Ronquillo

Fpoa

Lam

et al. 2013

Techniques in Shoulder &Amp; Elbow Surgery

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“…These outcomes consisted of patient-determined (a) frequency of pain during activity, sleep, and when extremely painful, (b) severity of pain at rest, with overhead activity and when asleep, (c) level of shoulder stiffness, (d) difficulty reaching behind the back and activities above the head, (e) overall rating of the shoulder 18,19 ; objective strength measurements of the shoulder in external and internal rotation, supraspinatus strength along the scapular plane, lift-off and adduction 19 ; and presence of impingement signs 19 at 1, 6, 12 weeks, and 6 months post-ePTFE interpositional arthroscopic rotator cuff reconstruction compared with preoperative data. These outcomes consisted of patient-determined (a) frequency of pain during activity, sleep, and when extremely painful, (b) severity of pain at rest, with overhead activity and when asleep, (c) level of shoulder stiffness, (d) difficulty reaching behind the back and activities above the head, (e) overall rating of the shoulder 18,19 ; objective strength measurements of the shoulder in external and internal rotation, supraspinatus strength along the scapular plane, lift-off and adduction 19 ; and presence of impingement signs 19 at 1, 6, 12 weeks, and 6 months post-ePTFE interpositional arthroscopic rotator cuff reconstruction compared with preoperative data.…”

Section: Tertiary Outcomesmentioning

confidence: 99%

“…19 Strength assessments included internal rotation and external rotation strength with the arm in 0 degrees of abduction, supraspinatus strength with the arm abducted 90 and 30 degrees from the coronal plane (in the scapular plane), lift-off strength, and adduction strength with the arm 30 degrees abducted and the elbow extended, serving as the internal control for the strength testing.…”

Section: Physical Examinationmentioning

confidence: 99%

Morphologic Changes of Synthetic (ePTFE) Interpositional Patch Repair for Massive Irreparable Rotator Cuff Tear

Ronquillo

Briggs

Lam

et al. 2013

Techniques in Shoulder &Amp; Elbow Surgery

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Background: Massive, irreparable rotator cuff tears are difficult to manage. One option is to replace the lost tissue with a synthetic patch, for example, expanded polytetrafluoroethylene (ePTFE). There is, however, no information regarding ePTFE patch healing in humans. The aim of this study, therefore, was to evaluate healing of an irreparable rotator cuff tear treated with an interpositional ePTFE patch. Methods:The shoulders of consecutive patients undergoing interpositional ePTFE (Gore-Tex) patch repair for reconstruction of an irreparable rotator cuff tear by a single surgeon were evaluated by an experienced ultrasonographer using a standardized protocol, and by validated patient and examiner outcome measures preoperatively, and at 1, 6, 12 weeks, and 6 months postarthroscopic rotator cuff reconstruction.Results: Ten patients with an average age of 64 years (range, 42 to 85 y) and mean ± SEM rotator cuff defects of 20 ± 3.3 cm 2 repaired with an ePTFE interpositional graft completed the study. Signs of healing on ultrasound were present at the patch to bone interface in 60% (6/10) of shoulders in a week, whereas 30% (3/10) showed signs of healing at the patch to tendon interface at 12 weeks after surgery. ePTFE patch to tendon thickness was 3.1 ± 0.3 mm a week after surgery, decreasing to 1.9 ± 0.2 mm at 6 months (P = 0.05). The patch landing site dimensions (7.3 ± 0.9 mm), thickness at the patch to bone interface (3.7 ± 0.3 mm), and vascularity at the patch to bone and patch to tendon interfaces were unchanged over 6 months. The subacromial bursa was thickened at 1 week postoperatively (2.1 ± 0.2 mm), thinned at 6 weeks (1.7 ± 0.2 mm, P = 0.04), thicker at 12 weeks (2.2 ± 0.6 mm), and was within normal thickness after 6 months at 1.2 ± 0.1 mm (P < 0.0003). Healing at the patch to bone interface was noted in 10/10 patients, and 9/10 patients at the patch to tendon interface, 6 months after surgery. There were no retears. Frequency and level of pain improved (P < 0.05), whereas the shoulders were less stiff (P = 0.002). The overall rating of patients on their shoulders improved from very bad to poor before surgery to fair to good 6 months after surgery (P = 0.002). Internal rotation, external rotation, and adduction strengths improved 1.6-fold (P < 0.05), whereas the supraspinatus strength doubled (P = 0.0006). Impingement signs were less at 6 months (P = 0.001). Conclusions:This study showed excellent healing of massive, irreparable rotator cuff tears after reconstruction using ePTFE interpositional patch. Signs of healing on ultrasound were present at the patch to bone and patch to tendon interfaces at 1 and 12 weeks, respectively. Patch to tendon interface thickness increased after surgery and gradually decreased in thickness after 6 months, whereas the thickening of the subacromial bursa at 1 week after surgery normalized over 6 months. There were no retears. These morphologic changes were accompanied by improvements in pain, strength, and impingement signs.

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“…Passive range of motion for forward flexion, abduction, external rotation and internal rotation were measured by visual estimation, which has been demonstrated to have fair-togood reliability compared to other methods. 15 Quantitative strength measurements of the shoulder for internal rotation, external rotation, abduction in the scapular plane (supraspinatus), abduction and lift off were taken using a Handheld Force Gauge (HGF-110; Transducer Techniques, Temecula, CA, USA) which has been found to be the most reliable and discriminatory means of assessing shoulder strength. 16,17 Rotator cuff functional index (RFI) was derived from these measurements as described by Osbahr and Murrell.…”

Section: Outcome Measuresmentioning

confidence: 99%