Transosseous arthroscopic repair of partial articular-surface supraspinatus tendon tears

Partial articular-surface tendon avulsion (PASTA) lesions of the supraspinatus muscle represent a common cause for shoulder impairment and a preceding pathology for full-thickness tendon tears. Arthroscopic tendon repair is a possible surgical method of treatment. The purposes of cuff repair are anatomical tendon healing, prevention of tear size progression to completion and reduction of shoulder pain. In this report, we describe a transtendon arthroscopic technique of transosseous refixation of articular-side partial tears leaving the bursal layer of the supraspinatus tendon intact. A curved hollow needle is used to perform an all arthroscopic transosseous mattress suture. Thus, anatomical tendon-to-bone contact of the rotator cuff to the footprint is restored. Preliminary clinical results of 16 patients are convincing with significant pain relief and functional improvement.     

Abnormalities on MRI of the subscapularis tendon in the presence of a full-thickness supraspinatus tendon tear

OBJECTIVE: Our objective was to determine the association between size and chronicity of full-thickness supraspinatus tendon tears with subscapularis tendon abnormalities on MRI. MATERIALS AND METHODS: One hundred forty-two MRI examinations with full-thickness supraspinatus tendon tears were categorized on the basis of the supraspinatus muscle (SS): normal muscle (SS(normal)), suggesting a recent or small tear; reduced muscle bulk without fatty atrophy (SS(volume loss)); and those with fatty atrophy, suggesting a large or chronic tear (SS(fatty atrophy)). Subscapularis tendon abnormalities, the subcoracoid interval, and subcortical bone marrow edema in the lesser tuberosity and coracoid process were recorded. RESULTS: The mean size of supraspinatus tendon tears in the SS(normal) (n = 45) group was 8.5 mm, 16.6 mm in SS(volume loss) (n = 53), and 29 mm in the SS(fatty atrophy) group (n = 44). Subscapularis tendon abnormality was identified in 22% of SS(normal) patients, 61% of SS(volume loss), and 86% of the SS(fatty atrophy) group (p < 0.001). There was moderate correlation between chronicity of supraspinatus tendon tears and subscapularis tendon abnormality (r = 0.47; p < 0.0001), with no correlation between the subcoracoid interval and abnormalities of the subscapularis tendon. There was moderate correlation between chronicity of supraspinatus tendon tears and bone marrow changes in the lesser tuberosity (r = 0.44; p < 0.0001). CONCLUSION: Subscapularis tendon abnormality is related to chronicity of supraspinatus tendon tears. Bone marrow edema in the lesser tuberosity with a subscapularis tendon abnormality suggests increased stress at the subscapularis tendon insertion with chronicity of full-thickness supraspinatus tendon tears. Lack of correlation with the subcoracoid interval indicates that anterior instability may be a more important contributing factor to subscapularis tendon abnormalities than static subcoracoid impingement in the setting of a full-thickness supraspinatus tendon tear.     

Narrowed coraco-humeral distance on MRI: Association with subscapularis tendon tear

Purpose

To highlight the relationship between coraco-humeral distance and subscapularis tendon tear.

Suture-bridge subscapularis tendon repair technique using low anterior portals

A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge creation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approached using other arthroscopic techniques. From a biomechanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique.     

Repair of tears of the subscapularis tendon

Tears of the subscapularis are much less common than tears of the supraspinatus and infraspinatus. Subscapularislesions are usually traumatic in etiology and occur in younger patients. These lesions can be complete or limited to the superior insertion of the subscapularis, and they may be isolated or occur with other rotator cuff lesions. In most instances, treatment of subscapularis tears is surgical. In this article, we present the clinical and radiographic findings, discuss operative indications, and illustrate our preferred surgical technique for tears of the subscapularis tendon.     

Clinical outcome and structural integrity of all-arthroscopic repair of degenerative subscapularis tendon tears

Purpose

The purpose of this study was to evaluate the clinical outcome of all-arthroscopic repair of degenerative subscapularis tendon tears and post-operative structural integrity using magnetic resonance imaging with a short-term follow-up.

Methods

Twenty-one patients were treated all-arthroscopically for a full-thickness degenerative subscapularis tendon tear. Median patient age was 55 years (range, 41–69). Median follow-up was 25 months (range, 15–44). Patients were evaluated prior to surgery and at follow-up: active range of motion, VAS pain, Simple Shoulder Test (SST), and the Disabilities of the Arm, Shoulder, and Hand score (DASH). At final follow-up, the Constant–Murley score was evaluated.

