OBJECTIVE: To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon (LHBT) in situ for repairing rotator cuff tear. METHODS: A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023. All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ. There were 12 males and 19 females, with an average age of 61.6 years (range, 53-76 years). There were 10 cases of acute injury and 21 cases of chronic injury. According to DeOrio and Cofield classification criteria, the degree of rotator cuff tear rated as medium-sized tears in 3 cases, large tears in 12 cases, and massive tears in 16 cases. Associated injuries included 5 cases of shoulder joint adhesions, 12 cases of subscapularis muscle tears, and 31 case of shoulder impingement syndromes. The shoulder range of motion (ROM) (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores [visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, Constant-Murley score] were recorded before operation and at last follow-up. MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity. RESULTS: All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes (mean, 144 minutes). The 3-5 anchors (mean, 3.8 anchors) were used during operation. All incisions healed by first intention. All patients were followed up 12-29 months (mean, 18.5 months). At 3 months after operation, 2 cases developed joint adhesions, 3 had internal rotation limitations, and 2 experienced residual pain at the intertubercular groove, all resolved with conservative management. No Popeye deformity occurred during follow-up. At last follow-up, shoulder ROM (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores (VAS, UCLA, and Constant-Murley scores) showed significant improvements compared to preoperative values ( P<0.05). At last follow-up, MRI evaluation showed that the rotator cuff healing rate reached 90.3% according to the Sugaya classification criteria. LHBT exhibited normal morphology, course, and continuity without dislocation. Surrounding synovial sheath showed no thickening or effusion. CONCLUSION Arthroscopic double fixation and enhanced suture of LHBT in situ for repairing rotator cuff tear can significantly reduce shoulder joint pain, improve ROM, and achieve a high rotator cuff healing rate.
Humans ; Male ; Middle Aged ; Arthroscopy/methods* ; Rotator Cuff Injuries/physiopathology* ; Female ; Retrospective Studies ; Aged ; Range of Motion, Articular ; Suture Techniques ; Treatment Outcome ; Rotator Cuff/surgery* ; Shoulder Joint/physiopathology* ; Tendons/surgery*

OBJECTIVE: To explore early curative effect of upper joint capsule reconstruction combined with biceps tendon transposition in treating irreparable rotator cuff tears. METHODS: From October 2019 to March 2021, 16 patients with irreparable rotator cuff tear were underwent arthroscopic autogenous semitendinosus tendon transplantation for upper articular capsule reconstruction combined with biceps tendon transposition, included 12 males and 4 females, aged from 53 to 72 years old with an average of (62.13±5.35) years old; 3 patients on the left side and 13 patients on the right side. All patients had preoperatively limited joint mobility, resting pain, and mobility pain, and had a history of failure to respond to conservative treatment for more than 8 months. The duration of preoperative symptoms ranged from 45 to 144 months with an average of (85.25±32.08) months. Visual analogue scale (VAS) of shoulder pain, University of California Los Angeles (UCLA) score, Constant-Murley score, active and passive motion of shoulder joint were compared before operation and 2 years after operation, complications were recorded. RESULTS: All 16 patients were followed up for 21 to 32 months with an average of (24.25±3.57) months. There were no complications such as incision infection, vascular and nerve injury, retear occurred. VAS, UCLA and Constant-Murley scores were improved from (5.75±1.18), (11.88±3.38) and (33.38±9.34) before operation to (1.13±0.89), (32.56±2.71), (89.06±6.25) at 2 years after operation (P<0.05). Anterior flexion, abduction, lateral external rotation and lateral internal rotation of shoulder joint were improved from (79.75±21.36) °, (62.06±10.49) °, (19.19±5.41) °, (3.04±0.21) °, respectively to (156.94±13.18) °, (116.19±12.59) °, (42.63±6.07) °, (8.16±0.64) ° at 2 years after operation. Anterior flexion, abduction, lateral lateral rotation and lateral internal rotation of shoulder joint were improved from (116.28±21.47) °, (107.12±9.67) °, (27.62±4.70) °, (4.21±0.41) °, respectively to (165.28±7.15) °, (153.34±4.69) °, (52.46±4.46) °, (9.68±0.68) ° at 2 years after operation, and the difference was statistically significant (P<0.05). CONCLUSION Arthroscopic autograft of semitendinosus tendon combined with transposition of biceps tendon could achieve satisfactory early clinical results in treating patients with irreparable rotator cuff tear, which is a reliable and effective surgical method.
Humans ; Male ; Female ; Middle Aged ; Aged ; Arthroscopy/methods* ; Rotator Cuff Injuries/physiopathology* ; Plastic Surgery Procedures/methods* ; Range of Motion, Articular ; Shoulder Joint/surgery* ; Tendon Transfer

