Subscapularis tendon tear: primary and associated signs on MRI

PURPOSE: The purpose of this work was to investigate signs of subscapularis tendon tear on MRI. METHOD: Preoperative written interpretations of high field (n = 9) and low field (n = 7) MRI of 16 patients with tears confirmed at surgery or arthroscopy were reviewed, followed by retrospective review of these studies. RESULTS: A preoperative diagnosis of subscapularis tear was made in five (31%) cases. On retrospective review, primary signs of tear were present in 15 (94%) cases and in two-thirds were limited to the cranial third of the tendon. Supraspinatus tears were present in 69% of cases. Associated findings included medial dislocation (n = 4) or subluxation (n = 3) of biceps tendon, biceps tendinopathy (n = 2), superior labral tear (n = 5), and effusions of superior subscapularis recess (n = 6), subcoracoid bursa (n = 2), or both (n = 5). One or more associated signs were present in 94% of cases. CONCLUSION: Subscapularis tear is frequently missed on MRI. Recognizing that primary signs of tear may be limited to the cranial third of the subscapularis tendon and identifying associated signs should facilitate diagnosis.     

Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability

Purpose

Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance.

Methods

The study included 48 patients [median age 30 (range 16–69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes.

Results

At a median follow-up period of 25 (range 12–73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p?=?0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.).

Conclusion

Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure.

Level of evidence

Retrospective cohort study, Level III.

     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

Rim-rent tear of the rotator cuff: a common and easily overlooked partial tear

OBJECTIVE: The purpose of this study was to determine the incidence of rim-rent rotator cuff tears in a population of patients referred for shoulder MRI and to determine the sensitivity of MRI for the detection of these tears. CONCLUSION: Rim-rent tears are a common type of partial-thickness rotator cuff tear, much more commonly present than has been previously reported. In particular, infraspinatus rim-rent tears are more common than previously believed. Rim-rent tears of the infraspinatus tendon and those involving the anterior-most fibers of the supraspinatus tendon are commonly overlooked on MRI, possibly because of failure to appreciate the high incidence of these types of tears and failure to inspect the anterior-most fibers of the rotator cuff.     

Throwing effectiveness and rotational strength of the shoulder in team handball

AIM: The purpose of this study was to examine: a) the influence of simulated game activities (SGA) in throwing effectiveness and rotational strength of the shoulder; and b) the relationship between the rotational strength of the shoulder and ball velocity and accuracy in team handball. METHODS: Sixteen female handball players participated following a SGA, which included distinctive handball activities for 60 min (2 halves of 30 min). For testing ball velocity and accuracy, every 10 min, subjects performed 3 shots on the spot towards a target from 7 m distance. Shoulder isokinetic strength during internal (IR) and external rotation (ER) was evaluated in 3 angular velocities (60, 180, and 300 degrees /s) before SGA, during half-time and at the end of SGA. RESULTS: Throwing effectiveness was significantly affected by time, as aiming accuracy was gradually decreased. However, ball velocity remained stable. The correlation between ball velocity and deviation was not significant throughout the SGA. No statistically significant differences between measurements were found in maximum isokinetic torque, except from the case of ER at 180 degrees /s, where there was a significant difference between initial measurement (IM) and A and B halves. A significant relationship between isokinetic torque and ball velocity was found only for the IM for ER (180, 300 degrees /s) and IR (300 degrees /s). CONCLUSION: The main findings of this study are that, during a game simulation, time affects only aiming accuracy and not ball velocity or rotational strength of the shoulder. Moreover, peak torque of IR and ER of the shoulder is not related with ball velocity and throwing effectiveness.     

Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers

Isokinetic, shoulder rotational strength was evaluated in 26 high school baseball pitchers before the start of spring practice. Using the Cybex II (Cybex, Division of Lumex, Inc., Ronkonkoma, NY), test data were gathered on the dominant and nondominant shoulders in the supine 90 degrees abducted test position (90 degrees AbTP) and the standing neutral test position (neutral TP). Tests were performed at 90 and 240 deg/sec. The HUMAC (Computer Sports Medicine, Inc., Flemington, NJ) computer system was used to analyze data. Means and standard deviations for peak torque, total work, peak torque to body weight ratios, and agonist/antagonist ratios are presented. Comparison of dominant to non-dominant sides and 90 degrees AbTP to neutral TP values are reported. Peak torque and total work values for the throwing side internal rotators were significantly higher than the nonthrowing side in all tests. Pitching side external rotators failed to show this dominance. External/internal rotation ratios for peak torque and total work were significantly lower on the pitching side, suggesting a relative imbalance of cuff musculature compared to the nonpitching shoulder. Significant differences existed between data gathered in the two different test positions. In the 90 degrees AbTP, external rotation peak torque and total work values and external/internal rotation peak torque and total work ratios were higher than the equivalent values gathered in the neutral TP. Internal rotation peak torque and total work values tended to be higher in the neutral TP than in the 90 degrees AbTP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus

