A study of anterior pituitary hormones secretion in patients with glioma receiving interferon-beta treatment

Increases security of fixation in rotator cuff repair is usually achieved by increasing the strength of fixation. Paradoxically, the problem can be approached by techniques that decrease the strain at the margins of the tear so that weaker fixation will still be adequate. Such techniques provide greater safety tolerances for the strength characteristics of suture, tendon, and bone. The principle of margin convergence can be applied to rotator cuff repair as a means to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. This strain reduction should also contribute to pain reduction by virtue of decreased stimulation of mechanoreceptors in the rotator cuff. The cliché no pain, no strain can be converted to a paradigm by reversal of its components to no strain, no pain.     

Full-thickness supraspinatus tendon tears with intact superior glenohumeral capsule

Fourteen of 318 consecutive shoulder arthroscopies performed over 5 years were found to have a complete tear of the supraspinatus tendon with an intact superior glenohumeral joint capsule. All tears were surgically repaired into a bony trough in the greater tuberosity. All of these tears were found in the past 2 years, representing the last 155 arthroscopies performed. This would indicate that there were probably similar lesions that were missed in earlier cases. This represents a significant pitfall injury that may yield a negative arthrogram and may be overlooked in arthroscopic shoulder surgery unless close inspection of the bursal side of the rotator cuff is accomplished.     

A biomechanical evaluation of suture anchors in repair of the rotator cuff

Repair of the rotator cuff requires secure reattachment, but large chronic defects cause osteoporosis of the greater tuberosity which may then have insufficient strength to allow proper fixation of the tendon. Recently, suture anchors have been introduced, but have not been fully evaluated. We have investigated the strength of suture-to-anchor attachment, and the use of suture anchors in repairs of the rotator cuff either to the greater tuberosity or the lateral cortex of the humerus. The second method gave a significant increase in the strength of the repair (p = 0.014). The repairs were loaded cyclically and failed at low loads by cutting into bone and tendon, casting doubt on the integrity of the repair in early mobilisation after surgery. Repairs with suture anchors did not perform better than those with conventional transosseous attachment.     

Posterior superior impingement of the rotator cuff on the glenoid rim as a cause of shoulder pain in the overhead athlete

A case of impingement of the deep surface of the supraspinatus tendon on the posterior superior rim of the glenoid and mild anterior laxity has been presented. The partial-thickness tear of the undersurface rotator cuff tendon, degenerative tear of the posterior superior labrum, and osteochondral impression fracture of the humeral head have been documented. The purpose of this case report is to present the pathological findings associated with posterior superior glenoid rim impingement and emphasize its role as a cause of shoulder pain in the overhead athlete. In addition it is important to stress the fact that shoulder pain in the overhead athlete may be multifactorial.     

A psychoanalytic approach to the ethics of the physician-patient relationship

Thirteen patients aged 36-63 years underwent surgery for full thickness rotator cuff rupture. The average follow-up was 21.1 months (range 12-36 months). Supraspinatus tendon was torn in 7 cases, supraspinatus and infraspinatus in 4, subscapularis in 1 and all three tendons were ruptured in 1 patient. Subacromial decompression and cuff reconstruction was done in 11 cases, decompression combined with cuff debridement and partial subscapularis tendon reconstruction in 1 case and subscapularis reconstruction in 1 patient. Constant Score (version corrected for age and sex) was used for shoulder function evaluation. There were 6 very good, 4 good, 1 fair and 2 bad results. Recurrence of cuff tear was diagnosed sonographically in 2 cases of both supra- and infraspinatus rupture. Statistical analysis disclosed significant correlation between extent of the tear and final functional result. Constant Score can be recommended as an objective and useful method for shoulder function assessment.     

MR arthrography of the shoulder joint in a postoperative patient sample

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff.     

