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Assessment of the rotator cuff on sagittal MR image between shoulders with and without cuff tears
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
262
263
THE TREATMENT OF SYMPTOMATIC POSTERIOR GLENOHUMERAL INSTABILITY WITH AN ANTERIOR CAPSULAR SHIFT RECONSTRUCTION CA Rockwood, Jr., MD MA Wirth, MD, DG Seltzer, MD GI Groh, MD The University of Texas Health Science Center, San Antonio, Texas 78284-7774 USA This study included six females and five males with an average age of 24 years (range, 16 to 35 years). All patients underwent a comprehensive examination of the shoulder which demonstrated symptomatic posterior subluxation or dislocation of the shoulder when the internally rotated arm was horizontally abducted across the chest from a 90 degree adducted starting position. All patients demonstrated multidirectional laxity of the glenohumeral joint and generalized ligamentous laxity. Eight patients had recurrent posterior subluxation of the glenohumeral joint and three had rect~rrent posterior dislocation, which was radiographically documented. Patients were treated conservatively for an average of fourteen months (range, 3 to 24 months) prior to surgery. All patients underwent a specific capsular shift procedure, which has been previously described by the senior author, for recurrent anterior instability. Postoperatively, patients were evaluated using the grading system proposed by Rowe and Zarin. Nine patients with a minimum follow-up of two years were available for review at a mean follow-up of 32 months (range, 24 to 96 months). Five shoulders were graded as excellent, three good, and one fair.
ASSESSMENT O F T H E R O T A T O R CUFF ON SAGITTAL M R I M A G E B E T W E E N S H O U L D E R S W I T H AND W I T H O U T CUFF TEARS. T Sato, E ltoi, H Minagawa, T Kobayashi, N Konno, K Sato Department of Orthopedic Surgery, Akita University School of Medicine The purpose of this study is to compare the cross-sectional area of each muscle of the rotator cuff on sagittal MR image between shoulders with and without cuff tears. 31 shoulders with cuff tears, the size of which was less than 3 cm were enrolled in this study. There were 16 males and 19 females, with an average age of 58. 8 patients who had clinically no atrophy of the rotator cuff and no limitation in daily living were enrolled as RCT (-) group. There were 6 males and 2 females, with an average age of 28.
We measured the areas of the supraspinatus,
infraspinatus, teres minor, and subscapularis muscle. And we measured the diameter of the humeral head to normalize the date. The area ratio of the muscle to the humeral head was defined as SSP ratio, ISP ratio, TM ratio, and SSC ratio, respectively. In SSP, ISP, and SSC ratio, the value of the RCT (+) group was significantly lower than that of the RCT(-) group (p<0.0001, p=0.0062, p=0.016). However in TM ratio there was no significant difference between the two groups(p=o.323). In shoulders with supraspinatus tears, the atrophy of the cuff was observed not only in the supraspinatus but also in the infraspinatus and subscapularis muscles. Atrophy was not observed in the teres minor.
Abstracts
264
$83
SUPRASCAPULAR NERVE INJURY AND CUFF RE-TEAR AFTER PRIMARY REPAIR OF MASSIVE R O T A T O R CUFF TEARS. R.M. Zanotti, MD; J. E. Calpenter, MD; R. B. Blasier, MD; M. L. Greenfield, MPH; R. S. Adler, MD, PhD; M. B. Bromberg, MD, PhD. The University of Michigan, Ann Arbor, MI, 48109 Although poor post-operative function following repair of massive rotator cuff tears (RCT) has commonly been attributed to recurrent tears of the cuff tendons, iatrogenic injury to the suprascapular nerve from cuff mobilization may also occur. In this study, we measured th~ incidence of cuff re-tear and injury to the suprascapular nerve following the operative repair of massive RCT. Of one-hundred and four rotator cuff repairs performed over a five year perio& ten patients (seven males and three females--ages 22 to 68 years) had primary repairs of massive RCT which required cuff mobilization and an acromioplasty as their only procedure. These patients were evaluated at a mean of 2.5 years (range 2.0 to 3.0 years) post-operatively. At follow-up, EMG examination confirmed that one of the ten patients had an iatrogenic suprascapular nerve injury, while ultrasound evaluation revealed that two of ten repairs failed. Pain relief was achieved in all patients with intact repairs. Overall, seven of ten patients had neither evidence of nerve injury nor recurrent RCT, yet still showed limited active motion or marked weakness. It appears that operative injury to the suprascapular nerve during cuff mobilization can occur, but a host of other factors such as inadequate cuff muscle function may be responsible for poor functional outcomes seen following the repair of massive RCTs.
