肩关节镜下肩袖修复术治疗肩袖损伤的临床效果

目的探讨肩关节镜下肩袖修复术治疗肩袖损伤的临床效果。方法将我院2018年2月至2019年2月收治的52例肩袖损伤患者随机分为对照组(26例,开放式肩袖修复术)和观察组(26例,全肩关节镜下肩袖修复术)。比较两组的治疗效果。结果治疗后,两组的肩关节前屈、内旋、外旋活动度及Constant-Muley肩关节评分均增加,数字评估量表(NRS)评分均降低,且观察组显著优于对照组(P<0.05);观察组的治疗优良率显著高于对照组(P<0.05)。结论肩关节镜下肩袖修复术治疗肩袖损伤的临床效果显著,能够有效减轻患者疼痛,加快患者术后肩关节功能的恢复,值得临床推广应用。     

关节镜下修补肩袖全层撕裂

目的 探讨关节镜手术治疗肩袖全层撕裂的方法和疗效。方法 回顾2012年6月～2013年12月的21例肩袖撕裂的患者,采用关节镜下手术治疗。所有病例均行关节镜下肩袖清创术、缝线锚钉将肩袖肌腱于肱骨大结节处行止点重建、撞击征阳性患者行肩峰成形术。结果 随访时间4～16个月,平均9个月。应用UCLA评分标准进行肩关节功能评价,术前平均（7.3±2.0）分,术后（31.4±3.3）分（P <0.01）,评价体系中疼痛、功能、活动范围及肩关节提升部分明显优于术前。结论 肩关节镜下肩袖重建手术具有损伤小、肩关节功能恢复快等特点,可获得满意的临床效果。     

关节镜下缝线桥技术治疗老年创伤性肩关节脱位合并肩袖损伤的疗效评价

目的比较关节镜下缝线桥技术肩袖修补与保守方法治疗老年创伤性肩关节脱位合并肩袖损伤的疗效。方法前瞻性研究2010年8月-2013年8月采用关节镜下缝线桥技术肩袖修补或保守方法治疗老年创伤性肩关节脱位合并肩袖损伤患者共63例,根据患者治疗方法将其分为关节镜下缝线桥技术肩袖修补治疗组(手术组)和保守方法治疗组(对照组)。手术组完整随访30例,男16例,女14例;年龄66~83岁,平均74.5岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。对照组完整随访30例,男17例,女13例;年龄65~82岁,平均74.2岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。比较两组患者分组时、治疗1年后视觉模拟评分(VAS)、关节活动范围、简明肩关节功能测试(SST)评分、欧洲肩关节协会的Constant肩关节评分,并记录随访期间肩关节脱位复发例数。结果 60例患者获得至少1年的完整随访,手术组30例,对照组30例。分组时两组患者VAS评分、肩关节活动范围、SST评分、Constant评分组间差异无统计学意义(P0.05);随访1年时手术组患者的VAS评分、肩关节活动范围、SST评分和Constant评分均明显优于对照组,差异有统计学意义(P0.05)。随访期间手术组无肩关节脱位复发,对照组5例发生肩关节脱位复发,差异有统计学意义(P0.05)。结论采用关节镜下缝线桥技术肩袖修补治疗合并肩袖中、大型撕裂的老年创伤性肩关节脱位患者,可以明显改善患者肩关节功能,降低肩关节脱位复发率,长期随访结果有待进一步研究。     

