A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin

Calcific tendinitis is a common condition with characteristic clinical and radiological findings. Although we do not know which condition initiated the pathologic cascade, we present a rare case of calcific tendinitis of the long head of the biceps brachii at its origin, associated with a SLAP lesion. The calcium deposit was removed and the SLAP lesion was repaired with a suture anchor arthroscopically.     

Differences in distribution of myofiber types between the supraspinatus and infraspinatus muscles of sheep

Background: The m. supraspinatus stabilizes the shoulder joint to bear the body weight, and the m. infraspinatus assists in extension and flexion of the joint in sheep. Postural muscles have many SO myofibers, whereas locomotory muscles have numerous fast-twitch myofibers. In sheep the distribution of myofiber types within the two muscles, necessary for a better understanding of postural function, remains to be clarified. Methods: Muscle samples were removed from the whole transverse sections of the dorsal, middle, and ventral compartments of the m. supraspinatus and m. infraspinatus of sheep. Myofibers were classified into FG, FOG, SO-1, and SO-2 myofibers by histochemical methods. Results: The distribution of SO myofibers changed more greatly in the m. supraspinatus (15.0–99.1%) than in the m. infraspinatus (24.5–62.3%). SO myofibers were concentrated markedly in the caudal and deep regions near the spine and fossa of the scapula in the m. supraspinatus and distributed more in the medial part than in the lateral part in the m. infraspinatus. Such changes were caused by increases in percentage of SO-2 myofibers and not SO-1 myofibers. The craniolateral regions of the m. supraspinatus and the caudolateral regions of the m. infraspinatus had many fast-twitch (FOG plus FG) myofibers suited for rapid extension and flexion of the shoulder joint. Conclusions: The m. supraspinatus has the compartmentalized, deep, and caudal regions occupied by SO myofibers, which seem to be specialized for maintenance of the joint extension. The medial region of the m. infraspinatus may assist in the joint stabilization. © 1995 Wiley-Liss, Inc.     

Comparison of supraspinatus tendon and glenohumeral joint axes in MR imaging of the shoulder

Objective. In magnetic resonance (MR) imaging of the shoulder, oblique coronal images are used for evaluating the supraspinatus tendon (SST) of patients with suspected rotator cuff tear or impingement. This study aimed to compare orientation of the SST long axis with planes perpendicular to the glenohumeral joint (GHJ). Design and patients. The axial scans of 100 consecutive patients referred for MR imaging or MR arthrography of the shoulder were reviewed. Using the electronic cursors of a computer workstation, the angle of the SST long axis was measured and compared with the angle obtained through the GHJ utilizing three different landmarks: perpendicular to the joint (GHJ-90), joint–humeral head center axis (GHJ-H) and joint–scapular body axis (GHJ-S). Results. Differences in angulation between axes of the SST and the three GHJ axes averaged only about 5° [range of means 4.5–5.3°, range of standard deviation (SD) 3.8–4.6°]. In the majority of shoulders, angular differences measured 4 or less for all SST/GHJ comparisons. Similarly, small angular differences in the three GHJ axes were found: 4.5° (SD 3.3°) for GHJ-90/GHJ-S, 5.0° (SD 4.0°) for GHJ-S/GHJ-H and 2.9° (SD 3.0°) for GHJ-90/GHJ-H. Correlation between the GHJ-90 and GHJ-H axes was particularly good, with differences of 4° or less in 84% of shoulders. The orientations of the GHJ axes and that of the SST long axis are comparable. Conclusion. The GHJ may potentially be used as a landmark for obtaining oblique coronal images of the SST. Received: 19 November 1999 Revision requested: 18 January 2000 Revision received: 27 March 2000 Accepted: 5 April 2000     

声触诊组织成像量化技术评估正常人群冈上肌腱弹性变化

目的 探讨声触诊组织成像量化技术（VTIQ）评估正常人冈上肌腱弹性变化的价值。方法 对120名健康志愿者行二维超声及VTIQ检查,根据年龄将其分为组1（20~39岁）、组2（40~59岁）及组3（≥ 60岁）。测量冈上肌腱最大厚度及其浅层、深层剪切波速度（SWV）,比较不同性别、年龄组及优势手与非优势手侧冈上肌腱厚度及浅层与深层SWV值的差异。结果 同一性别内优势手侧与非优势手侧、不同性别间非优势手侧及优势手侧冈上肌腱厚度值差异均无统计学意义（P均>0.05）。3组间优势手侧及非优势手侧冈上肌腱厚度值差异均有统计学意义（P均<0.05）;组3优势手侧及非优势手侧冈上肌腱厚度均大于组1及组2（P均<0.05）,组1与组2差异均无统计学意义（P均>0.05）。3组组内优势手侧与非优势手侧冈上肌腱厚度值差异均无统计学意义（P均>0.05）。3组间优势手侧及非优势手侧冈上肌腱浅层、深层SWV值差异均有统计学意义（P均<0.001）;3组组内优势手侧冈上肌腱浅层、深层SWV值与非优势手侧差异均无统计学意义（P均>0.05）,但优势手侧及非优势手侧冈上肌腱深层SWV值大于浅层（P均<0.05）。组3男性冈上肌腱浅层及深层SWV均高于女性（P均<0.05）,其余2组差异均无统计学意义（P均>0.05）。结论 肌腱退行性变时,不仅在形态学上表现为厚度增加,在力学特征上还可表现为肌腱软化。VTIQ可间接评价冈上肌腱弹性变化。     