262
263
THE TREATMENT OF SYMPTOMATIC POSTERIOR GLENOHUMERAL INSTABILITY WITH AN ANTERIOR CAPSULAR SHIFT RECONSTRUCTION CA Rockwood, Jr., MD MA Wirth, MD, DG Seltzer, MD GI Groh, MD The University of Texas Health Science Center, San Antonio, Texas 78284-7774 USA This study included six females and five males with an average age of 24 years (range, 16 to 35 years). All patients underwent a comprehensive examination of the shoulder which demonstrated symptomatic posterior subluxation or dislocation of the shoulder when the internally rotated arm was horizontally abducted across the chest from a 90 degree adducted starting position. All patients demonstrated multidirectional laxity of the glenohumeral joint and generalized ligamentous laxity. Eight patients had recurrent posterior subluxation of the glenohumeral joint and three had rect~rrent posterior dislocation, which was radiographically documented. Patients were treated conservatively for an average of fourteen months (range, 3 to 24 months) prior to surgery. All patients underwent a specific capsular shift procedure, which has been previously described by the senior author, for recurrent anterior instability. Postoperatively, patients were evaluated using the grading system proposed by Rowe and Zarin. Nine patients with a minimum follow-up of two years were available for review at a mean follow-up of 32 months (range, 24 to 96 months). Five shoulders were graded as excellent, three good, and one fair.
ASSESSMENT O F T H E R O T A T O R CUFF ON SAGITTAL M R I M A G E B E T W E E N S H O U L D E R S W I T H AND W I T H O U T CUFF TEARS. T Sato, E ltoi, H Minagawa, T Kobayashi, N Konno, K Sato Department of Orthopedic Surgery, Akita University School of Medicine The purpose of this study is to compare the cross-sectional area of each muscle of the rotator cuff on sagittal MR image between shoulders with and without cuff tears. 31 shoulders with cuff tears, the size of which was less than 3 cm were enrolled in this study. There were 16 males and 19 females, with an average age of 58. 8 patients who had clinically no atrophy of the rotator cuff and no limitation in daily living were enrolled as RCT (-) group. There were 6 males and 2 females, with an average age of 28.
We measured the areas of the supraspinatus,
infraspinatus, teres minor, and subscapularis muscle. And we measured the diameter of the humeral head to normalize the date. The area ratio of the muscle to the humeral head was defined as SSP ratio, ISP ratio, TM ratio, and SSC ratio, respectively. In SSP, ISP, and SSC ratio, the value of the RCT (+) group was significantly lower than that of the RCT(-) group (p<0.0001, p=0.0062, p=0.016). However in TM ratio there was no significant difference between the two groups(p=o.323). In shoulders with supraspinatus tears, the atrophy of the cuff was observed not only in the supraspinatus but also in the infraspinatus and subscapularis muscles. Atrophy was not observed in the teres minor.
Abstracts
264
$83
SUPRASCAPULAR NERVE INJURY AND CUFF RE-TEAR AFTER PRIMARY REPAIR OF MASSIVE R O T A T O R CUFF TEARS. R.M. Zanotti, MD; J. E. Calpenter, MD; R. B. Blasier, MD; M. L. Greenfield, MPH; R. S. Adler, MD, PhD; M. B. Bromberg, MD, PhD. The University of Michigan, Ann Arbor, MI, 48109 Although poor post-operative function following repair of massive rotator cuff tears (RCT) has commonly been attributed to recurrent tears of the cuff tendons, iatrogenic injury to the suprascapular nerve from cuff mobilization may also occur. In this study, we measured th~ incidence of cuff re-tear and injury to the suprascapular nerve following the operative repair of massive RCT. Of one-hundred and four rotator cuff repairs performed over a five year perio& ten patients (seven males and three females--ages 22 to 68 years) had primary repairs of massive RCT which required cuff mobilization and an acromioplasty as their only procedure. These patients were evaluated at a mean of 2.5 years (range 2.0 to 3.0 years) post-operatively. At follow-up, EMG examination confirmed that one of the ten patients had an iatrogenic suprascapular nerve injury, while ultrasound evaluation revealed that two of ten repairs failed. Pain relief was achieved in all patients with intact repairs. Overall, seven of ten patients had neither evidence of nerve injury nor recurrent RCT, yet still showed limited active motion or marked weakness. It appears that operative injury to the suprascapular nerve during cuff mobilization can occur, but a host of other factors such as inadequate cuff muscle function may be responsible for poor functional outcomes seen following the repair of massive RCTs.