肩周肌群训练联合肌内效贴治疗肩袖损伤的疗效观察

目的：研究肩周肌群训练联合肌内效贴治疗肩袖损伤的临床疗效。方法：选取符合肩袖损伤标准的患者40例,随机分成研究组和对照组各20例。对照组进行肩周肌群训练,研究组在对照组基础上增加肌内效贴布,治疗疗程为4周。2组在治疗前（T1）、治疗4周后（T2）、治疗结束后1个月随访时（T3）进行评估,评价指标采用视觉模拟评分法（VAS）、Constant-Murley肩关节评分系统(CMS)、美国加州大学肩关节评分系统(UCLA)、患侧肩关节活动范围(ROM)。结果：在T2和T3时,2组患者VAS评分均较T1时明显下降（均P＜0.05）,CMS及UCLA评分均较T1时明显提高（均P＜0.05）,前屈、外展、内外旋活动度均较T1时明显增加（均P＜0.05）,且研究组VAS评分均更低于对照组（均P＜0.05）,CMS及UCLA评分均更高于对照组（均P＜0.05）,前屈、外展、内外旋活动度均更高于对照组（均P＜0.05）;在T3随访时,研究组VAS评分较T2时明显下降（P＜0.05）,CMS及UCLA评分均较T2时明显提高（均P＜0.05）,前屈、外展、内外旋活动度均较T2时明显增加（均P＜0.05）,而对照组各项评分和肩关节ROM较T2时差异均无统计学意义。结论：说明肩周肌群训练联合肌内效贴治疗肩袖损伤效果更好,而且在治疗结束后1个月内肌内效贴仍能够维持一定的效果,值得临床推广应用。     

100例肩关节镜下治疗肩袖损伤术后的护理

目的 对肩关节镜手术治疗肩袖损伤术前及术后护理与康复经验进行探讨.方法 对10例肩袖损伤患者进行肩关节镜手术治疗,分别行术前护理、术后护理、术后康复训练、并发症的观察.比较术前后患者肩关节功能情况.结果 术后患者肩关节功能的优良率优于术前,术前后比较,x2=7.81,P＜0.01,差异具有统计学意义.结论 肩关节镜手术的护理和康复指导是肩关节镜手术后肩关节功能恢复的有力保证.系统的整体护理是肩关节镜手术取得良好效果的重要保障.     

关节镜下修复联合关节腔灌注治疗肩袖损伤合并继发性冻结肩的疗效分析*

目的探讨关节镜下修复肩袖联合关节腔灌注玻璃酸钠+氨甲环酸+得宝松治疗肩袖损伤合并继发性冻结肩的临床疗效。方法回顾性分析2015年8月-2017年5月该院收治的肩袖损伤合并继发性冻结肩患者41例。其中,男12例,女29例,年龄42～68岁,平均55.5岁,病程6～11个月,主诉肩痛、活动受限,磁共振成像(MRI)提示肩袖有撕裂,全麻下先行手法松解,然后入镜观察,镜下松解,根据肩袖撕裂形态及大小选择相应术式行肩袖缝合,关闭切口后,盂肱关节留置引流管并灌注玻璃酸钠20 mg+氨甲环酸10 ml+得宝松1 ml,肩峰下留置引流管并灌注玻璃酸钠20 mg+氨甲环酸10 ml。术后根据骨质及肩袖撕裂情况,个体化设计康复方案进行患肩功能练习。结果手术均顺利完成,切口均Ⅰ期愈合,1例术后1个月因疼痛未缓解要求再次入院予以消炎止痛、关节腔封闭等治疗并好转出院,其余无相关并发症发生,随访时间平均9个月,术后末次随访时视觉模拟评分(VAS)由术前(7.0±1.2)分下降(1.1±0.1)分。术前:外旋5～50°,平均(29.6±13.4)°;前屈30～135°,平均(82.8±30.4)°,外展30～140°,平均(83.4±29.4)°;术后:外旋25～60°,平均(51.3±8.6)°,前屈85～180°,平均(160.3±22.8)°,外展80～180°,平均(157.1±22.3)°。术前术后VAS评分及活动度比较,差异均有统计学意义(P 0.05)。结论关节镜联合关节腔灌注治疗肩袖损伤合并继发性冻结肩,可有效缓解疼痛,改善关节活动度,加速康复,临床效果满意。     

关节镜下治疗肩袖损伤21例报告

目的探讨运用关节镜治疗肩袖损伤方面的作用。方法在关节镜下对肩袖损伤进行缝合,同时行肩关节前肩峰成形术。结果本组21例根据美国UCLA功能评分标准进行评定,优良率达95.24%。结论关节镜下治疗肩袖损伤能明确诊断、探查盂肱关节的其他疾患、不损伤三角肌止点、无张力缝合肩袖、术后疼痛轻、可以早期功能锻炼、术后肩关节粘连少、瘢痕少。     

