Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge.@*METHODS@#The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up.@*RESULTS@#All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied.@*CONCLUSION@#Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion lesion / 中国修复重建外科杂志

OBJECTIVE@#To explore the mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion.@*METHODS@#A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic "mini incision" transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones ( P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences ( P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation ( P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation ( P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear.@*CONCLUSION@#Arthroscopic "mini incision" transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.

Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision / 中华创伤杂志(英文版)

PURPOSE@#To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.@*METHODS@#We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student's t-test with statistical significance defined as p <0.05.@*RESULTS@#At the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness.@*CONCLUSION@#This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.

Arthroscopic repair and loosening of shoulder arthroscopy for patients with old supraspinatus tendon tears and dysfunction / 临床外科杂志

Objective To explore the effect of arthroscopic release combined with suture bridge treatment of old supraspinatus tendon tear with shoulder dysfunction.Methods 40 patients with old supraspinatus tendon tear were analyzed retrospectively.According to the operation method, the patients were divided into control group and experimental group with 20 cases each.Treatment of single row of loose strip anchor nails under arthroscope in control group, the experimental group was treated with the technique of loosening suture bridge under arthroscope.VAS score and ASES score were assessed before operation and after 1 month, 3 months, 6 months, and 12 months.Range of motion (ROM) was evaluated before operation and after 12 months.The analysis of complication was also preceded.Results All patients completed 12 months of follow-up.There were no difference between experimental group and control group in ASES score (27.6±5.5 vs 27.5±3.6), VAS score (7.6±0.5 vs 7.5±0.7) and shoulder bends forward[ (83.6±12.4) °vs (80.6±14.5) °], abduction[ (75.6±8.4) °vs (72.8±9.3) °], intorsion[ (20.1±3.7) °vs (21.2±2.9) °] at pre-operation (P＞0.05).At 1 month, 3 months, 6 months, and 12 months post-operation, VAS scores were 5.8±0.6, 4.2±0.5, 3.0±0.2 and 1.8±0.4 in experiment group and were 6.1±0.3, 4.4±0.6, 3.5±0.4 and 2.2±0.3 in control group, the difference was significant (P＜0.05).ASES scores were 35.8±3.6, 54.2±4.7, 73.1±3.2 and 85.8±2.6 in experiment group and were 34.1±3.3, 49.4±3.6, 69.5±2.4 and 72.2±3.1 in control group, the difference was significant (P＜0.05).After 12 months, there was a significant improvement in joint flexion, abduction, and lateral internal rotation in experimental group[ (160.4±10.2) °, (158.7±9.7) °, (48.1±5.9) °] than the control group[ (138. 4 ± 7. 2) °, (128. 7 ± 6. 5) °, (30.1 ± 4. 2) °]. No complications occurred in two groups, such as anchor loosening, pain, swelling and other complications. Conclusion Arthroscopic release combined with Suture Bridge can effectively improve the function of shoulder in patients with old supraspinatus tendon tear.

Ultrasound-Guided Shoulder Injections / 대한정형외과학회잡지

The shoulder pain is one of the most common problems to orthopaedic surgeons in clinic. Among therapeutic modality used to manage this pain, joint and periarticular injection, as well as suprascapular nerve block, show good clinical outcome. Ultrasound guidance is a safe technique, increasing the safety and accuracy of the procedure and reducing complications. An accurate understanding of the surface anatomy is important in performing the ultrasound-guided shoulder injections. This article aims to describe the surface anatomy and sono anatomy of both the shoulder and the surrounding structures and also summarize different infiltration techniques and peripheral nerve blocks.

Effect of a Specific Rehabilitation Program of Serratus Anterior and Lower Trapezius Muscles for Subacromial Impingement Syndrome on Subacromial Space and the Vascularity of Supraspinatus Tendon / 대한스포츠의학회지

PURPOSE: This study was designed to assess the effects of a rehabilitation program on clinical symptoms, subacromial space parameters and the supraspinatus vascularity in individuals with subacromial impingement syndrome (SIS). METHODS: Thirty-five participants (exercise group with SIS [EG]=11, non-exercise group with SIS [NEG]=10, control group [CG]=14) took part in this study. Only EG participated in 6-week rehabilitation program. Outcomes were evaluated at baseline, 6 weeks, and 10 weeks. Changes in symptoms and functional limitations were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire. Changes in acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT)/AHD were assessed using ultrasonographic measures. Quantitative analysis of tendon blood flow was performed by determining four regions of interest with power Doppler quantification and analysis software to normalize data for interpretation of the mean ratio of colored pixel to the region of interest (vascularization index [VI]) and the intensity per pixel (flow index [FI]). RESULTS: Following the rehabilitation program, the scores on SPADI were significantly improved (p < 0.05). However, AHD, STT/AHD, VI, and FI indicated no significant difference within groups or interactions of time and group in between groups. CONCLUSION: The rehabilitation program yielded improvements in symptoms, but not in subacromial parameters and the vascularity of supraspinatus in participants with SIS.

Assessment of the rotator cuff on MRI focussed on supraspinatus tendon

Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.

Ultrasonographic Finding of Painful Hemiplegic Shoulder Associated with Motor Recovery after Stroke

OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage: the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.

Calcific Tendinitis of the Supraspinatus Tendon in a 7-year-old Girl: A Case Report / 대한정형외과학회잡지

Calcific supraspinatus tendinitis is extremely rare in children. We report a case of a 7-year-old girl with painful calcific supraspinatus tendinitis of the right shoulder. The child was treated with arthroscopic surgery. After surgery, she made a full recovery. The radiographs taken six month after surgery showed no recurrence of the calcification. Physicians should be aware that unspecific shoulder pain in children can be caused by calcific supraspinatus tendinitis.