A new method of arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus was devised to preserve as much meniscal tissue as possible. To evaluate the clinical result of this method for horizontal tear of discoid lateral meniscus, 31 knees (30 patients) were reviewed at an average follow-up of 35 months (range 14-48 months). Horizontally torn discoid lateral menisci were classified as incomplete (11 cases) or complete (20 cases) by the Watanabe classification; no Wrisberg type was noted. Partial meniscectomy was performed in all cases. For the technique of a new method of partial meniscectomy, the unstable leaf of the horizontally torn meniscus was removed to the peripheral rim, but the stable one was preserved and reshaped to produce the similar appearance to the normal lateral meniscus in terms of width and thickness. It was trimmed to have a balanced rim of meniscal tissue about 6-8 mm in width. Meniscal repair was added to partial meniscectomy in one case. All the cases were rated using the Lysholm Knee Scoring Scale and were reviewed to recognize retear clinically. The scores increased after partial meniscectomy by average 20.7 (from 73.0 to 93.7). Recurrence of tear or aggravation of symptoms was not noted at the final follow-up.     

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.     

关节镜下异体骨-髌腱-骨纤维束重建治疗前交叉韧带部分损伤

目的 探讨异体骨-髌腱-骨纤维束（B-PT-B）重建前交叉韧带（ACL）全部纤维束和部分纤维束的早期疗效。方法在187例采用B-PT-B术式重建ACL的患者中，获得随访的ACL部分束损者共25例，其中采用全部纤维束重建的患者6例，部分纤维束重建19例。术后行X线和KT-1000检查，并按照IKDC、Lysholm、Irgang、Larson评分进行疗效评价。结果 所有患者随访时移植物位置良好，KT-1000检查双侧膝关节前向松弛度差值〈3mm。部分束重建组与全部束重建组各评分系统和分项评分系统无显著性差异。结论 异体B-PT-B重建治疗ACL部分损伤可以取得良好的临床疗效，与ACL全部束重建术相比综合评定无明显差异。     

Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon

BACKGROUND: Partial-thickness tear of the subscapularis tendon in the articular surface is common. HYPOTHESIS: Intra-articular repair of a partial articular-surface tear of the subscapularis tendon will provide a successful outcome. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 29 shoulders with an isolated partial articular-surface tear of the subscapularis tendon without another rotator cuff lesion were treated with arthroscopic intra-articular repair using suture anchors. Biceps tenodesis was performed in 16 patients. Outcomes were prospectively evaluated at a mean of 27 months (range, 19-41 months) using 3 objective (University of California at Los Angeles, American Shoulder and Elbow Surgeons Shoulder Index, Simple Shoulder Test) and 2 subjective (pain and function visual analog scales) measurements. RESULTS: There were 21 men and 8 women, with a mean age of 54 years (range, 41-65 years). Tear widths were small (<1 cm) in 16 shoulders and large (>1 cm) in 13 shoulders. Twenty-six shoulders had articular cartilage erosion on the adjacent humeral head. Lesions of the biceps tendon were noted in 25 patients (partial tear in 15 shoulders; subluxation in 13 shoulders). Shoulder pain scores improved after surgery (5.0 +/- 2.7 to 0.3 +/- 0.7, P < .05). According to American Shoulder and Elbow Surgeons Shoulder Index scores, 18 were excellent; 10, good; and 1, fair. Internal rotation strength deficit improved from 32% to 4%. Twenty-six patients returned to more than 90% of previous activity. There were no surgical complications; tear size and biceps tenodesis did not affect outcome (P > .05). CONCLUSION: Arthroscopic intra-articular repair of a partial articular-surface tear of the subscapularis tendon is an effective procedure that spares the intact tendon attachment in the bursal surface. Short-term outcomes were reliable by both objective and subjective measurements.     