超声引导下肩袖三角间隙注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤

目的：观察超声引导下肩袖三角间隙注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤的临床疗效。方法：将部分或全层小撕裂型肩袖损伤患者128例随机分为对照组42例、痛点注射组 43例和超声注射组43例（最终脱失7例）。3组患者均接受常规康复治疗,痛点注射组加行肩关节局部痛点注射,超声注射组加行超声引导下肩袖三角间隙注射。治疗前和治疗3周后对患者进行肩痛程度视觉模拟评分（VAS）、Constant-Murley肩关节评分系统（CMS）各分项评分及功能独立性测量量表（FIM）中的自理能力评定,并比较3组临床治疗的总有效率。结果：治疗3周后,3组患者VAS评分较治疗前比较均明显降低（均P＜0.01）,痛点注射组和超声注射组较对照组评分均更低（均P＜0.05）,且超声注射组更低于痛点注射组（P＜0.05）;3组患者CMS各项评分和FIM的自理能力评分较治疗前均明显提高（均P＜0.01）,痛点注射组和超声注射组较对照组上述评分均更高（均P＜0.05）,且超声注射组更高于痛点注射组（P＜0.05）;痛点注射组和超声注射组临床疗效的总有效率均明显高于对照组（均P＜0.05）,且超声注射组总有效率更高于痛点注射组（P＜0.05）。结论：超声引导下肩袖三角间隙注射结合常规康复技术较痛点注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤能更好地减轻患者临床症状,改善肩关节功能,提高日常生活自理能力,疗效更好。     

温针灸治疗肩袖损伤的效果北大核心CSCD

目的观察温针灸对肩袖损伤患者的治疗效果。方法2019年1月至2020年1月,福建中医药大学附属康复医院肩袖损伤患者70例随机分为对照组(n=35)和试验组(n=35),两组均接受Mulligan动态关节松动术和肩袖肌群肌肉能量技术(MET)治疗,试验组另于肩髃、巨骨、肩前、肩贞予温针灸,连续治疗2周。治疗前后采用肩关节疼痛与功能障碍指数(SPADI)、疼痛视觉模拟量表(VAS)、肩关节活动度(ROM)、肩关节等速肌力测试进行评定,随访观察并发症发生和复发情况。结果对照组脱落5例,试验组脱落4例。治疗后,两组SPADI评分、VAS评分均显著降低(|t|>5.039,P<0.001),ROM、等速肌力测试R值明显提高(|t|>2.751,P<0.01)。试验组SPADI评分、VAS评分显著低于对照组(|t|>3.616,P<0.001);ROM,前屈、后伸、内收、外展等速肌力测试R值高于对照组(|t|>2.214,P<0.05)。结论温针灸联合康复训练可进一步缓解袖损伤患者肩关节疼痛,提高肩关节活动度,促进肌力恢复,改善肩关节功能。     

关节镜下改良压配式双排缝合技术治疗肩袖大型撕裂早期疗效分析

目的评价关节镜下改良压配式(Improved-press-fit)双排缝合(DR)技术治疗肩袖大型撕裂的早期临床疗效。方法回顾分析2013年12月-2014年11月,采用关节镜下Improved-press-fit DR技术治疗52例大型肩袖全层撕裂患者。其中,男20例,女32例,平均年龄65.6岁(51~76岁),术后肩外展6周固定,允许早期被动活动度训练,在治疗前后分别采用疼痛视觉模拟评分(VAS)、肩关节前屈和体侧外旋角度(ROM)、美国加州大学洛杉矶分校肩关节评分(UCLA)及美国肩肘外科评分标准(ASES)进行疗效评价,观察术后6个月时功能恢复情况,并与术前相应指标进行比较。结果术后平均随访10.9个月(6~17个月),患者术后6个月时VAS疼痛评分(1.6±0.9)分,前屈上举(145.6±10.7)°,体侧外旋(30.8±8.5)°,UCLA评分(32.3±3.5)分,ASES评分(81.8±8.7)分,较术前均明显好转,所有评价指标差异有统计学意义(P0.05),随访期间无肩袖再撕裂发生。结论关节镜下Improved-press-fit DR技术治疗大型肩袖全层撕裂安全有效,与缝合桥技术相比可减少置钉数,缩短手术时间,操作简便,是一种简单、经济的缝合方法。     