基于MRI针刀治疗冈上肌肌腱炎的临床随机对照研究

目的:观察基于MRI针刀治疗冈上肌肌腱炎的临床疗效。方法:将72例冈上肌肌腱炎患者随机分为治疗组和对照组,每组36例。治疗组采用针刀治疗,对照组采用电针治疗,观察周期为2周。评价两组患者的临床疗效,比较两组患者的疼痛视觉模拟量表(VAS)评分及疼痛弧试验阳性率的变化。结果:治疗后,治疗组的总有效率为91.2%,对照组为84.8%,治疗组的疗效优于对照组(P0.05)。治疗后,两组患者的VAS评分均显著降低(P0.01),且治疗组患者的评分低于对照组(P0.01);两组患者的疼痛弧试验阳性率均显著降低(P0.01),治疗组患者的疼痛弧试验阳性率为17.65%,对照组为27.27%,但两组比较差异无统计学意义(P0.05)。结论:基于MRI针刀治疗冈上肌肌腱炎具有较好的疗效,可明显缓解患者的疼痛症状,改善患者的体征。     

高频超声及声触诊组织量化技术对男性肩袖损伤患者冈上肌腱的评价

目的:应用高频超声及声触诊组织量化技术(VTIQ)评价男性肩袖损伤患者冈上肌腱的变化。方法:收集50例确诊的肩袖损伤男性患者,分为A组(35~59岁)28例和B组(≥60岁)22例。患者均行常规检查及VTIQ检查,测量冈上肌腱的厚度及其近端、远端的剪切波速度(SWV)。结果:常规检查示B组双侧冈上肌腱厚度均大于A组(均P<0.05)。VTIQ技术得出B组双侧冈上肌腱远端及近端的SWV值均小于A组(均P<0.05),且2组双侧冈上肌腱远端的SWV值均大于近端(均P<0.05)。结论:高频超声常规检查及VTIQ技术能有效评估男性肩袖损伤患者冈上肌腱的二维形态学改变及SWV值变化,冈上肌腱随年龄增大逐步变厚,而SWV下降表明肌腱发生软化,可为临床治疗及康复训练提供参考价值。     

Rotator cuff strength is not augmented by blood flow restriction training

ObjectiveBlood flow restriction (BFR) training utilizes a tourniquet applied to the upper or lower extremities (UE or LE) to occlude blood flow while exercising. BFR training may help augment strength in muscles that are proximal to BFR cuff application. However, prior studies have failed to demonstrate augmented strength gains in the rotator cuff when the tourniquet is applied to the UE. The purpose of this study was to evaluate if a protocol consisting of LE exercises, performed with BFR, followed by rotator cuff exercises was superior in augmenting strength, and cross-sectional area (CSA) of the rectus femoris, in untrained subjects when compared to a non-BFR training group.DesignRandomized controlled trial.SettingUniversity.ParticipantsThirty-five subjects (mean age 25.8 ± 1.6 y) randomized to a BFR or non-BFR group.Main outcome measuresMuscular strength measured via hand held dynamometer and the CSA of the dominant rectus femoris was measured by diagnostic ultrasound.ResultsBoth groups experienced significant gains in LE and rotator cuff strength. Strength increased in the BFR group by 11.6% for the supraspinatus, 34.1% for shoulder ER, 23.4% for the quadriceps, and 17.1% for the hamstrings. Strength increased in the non-BFR group by 7.3% for the supraspinatus, 20% for shoulder ER, 12.8% for the quadriceps, and 10.7% for the hamstrings. However, there were no differences in strength gains between groups. Neither group experienced a significant increase in CSA for the rectus femoris.ConclusionThe BFR protocol used in this study did not augment strength for the rotator cuff in subjects who also performed LE exercises under occlusion.     

Complications of calcific tendinitis of the shoulder: a concise review

Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient.Level of evidence 5.