OBJECTIVE: To explore early clinical efficacy and advantages of Huoxue Fang's directional dialysis combined with extracorporeal shock wave in treating rotator cuff injury. METHODS: A retrospective analysis was performed for 42 patients with rotator cuff injury admitted from September 2020 to December 2022, and they were divided into shock wave group and directed dialysis group according to different treatment methods. There were 20 patients in shock wave group, including 12 males and 8 females; aged from 47 to 68 years old with an average of (63.2±3.3) years old;the course of disease ranged from 2 to 6 weeks with an average of (3.1±1.4) weeks;10 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;non-steroidal drugs and extracorporeal shock wave therapy were performed. There were 22 patients in directed dialysis group, including 16 males and 6 females;aged from 44 to 67 years old with an average of (61.0±2.3) years old;the course of disease ranged from 2 to 8 weeks with average of (3.3±1.3) weeks;12 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;with Huoxue prescription directed transdrug therapy based on shock wave group. Visual analogue scale (VAS), University of California at Los Angeles (UCLA) and range of motion (ROM) were compared between two groups before treatment, 1 and 6 months after treatment;changes of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) between two groups were detected and compared. The complications between two groups were compared. RESULTS: All patients were followed up, shockwave group followed up for 6 to 8 months with an average of (7.1±1.9) months, 6 to 8 months with an average of (7.2±1.8) months in directed dialysis group, with no statistical significance between two groups (P>0.05). At 1 and 6 months after treatment, VAS in directed dialysis group were (3.85±0.99), (1.24±0.75), which were lower than that in shock wave group (4.91±0.89), (1.81±0.84) (P<0.05). UCLA scores in directed dialysis group (25.25±2.34), (32.71±2.33) were higher than those in shock wave group (21.67±3.38) °, (29.11±3.01) °(P<0.05). Forward bending (139.15±20.39) °, (150.14±20.55) °, external rotation (63.46±16.62) °, (73.35±13.82) °, internal rotation (46.99±2.93) °, (58.24±2.10) ° in directed dialysis group were better than those in shock wave group (130.61±22.27) °, (141.28±19.47) °, external rotation (57.36±17.53) °, (68.12±13.64) °, internal rotation (41.21±3.10) °, (49.16±3.21) ° (P<0.05). At 1 and 6 months after treatment, TNF-α, IL-1 and IL-6 in directed dialysis group were (2.12±0.49), (2.06±0.55), (0.69±0.26) μg·L-1;(1.27±0.25), (1.14±0.23), (0.37±0.11) μg·L-1, which were lower than those in shock wave group (2.87±0. 51), (2.67±0.48), (0.92±0.21) μg·L-1, (1.88 ± 0.26), (1.36±0.27), (0.45±0.09) μg·L-1(P<0.05). At the latest follow-up, 8 patients got excellent result, 10 good and 2 poor in shock wave group;10 patients excellent, 10 good, and 2 poor in directed dialysis group;there was no significant difference between two groups (P>0.05). There were no complications such as skin allergy, subcutaneous hemorrhage, ecchymosis, vascular and nerve injury occurred in both groups. CONCLUSION For the treatment of rotator cuff injury, Huoxue prescription combined with extracorporeal shock wave is effective, which could not only release the local adhesion tissue, improve local blood circulation, accelerate absorption of inflammatory exudate of the local soft tissue, and promote recovery of the diseased muscle bond and ligament. It could also effectively relieve shoulder pain, improve shoulder motion, restore shoulder function, improve patients' quality of life.
Humans ; Male ; Female ; Middle Aged ; Aged ; Extracorporeal Shockwave Therapy ; Retrospective Studies ; Rotator Cuff Injuries/physiopathology* ; Adult ; Drugs, Chinese Herbal/administration & dosage* ; Combined Modality Therapy ; Interleukin-6/metabolism*

