Midterm outcome after rotator cuff reconstruction

Rotator cuff tear is a common degenerative shoulder disorder that often requires surgical treatment. However, the correlation between the size of the tear and the functional results is somewhat controversial, which generates inconsistency among orthopaedic surgeons about the indications for and methods of rotator cuff reconstruction. Aims: The aim of the authors was to evaluate the midterm functional outcome after rotator cuff reconstruction and the possible connection between the results and the surgical technique or the postoperative ultrasound examination. In addition, recently published corresponding studies are also reviewed by the authors. Methods: Twenty-seven patients with full thickness rotator cuff tear were enrolled into the study who were treated either by arthroscopic (14 patients) or by open repair (13 patients) technique. Functional results were assessed using clinical tests. Ultrasound examination was also performed. Results: The average postoperative Constant Score was 73, the average DASH (Disabilities of the arm, shoulder and hand score) was 14. The Constant scores averaged 80 for the arthroscopic and 70 for the open group. Ultrasound examination showed partial or full thickness retear of the cuff in 40% of the cases. Conclusion: More than 70% of the patients had excellent or good results two years after the reconstruction. The change in the acromiohumeral distance or partial retear failed to affect the results significantly, but full thickness tear had an effect on them.     

Ultrasound Imaging for Tailored Treatment of Patients With Acute Shoulder Pain

PURPOSEThe objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine.METHODSIn a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging.RESULTSRotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease.CONCLUSIONSUltrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain.     

Employer Differences in Upper-Body Musculoskeletal Disorders and Pain Among Immigrant Latino Poultry Processing Workers

Between-employer differences in working conditions may lead to variable injury rates. The objective of this paper is to assess the difference in the prevalence of epicondylitis, rotator cuff syndrome, and low back pain among immigrant Latino poultry workers at plants of three different employers. Data were collected from a cross-sectional study among 286 poultry processing workers. Community-based sampling was used to recruit participants in western North Carolina. Rotator cuff syndrome (26.7%) and low back pain (27.9%) were more prevalent among employees of one specific employer. Multivariate analysis showed significant associations of low back pain and rotator cuff syndrome with age, task performed in the processing line, and employer. Employer is a major predictor of musculoskeletal disorders and pain. Line speed and work pace may account for these differences and provide an opportunity for regulation and intervention to protect the health of workers.     

A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.     

A questionnaire found disease-specific WORC index is not more responsive than SPADI and OSS in rotator cuff disease

ObjectivesTo compare responsiveness and minimal clinically important change (MCIC) for the disease-specific Western Ontario Rotator Cuff index (WORC) and the two region-specific questionnaires Shoulder Pain and Disability Index (SPADI) and Oxford Shoulder Scale (OSS) in patients with rotator cuff disease receiving corticosteroid injection therapy.Study Design and SettingOne hundred twenty-one patients with rotator cuff disease. Western Ontario Rotator Cuff index, SPADI, and OSS were administered before treatment and at 2 and 6 weeks after corticosteroid injection. Responsiveness was compared between questionnaires using the standardized response mean (SRM), area under the receiver operating characteristic curve, and reliable change proportion (RCP) statistics. Minimal clinically important change estimates were reported.ResultsThe differences between questionnaires were small and not consistent across the different responsiveness indices. Shoulder Pain and Disability Index was significantly more responsive than OSS measured by SRM and RCP at 2 and 6 weeks. Western Ontario Rotator Cuff index was significantly more responsive than OSS in RCP and area under receiver operating characteristic curve at 6 weeks. Shoulder Pain and Disability Index was significantly more responsive than WORC measured by RCP at 2 weeks. Minimal clinically important change was estimated to 5, 275, and 20 points for OSS, WORC, and SPADI, respectively.ConclusionsAll questionnaires are suitable for measuring change in patients with rotator cuff disease. Disease-specific WORC index is not more responsive than the region-specific SPADI and OSS in rotator cuff disease.     