The effects of aging on quantitative sonographic features of rotator cuff tendons

PURPOSE.: Grayscale analysis is a practical, objective, and easy way to quantify echogenicity during ultrasonography. The purpose of the current study was to measure the changes in thickness and echogenicity that result from aging of the rotator cuff and long head of the biceps tendons. METHODS.: The study comprised 45 volunteers, aged between 20 and 84 years and without history of shoulder pain. Participants were divided into three groups: young, middle-aged, and old. All subjects underwent standard ultrasonography of both shoulders. Tendon thickness and tear were recorded, and images in both transverse and longitudinal scans were taken for grayscale analysis. To reduce the attenuation effect from skin and subcutaneous fat, we used the ratio of echogenicity of the tendon to that of the reference muscle and compared the tendon echogenicity among the different age groups. Sonographic findings were also correlated with age. RESULTS.: The supraspinatus tendon was significantly thicker in elderly participants and this was positively correlated with age. Moreover, the echogenicity ratio of the supraspinatus tendon decreased in the elderly group and showed a negative correlation with age. There was a higher prevalence of supraspinatus tendon tears in the older participants. CONCLUSIONS.: Our results indicate that supraspinatus tendons became thickened, hypoechogenic, and more likely to tear with age. The study presents a simple and useful method to investigate the echogenicity of the rotator cuff quantitatively. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:471-478, 2012.     

Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: results from 58 sonographic examinations with surgical correlation

PURPOSE: To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears. METHODS: Preoperative sonographic examination was performed on 58 shoulders. Key biases on sonographic interpretation such as history-taking, physical examination, or concurrent imaging examinations were excluded by way of blinding. Tears of the rotator cuff were the positive findings of interest. Assessment of tear size and localization was done sonographically, and the results were compared with operative findings. RESULTS: All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than +/-1 cm. CONCLUSIONS: Blinded sonographic examination is effective in the detection and quantification of full-thickness tears of the rotator cuff but lacks sensitivity in the detection of partial-thickness tears.     

康复训练对运动性肩袖损伤微创术后患者肩关节功能恢复的影响

目的：探讨康复训练对运动性肩袖损伤微创术后患者肩关节功能恢复的影响。方法:将64例运动性肩袖损伤微创术后患者随机分为康复治疗组和对照组，其中康复治疗组34例，男18例，女16例,平均38.4±2.9岁；对照组30例，男18例，女12例，平均36.3±2.1岁。两组患者均采用常规的非甾体类抗炎药物和短波、脉冲磁疗治疗，康复治疗组同时按运动性肩袖损伤微创术后康复计划进行康复训练，采用美国加州大学肩评分表评估其疗效。结果：两组患者术后2周肩关节功能评分差异无显著性（P>0.05），术后4周，康复治疗组肩关节功能评分较对照组有所提高，但差异无显著性（P>0.05），术后8周、12周和16周，康复治疗组肩关节功能评分与对照组相比有明显改善，差异具有显著性（P<0.05，或P<0.01)。结论：研究针对运动性肩袖损伤的特点，设计科学、安全、有效的运动性肩袖损伤微创术后的康复计划，并依照康复计划对术后患者进行系统的康复训练，可以明显促进肩关节功能的恢复。     

