Interventions for tears of the rotator cuff in adults.

BACKGROUND: Tears of the rotator cuff tendons, which surround the joints of the shoulder, are one of the most common causes of pain and disability in the upper extremity. OBJECTIVES: To review the efficacy and safety of common interventions for tears of the rotator cuff in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised trail register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library issue 2, 2002), MEDLINE (1966 to December 2001), EMBASE (1974 to December 2001), Biological Abstracts (1980 to December 2001), LILACS (1982 to December 2001), CINAHL (November 1982 to December 2001), Science Citation Index and reference lists of articles. We also contacted authors and handsearched conference proceedings focusing on shoulder conditions. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving tears of the rotator cuff were the focus of this review. All trials involving conservative interventions or surgery were included (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, and open or arthroscopic surgery). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed suitability for inclusion, methodological quality and extracted data. Dichotomous data were presented as relative risks (RR) and 95% confidence intervals (CI), using the fixed effects model. MAIN RESULTS: Eight trials involving 455 people were included and 393 patients analysed. Trials were grouped in eight categories of conservative or surgical treatment. The median quality score of all trials combined was 16 out of a possible 24 points, with a range of 12-18. In general, included trials differed on diagnostic criteria for rotator cuff tear, there was no uniformity in reported outcome measures, and data which could be summarised were rarely reported. Only results from two studies comparing open repair to arthroscopic debridement could be pooled. There is weak evidence for the superiority of open repair of rotator cuff tears compared with arthroscopic debridement. REVIEWER'S CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for tears of rotator cuff in adults. As well as the need for further well designed clinical trials, uniform methods of defining interventions for rotator cuff tears and validated outcome measures are also essential.

An anatomical study of the dorsal cutaneous branches of the digital arteries.

This study describes the anatomy of the dorsal digital arteries in the 144 fingers of 18 pairs of fresh human cadaver hands. Previous studies have shown two constant branches in the proximal and middle pulp spaces from each proper digital artery. We have shown that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. Thus cutaneous flaps can be safely planned on these dorsal vessels.

Endoscopic harvesting of the sural nerve graft: a cadaveric investigation.

This study investigated an endoscopic technique of harvesting the sural nerve graft. Using endoscopic instrumentation, the sural nerve was harvested from six cadaveric legs. A 2-cm longitudinal incision was made immediately posterior to the lateral malleolus, and a 5-mm endoscope was introduced. The path of the nerve was followed to the popliteal space, and nerve dissection was performed from proximal to distal. Air inflation of a balloon was used to enlarge the endoscopic cavity. The cavity created around the nerve was insufflated with carbon dioxide gas, allowing complete nerve isolation. Using a 0.5-cm transverse incision, the nerve was cut and removed. This endoscopic sural nerve grafting approach offers potential advantages such as less injury to soft tissues, decreased pain, nerve integrity preservation, and good aesthetic results.