A survey of glenohumeral joint rotational range and non-specific shoulder pain in elite cricketers

ObjectivesTo determine if a glenohumeral joint internal rotation range of motion difference (IRD) and external rotation difference (ERD) exists between dominant and non-dominant shoulders of cricketers as demonstrated in other overhead sports, and, if present, to establish if differences exist between cricketers with and without a history of gradual onset non-specific shoulder pain.DesignAn observational study.SettingNon-clinical, at national cricket indoor training venues.ParticipantsOne hundred and nine elite male and female cricketers (11–35 years), representing 97% of the England and Wales national and West of England regional Under 13 teams, consented. The final number included for data analysis was 133.Main outcome measuresData relating to playing position, cricket exposure, shoulder pain and demographic details collected using a questionnaire. Passive isolated glenohumeral rotation measured in 90° shoulder abduction using an inclinometer.ResultsCricketers who regularly bowl or throw overarm had significantly less internal (−7.9°, p<0.001) and greater external (8.6°, p<0.001) dominant to non-dominant glenohumeral rotation. Wicket-keepers had tendencies for smaller differences that were still statistically significant [mean IRD −5.9° (p<0.001); ERD 5.0° (p=0.002)]. Cricketers who experienced shoulder pain demonstrated a significantly greater IRD [mean 3.2° (p=0.032)] than those who did not.ConclusionsThe results of this study support measurement of passive glenohumeral joint rotation during musculoskeletal profiling and indicate that a possible link between increased IRD and non-specific shoulder pain warrants further investigation.     

Anterior cruciate ligament insertion after partial tear: histological changes and chondrocyte turnover

Purpose  

The purpose of this study was to clarify the effects of partial resection on the glycosaminoglycan (GAG) layer thicknesses and chondrocyte turnover (apoptosis and cell proliferation) between uncalcified fibrocartilage (UF) and calcified fibrocartilage (CF) layers in an anterior cruciate ligament (ACL) insertion.     

磁共振肩关节造影在肩袖完全撕裂诊断的临床应用

目的:探讨磁共振肩关节造影检查对肩袖完全撕裂的诊断价值.方法:回顾性分析54例肩袖完全撕裂MR关节造影及MRI表现,与肩关节镜手术结果对照.结果:54例肩袖完全撕裂病例,MRI诊断的敏感度、特异度及准确度分别是87.03％、50.00％和79.41％;MR关节造影诊断Ⅰ型9例、Ⅱ型21例,其敏感度分别为88.89％、95.24％;特异度分别为97.87％、97.14％;准确度分别为96.43％、96.43％;明显高于常规MRI诊断,差异均有统计学意义(P＜0.05);与关节镜结果对比,其一致性极佳(Kappa=0.841);而对于Ⅲ型肩袖完全撕裂,MR关节造影均不能显示.结论:MR关节造影能较准确判断Ⅰ型、Ⅱ型肩袖完全撕裂范围及程度,是MRI诊断肩袖损伤的有效补充,为临床诊断和治疗能提供更准确的依据,而对于Ⅲ型肩袖完全撕裂,MR关节造影不能显示其损伤部位及程度,无法对其进行诊断.     

Isokinetic evaluation of shoulder rotational strength between the plane of scapula and the frontal plane

The purpose of this study was to determine whether shoulder rotational strength was greater in the plane of the scapula or the frontal plane. Isokinetic shoulder rotational strength was evaluated in 20 subjects. Using the Merac (Universal Gym Equipment, Inc., Cedar Rapids, IA), test data was gathered in the right shoulders, in 45 degrees abduction, at a speed of 60 deg/sec, in the plane of the scapula and the frontal plane. Each subject returned within 1 week for retests to establish reliability. The average correlational coefficient across tests was 0.87. The Merac computer system was used to analyze data. Mean and standard deviations for peak torque to body weight were calculated. A paired t-test was used to examine the difference in the means for internal and external rotation between the two positions. The results indicated no significant difference between the two positions for shoulder internal rotational strength values. However, shoulder external rotational strength values in the plane of the scapula were statistically significantly higher than in the frontal plane (P less than 0.001). These preliminary results suggest isokinetic strength training and testing may be preferable in the plane of the scapula rather than the frontal plane.     