OBJECTIVE: To explore clinical effect of reverse shoulder replacement in treating giant irreparable rotator cuff tear complicated with glenohumeral arthritis. METHODS: A retrospective analysis was performed on 18 patients (18 shoulders) with glenohumeral arthritis combined with large irreparable rotator cuff tear admitted from April 2020 to April 2022, including 10 males and 8 females, aged from 60 to 78 years old;7 patients on the left side, 11 patients on the right side;the course of disease ranged from 6 to 21 months;7 patients with grade 3 and 11 patients with grade 4 according to Goutallier grading;8 patients with grade 4b and 10 patients with grade 5 according to Hamada grading. Shoulder joint motion, visual analogue scale (VAS), University of California at Los Angeles (UCLA) score and Constant-Murley shoulder joint function score and complications were compared at the latest follow-up. RESULTS: Eighteen patients were followed up for 24 to 48 months. At the latest follow-up, shoulder joint flexion ranged from 120° to 145°, abduction ranged from 100° to 130°, and rotation ranged from 45° to 60°. VAS ranged from 1 to 3;Constant-Murley score ranged from 80 to 95;and UCLA scores ranged from 27 to 35, and 6 patients obtained excellent result, 11 good and 1 average. Dislocation of shoulder joint occurred in 1 patient at 3 months after operation, but no dislocation occurred after manual reduction. The incision surface infection occurred in 1 patient at 1 week after operation, and the incision healed after anti-infection and cleaning. The other patients did not have complications such as dislocation, infection, prosthesis loosening and peripheral fracture. CONCLUSION Reverse shoulder replacement for the treatment of huge irreparable rotator cuff injury combined with glenohumeral arthritis disease, the clinical effect is good, could significantly improve shoulder joint function and improve quality of life, but still need to strengthen the prevention and treatment of postoperative complications such as dislocation and infection.
Humans ; Male ; Female ; Middle Aged ; Rotator Cuff Injuries/physiopathology* ; Aged ; Retrospective Studies ; Arthroplasty, Replacement, Shoulder/methods* ; Range of Motion, Articular ; Shoulder Joint/physiopathology*

Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.
Accidental Falls ; Aged ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Range of Motion, Articular ; Recurrence ; *Rotator Cuff Injuries/diagnosis/diagnostic imaging/physiopathology ; *Shoulder/diagnostic imaging/pathology/physiopathology ; *Shoulder Dislocation/diagnosis/diagnostic imaging/physiopathology

BACKGROUND: This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard. METHODS: We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography. RESULTS: The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear. CONCLUSIONS: It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography.
Adult ; Aged ; Aged, 80 and over ; Arthrography ; Arthroscopy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Rotator Cuff/injuries/physiopathology/surgery/*ultrasonography ; Shoulder Joint/physiopathology/surgery/*ultrasonography ; Tendon Injuries/diagnosis/physiopathology/surgery/*ultrasonography ; Wound Healing

BACKGROUND: The purpose of our study is to evaluate the clinical results of arthroscopic suture bridge repair for patients with rotator cuff tears. METHODS: Between January 2007 and July 2007, fifty-one shoulders underwent arthroscopic suture bridge repair for full thickness rotator cuff tears. The average age at the time of surgery was 57.1 years old, and the mean follow-up period was 15.4 months. RESULTS: At the last follow-up, the pain at rest improved from 2.2 preoperatively to 0.23 postoperatively and the pain during motion improved from 6.3 preoperatively to 1.8 postoperatively (p < 0.001 and p < 0.001, respectively). The range of active forward flexion improved from 138.4degrees to 154.6degrees, and the muscle power improved from 4.9 kg to 6.0 kg (p = 0.04 and 0.019, respectively). The clinical results showed no significant difference according to the preoperative tear size and the extent of fatty degeneration, but imaging study showed a statistical relation between retear and fatty degeneration. The average Constant score improved from 73.2 to 83.79, and the average University of California at Los Angeles score changed from 18.2 to 29.6 with 7 excellent, 41 good and 3 poor results (p < 0.001 and p = 0.003, respectively). CONCLUSIONS: The arthroscopic suture bridge repair technique for rotator cuff tears may be an operative method for which a patient can expect to achieve clinical improvement regardless of the preoperative tear size and the extent of fatty degeneration.
Adult ; Aged ; Arthroscopy/*methods ; Female ; Humans ; Male ; Middle Aged ; Muscle Strength ; Pain, Postoperative ; Range of Motion, Articular ; Rotator Cuff/*injuries/*surgery ; Shoulder Joint/physiopathology ; *Suture Techniques

