Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effectiv...Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate(over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should allbe considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate doseresponse and to determine long-term follow-up effects.展开更多
Background： The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the cu...Background： The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods： Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can （EC） test, full can （FC） test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically tbr their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results： The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity （94.1%）, with a low negative likelihood ratio （NLR, 0.08） and comparable specificity （76.6%） compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test （z = 1.438, P = 0.075） or the FC test （z = 1.498, P = 0.067）. The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position （X2 = 0.578, P = 0.898） and size （Fisher＇s exact test, P 〉 0.999） compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions： The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and co展开更多
INTRODUCTIONRotator cuffinjuries are common in all athletic. Of all rotator cuff injuries, the supraspinatus tendon involves mostly. Severe supraspinatus tendon injury may affect the patient＇s quality of life. Howeve...INTRODUCTIONRotator cuffinjuries are common in all athletic. Of all rotator cuff injuries, the supraspinatus tendon involves mostly. Severe supraspinatus tendon injury may affect the patient＇s quality of life. However, supraspinatus tendon injury can be relatively asymptomatic in some cases and may require sonographic examination for diagnosis, With continued improvement in shoulder arthroscopy, surgical treatment for supraspinatus tendon injury has become more effective and less invasive.展开更多
AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 mal...AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.展开更多
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 follow...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.展开更多
文摘Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate(over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should allbe considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate doseresponse and to determine long-term follow-up effects.
文摘Background： The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods： Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can （EC） test, full can （FC） test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically tbr their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results： The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity （94.1%）, with a low negative likelihood ratio （NLR, 0.08） and comparable specificity （76.6%） compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test （z = 1.438, P = 0.075） or the FC test （z = 1.498, P = 0.067）. The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position （X2 = 0.578, P = 0.898） and size （Fisher＇s exact test, P 〉 0.999） compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions： The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and co
文摘INTRODUCTIONRotator cuffinjuries are common in all athletic. Of all rotator cuff injuries, the supraspinatus tendon involves mostly. Severe supraspinatus tendon injury may affect the patient＇s quality of life. However, supraspinatus tendon injury can be relatively asymptomatic in some cases and may require sonographic examination for diagnosis, With continued improvement in shoulder arthroscopy, surgical treatment for supraspinatus tendon injury has become more effective and less invasive.
文摘AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.
基金This paper is supported by Zhejiang Medical and Health Science and Technology Project(2019RC309)Taizhou Science and technology plan project(1701ky49).
文摘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.