肩袖损伤患者术后功能康复护理对患者生活质量的影响

目的探讨肩袖损伤患者肩关节镜手术治疗中选用康复护理的价值。方法选择2019年1月—2020年6月收治的80例肩袖损伤患者均分为两组(随机信封法),对照组40例选用常规护理,观察组40例选用康复护理,统计对比生活质量、并发症发生率、护理效果。结果观察组生活质量高于对照组,数据对比,P<0.05。观察组并发症发生率(7.50%)低于对照组(25.00%),数据对比,χ2=4.5006,P<0.05。观察组住院时间、术后疼痛程度、肩部功能恢复时间低于对照组,肩关节功能评分(30.14±1.25)分高于对照组(25.26±2.19)分,数据对比,t=12.2396,P<0.05。结论将功能康复护理应用在肩袖损伤患者肩关节镜手术治疗中对降低术后疼痛程度,缩短住院及恢复时间,提高关节功能评分及生活质量效果更理想。     

Rotator cuff tear in an elderly woman performing progressive resistance training: case report from a randomized controlled trial

The purpose of this article is to document a rotator cuff tear sustained by an elderly woman performing progressive resistance training (PRT) in a recent randomized controlled clinical trial. The patient was a sedentary 73-y-old Caucasian woman. Investigation revealed an acute, full-thickness tear of the right supraspinatus secondary to performing a shoulder press exercise. Further investigation via MRI revealed degenerative disease of the acromioclavicular joint including lateral downsloping of the acromion and an anteroinferior acromial spur, which would presdispose to impingement. Conservative management was implemented in this case for over 6 months with minimal success. The patient remained functionally limited in virtually all activities of daily living. Given the medical history, health status, physical condition, and age of our patient, it is probable that degenerative changes predisposed the patient to the injury. To our knowledge this is the first published report of an older adult sustaining a rotator cuff tear during PRT.     

Hand-arm vibration syndrome with use of anti-vibration chain saws: 19-year follow-up study of forestry workers

Objectives: Hand-arm vibration syndrome (HAVS) consists of vascular and neurological component. Musculoskeletal component has not been delineated yet. In the present follow-up study, we evaluated the prevalence of HAVS and the cumulative exposure to vibration among a cohort of forestry workers. Special interest was given to numbness and musculoskeletal disorders of upper extremity and neck in forestry workers. Methods: A follow-up study starting from 1976 was conducted among forestry workers in Suomussalmi in Finland. Total exposure of hand-arm vibration was recorded during 11 cross-sectional surveys. The last study was carried out in 1995. The lifetime dose of vibration energy was calculated. A cohort of 52 forest workers participated to all 11 cross-sectional surveys 1976–1995. HAVS and musculoskeletal disorders were evaluated. Results: The prevalence of active vibration white finger (VWF) decreased from 13 to 4% in the cross-sectional study. In the cohort VWF decreased from 17 to 8% and numbness increased from 23 to 40%. Rotator cuff syndrome (P=0.034) and epicondylitis (P=0.004) associated with numbness. Regional neck pain was diagnosed in 38% of workers and associated with low back pain. In modeling VWF, the lifelong vibration energy (OR 1.03, CI 1.01–1.05), and smoking (OR 7.36, CI 1.07–50.76) were significant. Numbness was modeled by pain in upper extremities (OR 12.43, CI 2.42–63.80) and neck pain (5.97, CI 1.25–28.39), not by lifelong vibration energy. Right rotator cuff syndrome was modeled by age (OR 2.58, CI 1.04–6.41) and lifelong vibration energy (OR 1.04, CI 1.00–1.07). Conclusions: The prevalence of VWF constantly decreased. Numbness did not follow the vibration exposure profile. Numbness also associated with upper extremity musculoskeletal disorders. Hand-arm vibration associated with the right rotator cuff syndrome in forestry workers.     