BACKGROUND: The purpose of this study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repair, and to analyze the factors affecting the integrity of arthroscopically repaired rotator cuff tears of the shoulder. METHODS: One hundred sixty-nine consecutive shoulders that underwent arthroscopic rotator cuff repair, had a postoperative MRI evaluation and were followed for at least two years were enrolled in this study. The mean age was 57.6 years (range, 38 to 74 years) and the mean follow-up period was 39 months (range, 24 to 83 months). RESULTS: The rotator cuff was completely healed in 131 (77.5%) out of 169 shoulders and recurrent tears occurred in 38 shoulders (22.5%). At the last follow-up visit, the mean score for pain during motion was 1.53 (range, 0 to 4) in the completely healed group and 1.59 (range, 0 to 4) in the group with recurrent tears (p = 0.092). The average elevation strength was 7.87 kg (range, 4.96 to 11.62 kg) and 5.25 kg (range, 4.15 to 8.13 kg) and the mean University of California at Los Angeles score was 30.96 (range, 26 to 35) and 30.64 (range, 23 to 34), respectively (p < 0.001, p = 0.798). The complete healing rate was 87.8% in the group less than 50 years of age (49 shoulders), 79.4% in the group over 51 years but less than 60 years of age (68 shoulders), and 65.4% in the group over 61 years of age (52 shoulders, p = 0.049); it was 96.7% in the group with small-sized tears (30 shoulders), 87.3% in the group with medium-sized tears (71 shoulders), and 58.8% in the group with large-sized or massive tears (68 shoulders, p = 0.009). All of the rotator cuffs with a global fatty degeneration index of greater than two preoperatively had recurrent tears. CONCLUSIONS: Arthroscopic repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the minimum two-year follow up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle.
Activities of Daily Living ; Adult ; Aged ; *Arthroscopy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Strength ; Pain Measurement ; Range of Motion, Articular ; Recurrence ; Rotator Cuff/*injuries/pathology/*surgery ; Shoulder Joint/pathology/physiopathology ; Treatment Outcome

BACKGROUND: Diagnosing impingement syndrome without rotator cuff tear usually depends on the physical examination and roentgenography, and obtaining objective evidence for this condition is at best difficult. The purpose of this study was to ascertain whether quantitatively assessing this condition with using single photon emission computerized tomography (SPECT) can diagnose impingement syndrome and predict the postoperative results. METHODS: Before executing arthroscopic or open treatment, SPECT was performed on 73 patients and 24 volunteers and these people were followed up for 2 years. Any increased uptake on SPECT was investigated by using the axial view, which demonstrated the greatest uptake for the acromion, distal clavicle, greater tuberosity, lesser tuberosity and the coracoid process of the operated and non-operated sides. RESULTS: The patients who were diagnosed as having impingement syndrome with or without rotator cuff tear showed increased uptake on the operative side compared to the non-operated side in the assessed locations. The greater tuberosity of the humerus could be used for quantitative measurement as a postoperative prognostic factor. CONCLUSIONS: The bone SPECT method is useful for making the diagnosis of patients with impingement sydrome, and the results of quantitative assessment at the greater tuberosity can be used for evaluating the prognosis following the operation.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Humeral Head/*radionuclide imaging ; Male ; Middle Aged ; Pain Measurement ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Rotator Cuff/*injuries ; Shoulder Impingement Syndrome/physiopathology/*radionuclide imaging/surgery ; *Tomography, Emission-Computed, Single-Photon

INTRODUCTIONThe superior labral anterior and posterior (SLAP) lesion is a cause of chronic shoulder pain and significant disability. This study aims to review the distribution of types of SLAP lesions, associated lesions and the outcome of arthroscopic management.

MATERIALS AND METHODSThis series involved all 33 patients who underwent arthroscopic management of SLAP and associated lesions by a single surgeon. The pre- and postoperative disability scores were assessed using the disabilities of the arm, shoulder and hand (DASH) outcome measure.

RESULTSType 2 SLAP lesion (64%) was the most common. Forty-eight per cent of the cases were associated with an ipsilateral shoulder lesion. A 10- point pre- and postoperative DASH score reduction was noted in 63% of the patients with isolated SLAP lesions and 73% of those with associated lesions.

CONCLUSIONArthroscopic management of the SLAP and its associated lesions results in improved functional outcome. The presence of associated lesions should be actively sought and managed in the same operative session.

Adult ; Arthroscopy ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function ; Rotator Cuff ; physiopathology ; surgery ; Rotator Cuff Injuries ; Shoulder Joint ; injuries ; physiopathology ; surgery ; Treatment Outcome