Results of Nonoperative Management of Full-Thickness Tears of the Rotator Cuff

Bokor, Desmond J.; Hawkins, Richard J.; Huckell, Graham H.; Angelo, Richard L.; Schickendantz, Mark S.

doi:10.1097/00003086-199309000-00013

Cited by 225 publications

(147 citation statements)

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“…between surgical outcome and time post tear (as measured by duration of symptoms) with some studies recommending a short [3], others a long trial [5] of nonoperative treatment before surgery while still others suggest no correlation between duration of symptoms and relief of symptoms with surgery [6]. This is often due to the difficulty in determining the actual length of time the tear was present.…”

Section: Introductionmentioning

confidence: 99%

Tendon Properties Remain Altered in a Chronic Rat Rotator Cuff Model

Dourte

Perry

Getz

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Chronic rotator cuff tears are often associated with pain or poor function. In a rat with only a detached supraspinatus tendon, the tendon heals spontaneously which is inconsistent with how tears are believed to heal in humans. Questions/purposes We therefore asked whether a combined supraspinatus and infraspinatus detachment in the rat would fail to heal and result in a chronic injury in the supraspinatus tendon. Methods We acutely detached the supraspinatus and infraspinatus tendons in a rat model. At 4, 8, and 16 weeks post-detachment, biomechanical testing, collagen organization, and histological grading were evaluated for the detached supraspinatus and infraspinatus tendons and compared to controls. Results In the detached supraspinatus tendon, area and percent relaxation were increased at all time points while the modulus and stiffness were similar to those of controls at 4 and 8 weeks. Collagen disorganization increased at late time points while cellularity increased and cells were more rounded in shape. In the detached infraspinatus tendon, area and percent relaxation were also increased at late time points. However, the modulus values initially decreased followed by an increase in both modulus and stiffness at 16 weeks compared to control. In the detached infraspinatus, we also observed a decrease in collagen organization at all time points and increased cellularity and a more rounded cell shape. Conclusions Due to the ongoing changes in mechanics, collagen organization and histology in the detached supraspinatus tendon compared to control animals at 16 weeks, this model may be useful for understanding the human chronic tendon tear. Clinical Relevance This rat rotator cuff chronic model can be used to test hypotheses regarding injury and repair mechanisms that cannot be addressed in human patients or in cadaveric studies.

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Section: Introductionmentioning

confidence: 99%

Tendon Properties Remain Altered in a Chronic Rat Rotator Cuff Model

Dourte

Perry

Getz

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…3,[7][8][9][10] Early repair generally affords the best opportunity for return of shoulder function and strength in addition to pain relief. 2,[11][12][13][14] Although patient history, physical examination, and plain radiographs can provide information about the chronicity of a cuff tear, the diagnosis may not always be clear, and imaging tests, such as ultrasound may be important in providing additional information. The purpose of our study was to identify ultrasonographic findings that would help to differentiate acute from chronic RCT in patients with a painful shoulder.…”

Section: Discussionmentioning

confidence: 99%

Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears.

Teefey

Middleton

Bauer

et al. 2000

Journal of Ultrasound in Medicine

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This study was undertaken to identify differences in the sonographic appearance of acute and chronic full‐thickness rotator cuff tears. The ultrasonograms of 24 patients with an acute rotator cuff tear and 20 with a chronic tear were reviewed for tear size (width), location, and the presence and distribution of fluid. Among these 24 patients, 75% with a midsubstance tear location had an acute tear; 64% of patients with joint or bursal fluid had an acute tear; 80% of patients with a nonvisualized rotator cuff due to a massive tear had a chronic tear; and 73% of patients with no sonographic evidence of bursal or joint fluid had a chronic tear. In conclusion, a midsubstance location and the presence of joint or bursal fluid were more commonly associated with an acute tear. A nonvisualized cuff and the absence of joint and bursal fluid were more commonly observed with a chronic tear.

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“…Athletes often complain of weakness, associated clicking, crepitus, clunking or grinding with overhead activities. 1,8,19 Physical examination Miniaci and Salonen'9 suggest a systematic approach to the shoulder examination of an athlete. This includes inspection, palpation, range of motion, strength testing, neurologic assessment, and performance of special shoulder tests.19 In addition, a thorough assessment of the cervical spine and of the upper extremity should be included because of the frequent referred pain in the shoulder region.…”

Section: Pathophysiologymentioning

confidence: 99%

“…4 Conservative treatment of the partial and full-thickness rotator cuff tears are recommended by many authors prior to surgical treatment. 14,[7][8][9][10][11][12] This case demonstrates the classic presentation of a degenerative rotator cuff tear in an elderly athlete. The essential clinical and radiographic features are reviewed in conjunction with principles of management and rehabilitation.…”

Section: Introductionmentioning

confidence: 99%