基于经皮肩部穿刺超声造影诊断肩袖撕裂的一致性

目的 观察基于经皮肩部穿刺超声造影（CEUS）诊断各型肩袖撕裂（RCT）的一致性。方法 回顾性分析94例临床疑诊RCT患者的肩部二维超声、CEUS[单一经皮超声引导肩峰下滑囊超声造影（PUSB）或联合经皮超声引导肌腱病损区超声造影（PUTL）]及关节镜检查资料,分别由观察者1（主任医师）、观察者2（主治医师）、观察者3（住院医师）基于肩部穿刺CEUS评估有无RCT及其类型,观察其诊断一致性及效能。结果 94例中,关节镜检出17例较大全层撕裂（lF）、14例小全层撕裂（sF）、18例滑囊侧部分撕裂（bP）、23例关节侧部分撕裂（aP）及22例无撕裂（NT）。观察者间对全部病例的评估结果的一致性为较高或高（Kappa=0.67~0.95）。针对全层撕裂（FT）、部分撕裂（PT）、lF、sF、bP、aP和NT,观察者1 vs. 2、2 vs. 3的一致性均高（Kappa=0.81~0.95）、观察者1 vs. 3均较高（Kappa=0.71~0.80）。观察者诊断RCT的准确率为87.23%~96.81%。针对RCT,观察者3诊断bP的敏感度为77.78%（14/18）,3名观察者诊断的敏感度及特异度均>80.00%,对lF及NT的诊断敏感度均为100%（17/17）及90.91%（20/22）。结论 经皮肩部穿刺CEUS诊断各型RCT的一致性及敏感度、特异度均较高。     

MR mDIXON Quant技术定量的冈上肌及冈下肌脂肪浸润与肩袖损伤程度的相关性

目的 观察以MR mDIXON Quant技术定量的冈上肌及冈下肌脂肪浸润与肩袖损伤程度的相关性。方法 对82例单侧肩部疼痛伴活动受限患者行肩关节MR常规扫描及mDIXON Quant序列扫描，均显示肩袖损伤(均为冈上肌损伤)。根据MRI冈上肌损伤程度分为退变组、部分撕裂组和全层撕裂组。于mDIXON Quant序列后处理图像上测量冈上肌及冈下肌脂肪分数(FF)。比较3组间FF的差异，并分析冈上肌FF、冈下肌FF及肩袖损伤程度的相关性。结果 82例中，退变组31例，部分性撕裂组30例，全层撕裂组21例。全层撕裂组冈上肌FF[(2.09±0.39)%]高于部分撕裂组[(1.81±0.31)%]及退变组[(1.18±0.56)%,P均<0.05],部分撕裂组冈上肌FF高于退变组(P<0.05)。部分撕裂组[(1.61±0.45)%]及全层撕裂组[(1.72±0.61)%]冈下肌FF均高于退变组[(1.04±0.60)%,P均<0.05],部分性撕裂组与全层撕裂组冈下肌FF差异无统计学意义(P>0.05)。冈上肌FF(r_s=0.64,P<0...     

全肩关节镜与小切口治疗肩袖损伤的临床疗效比较

目的对比全肩关节镜与小切口两种不同手术方法治疗肩袖损伤的临床疗效。方法回顾性分析2012年1月-2018年5月新疆维吾尔自治区中医医院确诊为肩袖损伤并行全肩关节镜或小切口手术治疗的患者435例(435例肩),使用美国肩肘外科协会(ASES)和加州大学(UCLA)肩关节评分系统对上述患者进行术前及术后6个月的评估。结果所有患者手术顺利,切口愈合良好,术后无感染和神经血管损伤等并发症,其中23例出现修复后肩袖再次撕裂,5例出现术侧肩关节功能障碍,1例失去联系。共计406例(406例肩)获得随访,其中258例行全肩关节镜手术,148例行小切口手术。全肩关节镜患者术前ASES评分为(43.50±3.38)分,末次随访为(90.57±2.42)分,两者比较,差异有统计学意义(P 0.05);术前UCLA评分为(15.03±1.42)分,末次随访为(31.48±2.17)分,两者比较,差异有统计学意义(P 0.05)。小切口手术患者术前ASES评分为(43.72±3.30)分,末次随访为(90.28±2.27)分,两者比较,差异有统计学意义(P 0.05);术前UCLA评分为(15.07±1.23)分,末次随访为(31.80±2.36)分,两者比较,差异有统计学意义(P 0.05)。两种不同手术方式术前和末次随访ASES、UCLA评分比较,差异均无统计学意义(P 0.05)。结论全肩关节镜和小切口两种不同手术方式均能很好地改善患者临床症状。全肩关节镜有视野好、术中出血少和术后疼痛轻等优势;小切口手术方式有价格低、操作简单和易于推广等优势。选择何种手术方式取决于医师技术、器械和患者自身意愿。     