Path of glenohumeral articulation throughout the rotational range of motion in a thrower's shoulder model

BACKGROUND: Overhead-throwing athletes have increased external and diminished internal glenohumeral rotation that may alter glenohumeral kinematics. PURPOSE: To quantify the kinematic changes present in a cadaveric model of a thrower's shoulder. STUDY DESIGN: Controlled laboratory study. METHODS: In 8 fresh-frozen cadaveric shoulders, the rotator cuff and overlying muscles were removed, and the glenohumeral capsule, coracoacromial ligament, and coracohumeral ligament were left intact. The scapula was fixed, and the humerus was placed in 90 degrees of shoulder abduction in a 6 degrees of freedom testing device. A compressive force of 44 N was applied. A thrower's shoulder model was created, and sequential conditions were examined: intact, after anterior stretching, and after the addition of posterior-inferior capsular plication. Kinematic measurements were obtained through a complete range of glenohumeral rotation. RESULTS: Glenohumeral external rotation increased 16%, from 149 degrees to 173 degrees (P < .001), after stretching in external rotation and remained increased by 11% to 166 degrees (P < .001) after posterior-inferior capsular plication. With the addition of the posterior-inferior capsular plication, internal rotation averaged 7 degrees , which was not significantly different from the intact state (11 degrees, P = .55) or the stretched state (16 degrees, P = .07). The total glenohumeral rotation after stretching followed by posterior-inferior capsular plication did not differ significantly from intact state (P = .25). At maximum external rotation, the humeral head apex was shifted posteriorly in the stretched (P = .003) and plicated (P < .001) states compared with the intact state. The humeral head apex was posteriorly displaced at 135 degrees and 150 degrees of external rotation compared with the intact condition (P = .039 and .049, respectively). In maximum internal rotation, anterior stretching had no significant effect on the humeral head apex position. However, after posterior-inferior capsular plication, the humeral head apex was significantly shifted inferiorly (P = .005) and anteriorly (P = .03) in maximum internal rotation compared with the intact state. CONCLUSION: Significant changes in glenohumeral motion occur in this model during the simulated late-cocking and follow-through phases of throwing. In this model, posterior capsular tightness alters the humeral head position most profoundly during the deceleration and follow-through phases of throwing.     

Thigh muscle function after partial tear of the medial ligament compartment of the knee

The purpose of the study was to assess the isokinetic and isometric strength and power profile of the knees of 48 patients who had a previous second-degree sprain (partial tear) of the medial ligament compartment, the most common knee ligament injury in sports. The CYBEX II isokinetic dynamometer was used in the measurements. On an average of 8 yr after the injury, the mean strength deficit of the injured knees was minimal: 4 +/- 5% (range 0-28%) in extension and 2 +/- 4% (0-20%) in flexion. The average strength score (max. 100 points) was 90 +/- 11 (56-100), representing an excellent classification. In hamstrings, the relative strength deficit increased significantly with a higher speed of isokinetic movement (P less than 0.05). Compared with the strength parameters (peak torques), the other functional parameters of the injured knees (total work, average power, and peak torque acceleration energy) showed some but not significantly greater deficits (hamstrings 9-11%, quadriceps 6-8%). In conclusion, the general thigh muscle function in knees with old second-degree sprain of the medial ligament compartment appears good and acceptable, but the strength deficits are systematically greater in higher speeds of isokinetic movement. Therefore, rehabilitation utilizing high speed extension and flexion exercises is recommended.     

MR of 732 TMJs: anterior,rotational, partial and sideways disc displacements

Objective: The purpose of this study was to determine the prevalence of anterior, sideways, rotational and partial anterior disc displacements, as well as degenerative changes in patients with clinical signs and symptoms of internal disorders. Materials and methods: 732 MR Images of temporomandibular joints (TMJ) were produced for 366 symptomatic patients. Image analysis included assessment of disc positions and mobility, as well as recapture in coronal and mediolaterally divided sagittal planes in closed and open positions. Results: Of these images, 545 TMJ showed an internal derangement comprised of 52% anterior disc displacements without reduction, 26% anterior disc displacements with reduction, 11% partial anterior disc displacement, 5% pure sideways displacements and 4% stuck discs. Rotational disc displacements were observed in 34% of the anterior disc displacements without reduction group and in 53% of the anterior disc displacements with reduction group. A total of 97% of the partial anterior disc displacement occurred laterally. Degenerative changes increased with age, mainly in the anterior disc displacements without reduction group. Conclusion: Magnetic resonance imaging (MRI) investigations show that the disc is subject to a great variety of displacements and that there is a need for further research to refine the clinical therapy for TMJ internal derangements.