Magnetic resonance imaging of the musculoskeletal system. Part 6. The Shoulder

The role of magnetic resonance imaging in the diagnosis and treatment of patients with shoulder pain has increased remarkably in recent years, largely because of improved resolution of images and increased experience of musculoskeletal radiologists. In rotator cuff disease/impingement and instability, magnetic resonance imaging adds a new dimension to the clinical findings through the noninvasive visualization of either the pathology itself or frequently associated abnormalities. It is the associated abnormalities that are depicted in instability: glenoid irregularities, labral tears, capsular laxity, and Hill-Sachs deformities. Glenoid, labral, and Hill-Sachs abnormalities can be assessed with either magnetic resonance imaging or computed tomography arthrography. Magnetic resonance imaging has the advantages of noninvasiveness, multiplanar imaging capability and exquisite soft tissue contrast. In rotator cuff disease, magnetic resonance imaging depicts the status of the rotator cuff itself, revealing partial and full thickness tears, allowing an estimation of size and quality of tendon edges. Possible impingement sites can be identified. Primary instability with secondary impingement may be first suspected on magnetic resonance imaging. Postoperative complications, including recurrent tendon detachment, deltoid dehiscence, and infection, are clarified. Unsuspected but clinically important lesions, such as neoplasm, osteonecrosis, and ganglion with entrapment of the suprascapular nerve, each have characteristic magnetic resonance imaging appearances.     

MR imaging of impingement and rotator cuff disorders. A surgical perspective

The role of MR imaging in the diagnosis of impingement and rotator cuff disorders is expanding greatly. This article discusses the clinically pertinent history, physical examination, and surgical treatment of rotator cuff problems. A rationale for consideration of open, "mini-open," and arthroscopic surgical intervention is proposed. The utilization of MR imaging by the orthopedic surgeon for nonoperative, preoperative, and postoperative decision-making are presented. A close working relationship between the radiologist and the orthopedist is emphasized.     

Suppression of alloreactivity with gamma delta T-cells: relevance to increased gamma delta T-cells following bone marrow transplantation

Morphologic changes in the long head of the biceps brachii (LHB) and bicipital groove associated with cuff tears were studied in 170 cadavers. In specimens with minimum or moderate cuff tears, the primary finding was relative stenosis at the bicipital groove induced by enlargement of the LHB. However, this stenosis was not apparent in specimens with massive cuff tears and in these specimens, the medial wall of the groove exhibited wear and tear, a potential cause of LHB instability. We suggest that the long head of the biceps brachii muscle can potentially compensate for inadequate rotator cuff function. This increasing activity could lead to enlargement of the tendon and cause deterioration of the bicipital gliding mechanism.     

Geometric and mechanical properties of the coracoacromial ligament and their relationship to rotator cuff disease

One of the most common causes of pain and disability in the upper limb is inflammation of the rotator cuff tendons. When no significant bony abnormality exists in the surrounding structures, the coracoacromial ligament has been implicated as a possible cause of impingement on the cuff tendons. Geometric and mechanical properties of 20 coracoacromial ligaments, 10 from shoulders with rotator cuff tears and 10 from normal shoulders, were accurately determined. In comparing rotator cuff tear and normal specimens, statistically significant changes in geometric properties were measured in the lateral band, but not in the medial band, of the ligament. The lateral band, which is the region most likely to impinge on the rotator cuff, was shorter and had a larger cross-sectional area in specimens with rotator cuff tears. Although there were no statistical differences in structural properties of the ligament between normal and rotator cuff tear groups, significant changes were evident in material properties. Previously reported histologic differences in the ligament in shoulders with rotator cuff tears are supported by the decreased material properties measured in the current study. Whether the differences in the coracoacromial ligament cause impingement or are due to impingement is still unknown at this time.     

Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People''s Republic of China

The rotator cuff tear is an extremely common disorder in the general as well in the orthopaedic praxis. The etiology is multifactorial with intrinsic and extrinsic factors. Clinical assessment of the patient is important for an exact diagnosis and an individual treatment plan. The treatment options of full thickness tears include conservative as well as operative procedures. Over the last years, modified techniques have improved the results of rotator cuff reconstruction.     