Managing shoulder pain in general practice--the value of academic detailing

After low back pain and neck pain, shoulder pain is the third musculoskeletal reason for presentation to general practice, with a self reported prevalence of 16-26%. Approximately 1% of the adult population is expected to visit a general practitioner annually for shoulder pain. Shoulder complaints are more common in women and despite the fact that 50% of acute shoulder pain resolves in 8-10 weeks, many patients present with the anticipation of being referred for imaging.     

Work-related musculoskeletal symptoms among sheet metal workers

We report results of two pilot studies of the relationship between musculoskeletal disorders and work tasks in sheet metal workers. These two studies were undertaken as pilot investigations to determine if symptoms of carpal tunnel syndrome or other work-related musculoskeletal symptoms are present in sheet metal workers, and to determine if we could begin to identify the factors in sheet metal work that cause them. In the first study, telephone interviews were conducted with 18 disabled sheet metal workers; the second survey entailed self-administered questionnaires completed by 47 active and retired sheet metal workers. Among the disabled workers, rotator cuff cases reported the greatest percent of time spent hanging duct, an overhead task commonly carried out during field work. Carpal tunnel cases reported more hand tool use than the rotator cuff cases. The questionnaire survey of active and retired workers found the proportion of time spent in a sheet metal shop (contrasted with field work) to be positively associated with hand symptoms; sheet metal workers who spent at least 65% of their time in the shop had an odds ratio of 3.4 for symptomatic hand cumulative trauma disorder (CTD) (p = 0.12). The proportion of time spent hanging duct was positively associated with both neck and shoulder symptoms, with odds ratios of 7.9 (p = 0.08) and 2.7 (p = 0.16), respectively. The results show that symptoms of neck, arm, and hand pain are common in sheet metal workers who are actively working, that carpal tunnel syndrome or hand pain is positively associated with more time spent working in the shop, and that shoulder pain or shoulder injuries is associated with work overhead (hanging duct). Ergonomic risks and cumulative trauma disorders have not been well characterized in the construction industry; these data strongly suggest that a subset of work tasks in construction increase the risk of cumulative trauma disorders.     

Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis

OBJECTIVES—To assess the occurrence and persistence of two restrictively defined neck-shoulder disorders among sewing machine operators. To assess factors associated with the development of neck-shoulder disorder and prognostic factors for remaining a case, when disorders were already present.
METHODS—In an initial group of 243 sewing machine operators, 178 were followed up for 2 years. At baseline and at 1 and 2 years follow up the participants underwent a clinical examination of the neck and arms and filled in a questionnaire about current musculoskeletal complaints. Clinical criteria for two main neck-shoulder disorders were defined: rotator cuff tendinitis and myofascial pain syndrome. A baseline control group consisted of 357 women with varied non-repetitive work.
RESULTS—At baseline the overall prevalence of myofascial pain syndrome and rotator cuff tendinitis was 15.2% and 5.8% among sewing machine operators compared with 9.0% and 2.2%, respectively, among controls. The presence of the disorders was strongly associated with a self perception of poor general health. Although myofascial pain syndrome showed a U shaped association with years as a sewing machine operator, rotator cuff tendinitis was absent among the newest recruits and present among 15% of the women with more than 20 years as a sewing machine operator. Besides years as a sewing machine operator, the risk of having a neck-shoulder disorder at baseline was significantly associated with high stress (prevalence ratio (PR)=2.54; 95% confidence interval (95% CI) 1.28 to 5.05) when adjusted for age, body mass index, smoking, living alone with children, job strain, and social support from colleagues and supervisors. Only one of 13 participants with rotator cuff tendinitis at baseline recovered during follow up. Myofascial pain syndrome showed a much more fluctuating tendency. Low social support (RR 3.72; 95% CI 1.22 to 11.30) and smoking (RR 3.93; 95% CI 1.33 to 11.58) were associated with the development of neck-shoulder disorders, which was also associated with neck-shoulder pain score and living alone with children.
CONCLUSION—Rotator cuff tendinitis showed a higher degree of persistence than myofascial pain syndrome. Both disorders highly influenced the perception of general health. Women who lived alone with children, were smokers, or experienced low support from colleagues and supervisors had a higher risk of contracting a neck-shoulder disorder.