Results

Mean active range of motion showed significant post-operative improvement (p < 0.001). VAS pain improved from 8.3 (SD ± 1.3) pre-operatively to 2.7 (SD ± 1.8) post-operatively (<0.001); SST increased from 20 % (SD ± 26) pre-operatively to 83 % (SD ± 27) post-operatively (<0.001); DASH scores improved 67 (SD ± 19) to 18 (SD ± 21) post-operatively (<0.001). Post-operative Constant–Murley score was 79 (SD ± 12). Two patients had failure of the repair on post-operative MRI. Twelve cases (57 %) showed post-operative progression of fatty muscle infiltration.

Conclusion

All-arthroscopic repair is an effective treatment modality for degenerative subscapularis tendon tears with an anterosuperior tear pattern with good clinical results and high patient satisfaction. Although there was a high tendon-to-bone healing rate, fatty muscle infiltration was progressive in more than half of the patients.

Level of evidence

Therapeutic case series, Level IV.     

Magnetic resonance imaging appearance of partial latissimus dorsi muscle tendon tear

There is still a paucity of information about the clinical presentation, treatment and imaging findings of latissimus muscle tears. Only one study has specifically described the magnetic resonance imaging (MRI) features of latissimus tendon tears. We describe a case of a high-grade tear in the latissimus muscle tendon in an active water skier with no significant prior medical history. MRI demonstrated at least a 50% tear of the latissimus tendon, manifesting as increased signal intensity on T2-weighted sequences and surrounding edema, as well as a diminutive tendon at the humeral insertion.     

Isolated and combined tears of the subscapularis tendon

BACKGROUND: Isolated and combined subscapularis tendon tears are rare and are described in the literature only in small numbers. HYPOTHESIS: The outcome of surgical intervention for isolated and combined subscapularis tendon tears may be influenced by the tear pattern of the anterior rotator cuff and the period of time between trauma and surgical procedure. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1994 and 1999, 34 shoulders with isolated traumatic tears (16 shoulders) or subscapularis tendon rupture combined with a supraspinatus tendon tear were treated operatively. The average patient age was 51 years, and the mean follow-up period was 37 months. For statistical analyses, the Friedman and Mann-Whitney tests were used. RESULTS: In patients with isolated tears, the Constant score rose from an average of 43.9 to 88.7 points (P < .01), and in patients with combined tears, it rose from an average of 40.6 to 74.7 points (P <.01). Isolated tears improved 14 points more than combined tears (P <.05). The delay between trauma and surgical intervention was inversely proportional to the improvement in the Constant score. The Spearman coefficient of correlation was -0.97 in isolated tears and -0.89 in combined tears. CONCLUSIONS: Young patients with isolated traumatic tears of the subscapularis tendon and immediate repair have the best prognostic factors for treatment. Accuracy in the trauma history and the clinical and radiographic examination is demanded.     

Arthroscopic management of calcific tendinitis of the subscapularis tendon

Calcific tendinitis is a common disorder of the rotator cuff. Conservative treatment is frequently successful. For the patients remaining symptomatic after conservative treatment, excision of the calcium deposits offers a generally reliable pain relief. While calcific tendinitis is seen commonly affecting the supraspinatus tendon, it has been rarely reported involving the subscapularis tendon. We report on the clinical features, radiographic findings, arthroscopic treatment and results of one patient who presented a calcific tendonitis involving the subscapularis tendon of the left shoulder unresponsive to conservative treatment and associated subcoracoid stenosis and coracoid impingement.     

A novel technique to measure active tendon forces: application to the subscapularis tendon

This paper describes the design and use of a novel system for quantification of active tendon forces. An arthroscopically implantable force probe (AIFP) was inserted arthroscopically into the subscapularis tendon of the shoulder in vivo. The output response of this device was calibrated in situ with known forces applied to the tendon using an arthroscopic technique. On recovery of motor control following interscalene regional anaesthesia, the force within the tendon during active muscle contraction was measured. The AIFP was then retrieved through an arthroscopic portal. The technique showed that the subscapularis may produce forces of 250 N during maximum internal rotation of the shoulder.     

Severe atrophy and fatty degeneration of the infraspinatus muscle due to isolated infraspinatus tendon tear

Atrophy of both the supraspinatus and infraspinatus muscles is usually caused by chronic rotator cuff tear, but may also derive from suprascapular nerve entrapment at the spinoglenoid notch. Isolated infraspinatus muscle atrophy is uncommon, and typically associates with suprascapular nerve entrapment occurring distal to the spinoglenoid notch. However, isolated atrophy of the infraspinatus muscle due to insertional tear of the infraspinatus tendon may also occur. We present a case of a 43-year-old male with isolated infraspinatus muscle atrophy and fatty degeneration following an isolated full-thickness infraspinatus tendon tear at the insertion site on the humerus. While it is important to rule out other causes of infraspinatus muscle atrophy, such as concomitant rotator cuff tendon/muscle pathology or suprascapular nerve palsy, we present this case to increase awareness of this uncommon clinical presentation and the potential implications for treatment.     

