• 제목/요약/키워드: Rotator Cuff Tears

검색결과 220건 처리시간 0.022초

Clinical and Radiological Results after Arthroscopic Superior Capsular Reconstruction in Patients with Massive Irreparable Rotator Cuff Tears

  • Yoon, Jeong Yong;Kim, Paul Shinil;Jo, Chris Hyunchul
    • Clinics in Shoulder and Elbow
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    • 제21권2호
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    • pp.59-66
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    • 2018
  • Background: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. Methods: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. Results: All patients were men, and the average age was $59.5{\pm}4.18years$ (range, 53-65 years).The minimum follow-up was 18 months with a mean follow-up was $27.33{\pm}7.58months$ (range, 18-36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. Conclusions: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

Effect of suprascapular nerve injury on muscle and regenerated enthesis in a rat rotator cuff tear model

  • Kenichiro Eshima;Hiroki Ohzono;Masafumi Gotoh;Hisao Shimokobe;Koji Tanaka;Hidehiro Nakamura;Tomonoshin Kanazawa;Takahiro Okawa;Naoto Shiba
    • Clinics in Shoulder and Elbow
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    • 제26권2호
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    • pp.131-139
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    • 2023
  • Background: Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model. Methods: Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively. Results: SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups. Conclusions: In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Level Basic research, controlled laboratory study.

Partial Thickness Rotator Cuff Tears

  • Shin, Sang-Jin;Seo, Myeong-Jae
    • Clinics in Shoulder and Elbow
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    • 제17권2호
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    • pp.91-100
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    • 2014
  • Partial-thickness rotator cuff tear (PTRCT) is not single disease entity but one phase of disease spectrum. Symptoms of PTRCT vary from being asymptomatic to severe pain leading to deterioration in quality of life. Pathogenesis of degenerative PTRCT is multifactorial. Whereas articular sided PTRCT is usually caused by internal causes, both internal and external causes have important role in bursal sided PTRCT. A detailed history, clinical examination and magnetic resonance angiography are used in the diagnosis of PTRCT. Treatment of PTRCT is chosen based on age, demands of patients, causes and depth of tear. In most patients, non-operative treatment should be initiated. Whereas debridement can be done for less than 6 mm of articular sided PTRCT and in less than 3 mm of bursal sided PTRCT, repair techniques should be considered for higher grade PTRCT than that. Although the effect of acromioplasty is not clear, acromioplasty may be performed when the extrinsic causes appear to be the cause of tear. Either transtendon repair technique or repair after tear completion provided satisfactory clinical outcomes in treatment of articular sided PTRCT.

극상근건 파열에 대한 복합 한방치료의 효과 : 증례보고 (Effect of Integrative Korean Medicine Treatment for Tear of Supraspinatus Tendon: A Case Report)

  • 홍혜원;박지원;정명인;김가현;윤주영;이시원
    • Korean Journal of Acupuncture
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    • 제40권1호
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    • pp.18-24
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    • 2023
  • A 53-year-old woman with right shoulder pain after falling down presented at our outpatient department after conventional treatment that had little effect. She was treated with integrative Korean Medicine treatment as an outpatient from February 2, 2022 to July 4, 2022. Based on Magnetic Resonance Imaging (MRI) findings, the patient was diagnosed with a right rotator cuff tear. With 39 treatment sessions, Numeric Rating Scale (NRS) score decreased and showed improvement in assessment. On May 6, MRI was retaken to show restoration of the supraspinatus tendon tear. The patient felt almost no pain on July 4, declaring the end of treatment. This successful case suggests that integrative Korean Medicine treatment might be an attractive alternative for severe rotator cuff tears.

대범위 이상의 회전근 개 파열에 대한 관절경 감시하 소절개 봉합술의 임상 결과 및 수술의 유효성 (The Evaluation for the Usefulness of Arthroscopic Miniopen Repair which Related with Large and Massive Sized Full Thickness Rotator Cuff Tear and Clinical Results)

  • 고상훈;조성도;최승원;박문수;곽창열;김상우;정광환;차재룡
    • Clinics in Shoulder and Elbow
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    • 제9권1호
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    • pp.83-88
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    • 2006
  • Purpose: To evaluate the usefulness of arthroscopic decompression and miniopen repair that was related with large and massive sized full thickness rotator cuff tear and assess clinical result. Materials and Methods: Twenthy-nine cases of miniopen repaired full thickness tear of rotator cuffs that arthroscopically decompressed were studied. From October 1998 to December 2004 we have analysed 29 repairs of large and massive sized FTRCT, the average age 44 ($32{\sim}71$) years old, mean follow-up was 34 ($12{\sim}84$) months. We analyzed the results statistically by paired t-test. Results: Postoperative VAS of pain improved average 7.0 to 1.7, UCLA score improved 13.7 to 31.9, ADL improved 11.3 to 25.3 respectively (all, P=0.000). Twenty five cases(82.8%) of the patients showed excellent & good results at the final follow-up. The satisfied rate was 26 cases(89.7%). Conclusions: Arthroscopic decompression and miniopen repair in large and massive sized full thickness rotator cuff tears are effective surgical methods.

Dexamethasone Facilitates NF-κB Signal Pathway in TNF-α Stimulated Rotator Cuff Tenocytes

  • Ji, Jong-Hun;Kim, Young-Yul;Patel, Kaushal;Cho, Namjoon;Park, Sang-Eun;Ko, Myung-Sup;Park, Suk-Jae;Kim, Jong Ok
    • Journal of Microbiology and Biotechnology
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    • 제29권2호
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    • pp.297-303
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    • 2019
  • Corticosteroids are commonly used for pain control in rotator cuff tear. Deregulated $NF-{\kappa}B$ activation is a hallmark of chronic inflammatory diseases and has been responsible for the pathogenesis of rotator cuff tear. The Dexamethasone(DEXA) is a synthetic corticosteroid. The purpose of this study was to examine the exact effect of dexamethasone on $NF-{\kappa}B$ signaling in rotator cuff tear. We measured $NF-{\kappa}B$ expression in four groups: control, $TNF-{\alpha}$-treated, DEXA-treated, and combined treatment with $TNF-{\alpha}$ and DEXA. Tenocytes were isolated from patients with rotator cuff tears and pre-incubated with $TNF-{\alpha}$ (10 ng/ml), DEXA ($1{\mu}M$), or both of them for 10 min, 1 h, and 2 h. Expression of p65, p50, and p52 in the nuclei and cytosol was analyzed by western blotting and immunofluorescence imaging using confocal microscopy. We also evaluated nucleus/cytosol (N/C) ratios of p65, p50, and p52. In our study, the combined treatment with DEXA and $TNF-{\alpha}$ showed increased N/C ratios of p65, p50, and p52 compared with those in the $TNF-{\alpha}$ group at all time points. Additionally, in the DEXA group, N/C ratios of p65, p50, and p52 gradually increased from 10 min to 2 h. In conclusion, DEXA promoted the nuclear localization of p65, p50, and p52, but was not effective in inhibiting the inflammatory response of $TNF-{\alpha}$-stimulated rotator cuff tear.