Keywords: rotator cuff syndrome; myofascial pain syndrome; follow up study; prognostic risk factors     

针灸联合补肝肾方治疗老年肩袖损伤的临床疗效研究

目的研究针灸联合补肝肾方治疗老年肩袖损伤的临床疗效。方法选取符合肩袖损伤诊断标准的患者78例,随机分为对照组和治疗组。对照组给予曲安奈德联合利多卡因局部注射治疗;治疗组给予针灸联合补肝肾方治疗,连续治疗3个月。分别于治疗前后评估患者肩关节疼痛程度、肩关节主动活动范围和关节功能评定结果,并于治疗后统计两组的临床疗效。结果治疗组临床疗效高于对照组,肩关节疼痛程度、肩关节主动活动范围和关节功能评定结果的改善均优于对照组。结论针灸联合补肝肾方治疗老年肩袖损伤临床有效,可明显缓解疼痛,改善肩关节功能。     

碳青霉烯类抗菌药药理作用及临床应用效果分析

目的探究碳青霉烯类抗菌药药理作用及临床应用效果。方法选取2017年1月—2018年1月收治的100例肺部感染患者作为研究对象,将行头孢哌酮舒巴坦治疗者50例作为对照组,行头孢哌酮舒巴坦及亚胺培南西司他丁钠结合治疗者50例作为研究组,比较两组临床相关指标、肺功能及不良反应。结果研究组治疗后细菌学检查复常时间等临床各相关指标水平均优于对照组(P0.05);两组治疗后肺功能各指标水平均较治疗前优,且以研究组RV/TLC为(0.41±0.02)%、FEV1/FVC为(0.67±0.12)%的优化幅度更大(P0.05);研究组不良反应总发生率为2.00%,显著低于对照组(P0.05)。结论肺部感染患者经头孢哌酮舒巴坦与碳青霉烯类药物治疗后效果更佳,可有效改善患者临床症状,减轻炎性反应,且药物不良反应少。     

比较研究全肩关节镜与关节镜辅助下切开治疗肩袖损伤的效果

目的:对比研究全肩关节镜和关节镜辅助下切开治疗肩袖损伤的临床效果.方法:选取2018年1月~2019年1月本院接收的肩袖损伤患者90例,将于关节镜辅助下实施切开治疗的45例设为A组,将开展全肩关节镜切开术的45例设为B组,对比两组患者的临床治疗结果.结果:治疗后,B组患者的UCLA评分与ASES评分均明显高于A组,P<0.05;B组患者的VA S评分明显低于A组,P<0.05;B组患者的术后并发症发生率4.44%与A组的6.67%则并无明显差异,P>0.05.结论:相较于关节镜辅助下切开治疗,肩袖损伤患者采用全肩关节镜切开治疗的疗效更为显著,可有效改善患者的关节功能与疼痛症状.     

Prevalence of musculoskeletal disorders among immigrant Latino farmworkers and non-farmworkers in North Carolina

This paper evaluates the variability in the prevalence of epicondylitis, rotator cuff syndrome, low back pain, and lower extremity pathology among immigrant Latino farmworkers and non-farmworkers. Data were collected from a study among 272 farmworkers and non-farmworkers. Participants were recruited in eastern and central North Carolina. A physical examination was conducted by trained physicians. Prevalence of musculoskeletal disorders (MSDs) among Latino manual workers is high compared with other workers in similar occupations. Non-farmworkers (49%) had a higher prevalence of MSDs than farmworkers (35%). Epicondylitis (20.2%) and rotator cuff syndrome (19.1%) were most prevalent. Age was found to be significant among those who had epicondylitis (adjusted odds ratio [AOR] = 1.04) and lower extremity pathology (AOR = 1.07). Latino immigrant manual workers have high prevalence of MSDs. Further studies are needed to identify possible factors that make these populations more vulnerable to MSDs.     