体外冲击波治疗肩袖损伤术后肩关节功能障碍的临床研究

目的:肩部触发点体外冲击波联合康复训练治疗肩袖损伤术后的效果分析。方法:于我院收治的肩袖损伤术后患者中抽取80例,以随机数字表法分为对照组和观察组各40例,对照组采用康复训练,观察组采用肩部触发点体外冲击波联合康复训练,对比2组治疗前后Constant-Murley肩关节功能评分量表(CMS)、加州大学肩关节评分(UCLASS)评分和关节活动范围(ROM)、疼痛情况(VAS)、患者满意度和临床疗效等。结果:治疗后,2组CMS评分、UCLASS评分及肩关节ROM均较治疗前明显提高(P<0.05),且观察组治疗后CMS各项评分均明显高于对照组(P<0.05),UCLASS中疼痛、功能、肩关节屈曲角度以及满意度等评分均明高于对照组(P<0.05);观察组治疗后ROM各项评分均明显高于对照组(P<0.05);2组VAS评分均较治疗前明显下降(P<0.05),且观察组治疗后VAS评分均明显低于对照组(P<0.05);观察组满意度及治疗优良率均显著高于对照组(P<0.05)。结论:对肩袖损伤患者,采用肩部触发点体外冲击波联合康复训练效果显著,可明显改善患者...     

Surgery or conservative treatment for rotator cuff tear: a meta-analysis

Purpose: Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear.

Method: Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis.

Results: Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI ?0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was ?0.93 (95% CI ?1.65 to ?0.21) cm on a 0–10 pain visual analogue scale favouring surgery. The difference was statistically significant (p?=?0.012) in 1-year follow up but below the level of minimal clinically important difference.

Conclusion: There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality.

• Implications for Rehabilitation

• There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone.

• There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear.

• As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.

     

In vitro kinematics of the shoulder following rotator cuff injury

BACKGROUND: Tears in the rotator cuff may result in altered mechanics of the glenohumeral joint. It is not unusual for some patients with cuff tears to exhibit near normal motion with the injured shoulder, while other patients with the same magnitude of injury are unable to achieve full elevation on the injured side. METHODS: The effect of simulated tears of the rotator cuff on active glenohumeral joint kinematics was investigated by testing eight cadaveric specimens using an in vitro shoulder simulator. Active abduction of the humerus was produced by applying forces to simulate loading of the supraspinatus, subscapularis, infraspinatus/teres minor, and the anterior, middle, and posterior thirds of the deltoid. Three sequential 1cm lesions were created in the rotator cuff, the first two in the supraspinatus tendon and the third in the subscapularis tendon. FINDINGS: The plane of abduction moved posteriorly and became more abnormal throughout abduction with increased tear size. No difference was observed in the internal/external rotation of the humerus or the position of the humeral head on the glenoid during elevation. INTERPRETATION: In order to generate the motions achieved by the intact joint, patients with rotator cuff insufficiency likely employ other muscle groups. Retraining muscle groups surrounding the glenohumeral joint may decrease the need for surgical interventions.     

Ultrasonography of rotator cuff tears: a review of 500 diagnostic studies

Ultrasonography of the rotator cuff has been shown to be of value in diagnosing rotator cuff tears. This report summarizes our experience with our first 500 diagnostic examinations. All patients were examined in the hyperextended internal rotation view with commercially available high-resolution real-time ultrasound equipment. Patients were diagnosed as having a rotator cuff tear if a focal echogenic lesion or a defect within the rotator cuff was identified. This study confirmed the value of ultrasonography for the diagnosis of rotator cuff tears. Accuracy, sensitivity, and specificity all exceeded 90%, and correlated with surgical findings. This was better than arthrography in the same patient population. Ultrasound is an accurate noninvasive method of examining the rotator cuff for the presence of tears. We suggest that rotator cuff ultrasonography is the procedure of choice for the diagnosis of tears if adequate instrumentation is available.