Intra-articular variations of the long head of the biceps tendon

Purpose  

The long head of the biceps tendon (LHBT) generally runs free through its course in the glenohumeral joint. It can rarely be seen as attached to the joint capsule or the rotator cuff in different patterns. Although these variations are usually considered harmless in the literature, they may occur in conjunction with the labral pathologies. This study was designed to determine their prevalence and investigate their relationship with intra-articular pathologies encountered during arthroscopy.     

Intra-articular fibroma of tendon sheath arising in the acromioclavicular joint

Fibroma of the tendon sheath, a rare benign soft tissue tumor that most often occurs in the distal upper extremities (hands and wrist), is exceedingly rare to present as an intraarticular mass. Presented here is the first case in the English literature, to our knowledge, of a fibroma of the tendon sheath arising in the acromioclavicular joint. The patient presented with recurrent shoulder pain with activity without antecedent trauma. Radiographs were essentially normal. MR images demonstrated a lobulated, heterogeneous mass with contrast enhancement arising from the acromioclavicular joint. Following surgical resection, histopathology revealed hypocellular collagen matrix with spindle-shaped fibroblasts, confirming the diagnosis of fibroma of tendon sheath. The imaging features of the fibroma of the tendon sheath and a brief review of the literature are presented.     

Two cases of peroneus brevis tendon tear

A longitudinal tear of the peroneal tendon is thought to be the result of repetitive peroneal subluxation. However, this report documents two cases of longitudinal split of the peroneus brevis tendon that had no peroneal tendon subluxation. Primary suture was performed. Subluxation of the peroneal tendons was not identified surgically in either case.     

MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation

Objective

To evaluate the degree and location patterns of subscapularis tendon injury in patients with prior anterior shoulder dislocation (ASD).

Material and methods

Forty-five consecutive MR shoulder examinations in patients with a history of ASD and 20 consecutive MR examinations in patients without prior dislocation were reviewed. Two readers assessed for the presence and location of tendinosis and tearing in the subscapularis tendon, which was divided into three segments: superior, middle, and inferior. The readers also documented the presence of anterior labral tears, osseous Bankart defects and Hill–Sachs lesions. Fisher’s exact tests were performed to analyze the different types of pathology and their locations.

Results

Subscapularis tendinosis, and partial thickness and full thickness tears were more common in patients with a history of ASD. Tendinosis was found in 60-64.4% of the dislocation patients compared with 40% of the non-dislocation group. When stratified by location, the middle and inferior thirds were the most commonly affected with statistical significance (p?p?Conclusion Our study suggests an association between middle and inferior subscapularis tendon pathology and prior anterior shoulder dislocation. Based on our results, careful MR assessment of the subscapularis tendon by the radiologist is indicated in the setting of ASD as injury of this structure can be symptomatic and may be amenable to treatment.     

Intra-articular fibroma of tendon sheath involving the scapholunate and radiocarpal joints

Fibroma of tendon sheath is an uncommon benign soft tissue tumor with a predilection for the hand. A unique case involving the scapholunate and radiocarpal joints with bone erosion is reported. The patient presented with a transilluminating mass over the volar radial wrist associated with neuropathy in the superficial radial nerve distribution. Magnetic resonance imaging demonstrated a heterogeneous and lobulated mass with nonspecific signal characteristics closely associated with the scapholunate interval and the volar wrist soft tissues. Histologically it represented a fibroma of tendon sheath. The tumor is discussed and the relevant literature is reviewed.     

Irreducible anterior dislocation of the shoulder due to soft tissue interposition of subscapularis tendon

The shoulder joint is the most unstable joint in the body and is easily dislocated. Anterior shoulder dislocation is the commonest and can be associated with glenoid and humeral fractures. Anterior shoulder dislocations are not infrequently associated with cuff tendon tears; however, anterior shoulder dislocation is easily reducible. Irreducible anterior dislocation of the glenohumeral joint is uncommon, and this could be due to bony as well as soft tissue causes. Persistent anterior dislocation due to torn subscapularis interposition in the glenohumeral joint is very rare, and only a few operative cases have been reported in the literature. We present MR features of one such case and a literature review.