Treatment options for massive rotator cuff tears

Gerber, Christian; Wirth, Stephan; Farshad, Mazda

doi:10.1016/j.jse.2010.11.028

Cited by 150 publications

(153 citation statements)

References 89 publications

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“…4; 29; 30 All patients in our series presented with severe functional impairment of their shoulder, having exhausted all forms of non-operative measures prior to surgery. 16 All had high functional demands and were unwilling to accept their current level of disability. Twentythree patients (58%) had undergone at least one previous operation, with the large majority having failed previous attempts at rotator cuff repair.…”

Section: Discussionmentioning

confidence: 99%

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

Neukom

Catanzaro

et al. 2013

Journal of Shoulder and Elbow Surgery

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348

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Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years Ek, Eugene T H; Neukom, Lisa; Catanzaro, Sabrina; Gerber, Christian Abstract: BACKGROUND: The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the midterm to long-term results of RTSA for patients aged younger than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears, with or without arthritis. METHODS: Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64 years). At the latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171 months). RESULTS: The mean relative Constant score increased from 34% to 74% (P < .0001) and the subjective shoulder value improved from 23% to 66% (P < .0001). Significant improvements were seen in active forward elevation (72°to 119°), pain scores, and strength (P < .001). One or more complications occurred in 15 shoulders (37.5%), with 6 failures (15%) resulting in removal or conversion to hemiarthroplasty (3 with infection, 3 with glenoid loosening). Ten shoulders (25%) underwent partial or total component exchange, conversion to hemiarthroplasty, or removal. Of the 15 patients who developed complications, 9 did not require prosthesis removal or conversion and functional outcome and subjective shoulder value were similar to those with no complications (P > .4). CONCLUSION: RTSA in younger patients provides significant subjective improvement and substantial gain in overall function, which is maintained up to 10 years. Although the complication rate is high, most can be treated successfully without compromise to clinical outcome. However, it is imperative that the high complication rate is explained to patients, with the risks and benefits carefully considered. Conflict of interest/Disclaimer: Christian Gerber receives royalties from Zimmer Inc, which is related to the subject of this article. All other authors, their immediate family, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.Reverse shoulder arthroplasty in younger patients 2 ABSTRACT Background:The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the mid to long-term results of RTSA for patients less than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears with or without arthritis. Methods:Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64). At latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171). Results:Mean relative Constant score increased from 34% to 74% (p<0.0001) and subjective s...

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Section: Discussionmentioning

confidence: 99%

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

Neukom

Catanzaro

et al. 2013

Journal of Shoulder and Elbow Surgery

Self Cite

348

193

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“…Gerber et al, 2011] High rates of re-tear follow rotator cuff repair [Galatz et al, 2004] and tendon 3 transfer or shoulder arthroplasty are the main options when the tear is irreparable [Boes et al, 2006]. Physiotherapy has been suggested as a key alternative intervention in the management of MRCT when surgery is not feasible.…”

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

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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

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“…22 Such changes render cuff tears irreparable due to the poor tissue quality and altered mechanics which frequently results in osteoarthrosis and poor functional outcomes. 23 In primary health care the early diagnosis of a clinically significant medium or large rotator cuff tear, prior to loss of tissue viability is therefore important to inform decisions regarding conservative or surgical management and to optimize surgical outcomes. 24,25 In primary care practice, the clinical diagnosis of rotator cuff tears begins with a clinical examination.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Cadogan

McNair

Laslett

et al. 2013

Journal of Manual & Manipulative Therapy

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Objectives: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Methods: Participants were consecutively recruited from primary health care practices (n5203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P,0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. Results: A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86-1.00; negative likelihood ratio: 0.00, 95% CI: 0.00-0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86-0.95; positive likelihood ratio 4.66, 95% CI: 2.34-8.74). Discussion: Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.

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Treatment options for massive rotator cuff tears

Cited by 150 publications

References 89 publications

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

Electromyographic assessment of muscle fatigue in massive rotator cuff tear

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

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