Clinical inquiries. What is the best way to diagnose a suspected rotator cuff tear?

The evaluation of a suspected rotator cuff tear should start with a history and a clinical exam of the shoulder (strength of recommendation [SOR]: B, based on a systematic review of cohort studies). Three clinical test results in particular--supraspinatus weakness, weakness of external rotation, and impingement--or 2 positive tests for a patient older than 60 years were highly predictive of rotator cuff tear (SOR: B, based on individual prospective study). Either magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear (SOR: B, based on a systematic review of cohort studies). If a patient has an implantable device prohibiting MRI imaging, conventional arthrography is an alternative (SOR: A, individual randomized controlled trial). Suspected partial-thickness tears are best verified with an ultrasound (SOR: B, based on a systematic review of cohort studies).     

Isolated traumatic rupture of the subscapularis tendon

BACKGROUND: Although rotator cuff tears are well documented in the literature, there have been relatively few reported cases of isolated subscapularis tears. To our knowledge, no case has been reported that describes an isolated subscapularis tear in a woman without anterior shoulder dislocation or bony avulsion. METHODS: This report outlines the case of a healthy 46-year-old woman with no history of shoulder problems who sustained injury to her right shoulder while hanging a light fixture. We highlight several key points to early diagnosis and underscore operative management for a successful outcome. RESULTS AND CONCLUSIONS: Isolated subscapularis tendon ruptures are uncommon in women. Increased vigilance during the history and physical examination is necessary to detect these injuries. Subscapularis tendon ruptures are commonly mistaken for degenerative rotator cuff tears or subacromial impingement syndrome. The lift-off test can isolate a subscapularis injury. Pertinent radiographic and magnetic resonance imaging findings are described.     

综合康复疗法在肩袖损伤职业康复中的应用

目的 探讨医学训练疗法(medical training therapy,MTT)配合以超声波理疗(ultrasonic therapy)及关节松动术(joint loosening therapy)的综合康复疗法(ULM)对肩袖损伤的疗效。 方法 采用MTT配合超声波理疗及关节松动术为主的综合方法治疗59例肩袖损伤病人,于治疗前、治疗6周后分别评价其肩关节疼痛、日常生活能力、肌力、关节活动度及医患满意度等指标,分析疗效。 结果 57例肩伤患者完成6周的康复治疗,2例患者因疗效不佳中转关节镜手术治疗。完成治疗患者的肩关节日间痛可视化疼痛评分(visual analogue scale,VAS评分)由治疗前的(5.89 ±1.53)分降低至治疗后的(2.26 ±1.28)分,夜间痛VAS评分由治疗前的(7.30 ±1.70)分降低至治疗后的(2.67 ±1.66)分,两者在治疗前后比较,差异均有统计学意义(t=13.739、14.712,P<0.01)。肩关节功能综合评分由治疗前的(32.47 ±11.96)分提高到治疗后的(91.75 ±3.34)分,两者比较,差异有统计学意义(t=35.995,P<0.01)。 结论 以MTT配合超声波理疗及关节松动术为主的综合康复疗法对肩袖损伤的疗效较好,能全面促进患者肩关节功能康复。     

Work Organization and Musculoskeletal Health: Clinical Findings From Immigrant Latino Poultry Processing and Other Manual Workers

OBJECTIVE:: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. METHOD:: Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). RESULTS:: Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). DISCUSSION:: Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.     

Treatment of Impingement Syndrome: A Systematic Review of the Effects on Functional Limitations and Return to Work

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should^*, rotator cuff, impingement, work, sick leave, disabilit^*, function^*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.