Effects of acute administration of transdermal estrogen on postmenopausal women with systemic hypertension

Os acromiale, failure of fusion of the secondary centers of ossification of the acromion process, has been noted as a contributing factor in shoulder impingement syndrome and rotator cuff tears. Treatments for symptomatic os acromiale with or without rotator cuff tears have been reported in the literature and range from excision of small fragments to fusion of larger, fragments with internal fixation and bone grafting. Generally, rotator cuff repairs have been performed when possible. We report an acromion splitting approach through an existing os acromiale to gain exposure for the repair of a massive rotator cuff tear. Subsequent to this repair, the acromion was repaired with internal fixation. Good functional use of the patient's upper extremity was obtained and the patient expressed satisfaction with the surgical outcome. The acromion splitting approach is a viable approach in patients with an os acromiale and a coexistent rotator cuff tear.     

Arthroscopic treatment of rotator cuff disorders

The past 2 decades have seen rapid advancement in the field of shoulder arthroscopy in general and of rotator cuff disorders in particular. Arthroscopy allows superior visualization of pathologic conditions with less soft-tissue trauma than open exposures. Arthroscopic surgical techniques also are being applied to the actual treatment of many forms of rotator cuff disorders with clinical results similar to more traditional, open procedures. Although these techniques and their indications continue to evolve, it remains clear that, in carefully selected patients, arthroscopy has become a highly useful and effective tool in the diagnosis, evaluation, and surgical management of common disorders of the rotator cuff.     

Atrial natriuretic hormone decreases endocrine response to a combined dexamethasone-corticotropin-releasing hormone test

The presence or absence of tendon calcification was studied at six anatomic sites: Achilles, gastrocnemius, quadriceps, triceps (elbow), triceps long head (shoulder), and rotator cuff. The morphology of the calcifications was categorized in 156 patients with chondrocalcinosis in the knee. Achilles tendon, gastrocnemius, and quadriceps tendon calcifications were most common, ranging from 21%-25% of our patient population was thin linear bands. Triceps calcification at the elbow, rotator cuff calcifications, and long head of triceps tendon calcification were less common.     

A review of patients with high-risk carcinoma of the cervix treated with combined surgery and postoperative radiotherapy

The subacromial bursa is recognized as a site associated with the shoulder pain caused by rotator cuff disease in the middle-aged and elderly. Substance P is contained in primary afferent nerves, and its quantity increases during chronic pain. The amount of substance P in the subacromial bursa of patients with rotator cuff disease was examined. Radioimmunoassay and immunohistochemistry were employed to quantify and localize substance P. The preoperative pain level was measured with a visual analogue scale with 0 as no pain, 5 as moderate, and 10 as severe. Thirty-seven patients that had undergone operation were divided into two groups: one composed of 19 patients with subacromial bursitis and a partial-thickness tear of the rotator cuff (nonperforated cuff) and the other composed of 18 patients with a full-thickness tear (perforated cuff). Subacromial bursae obtained from seven fresh cadavers with no shoulder pain before death were used as controls. The visual analogue scale showed significantly greater pain in the group with the nonperforated rotator cuff than in the group with the perforated cuff. Consistent with these results, the amount of substance P in the subacromial bursa was significantly greater in the former group than in the latter. Nerve fibers immunoreactive to substance P were localized around the vessels, with a larger number of fibers in the group with the nonperforated rotator cuff. Therefore, an increased amount of substance P in the subacromial bursa appears to correlate with the pain caused by rotator cuff disease.     

Partial-thickness tears of the rotator cuff: evaluation and management

The approach to management of a partial-thickness rotator cuff tear is best made with the understanding that this is not a singular condition. Rather, partial tears represent the common outcome of a variety of insults to the rotator cuff. Degenerative changes due to aging, anatomic impingement, and trauma may all be etiologic agents. Overhead athletes may develop tears due to repetitive microtrauma or internal impingement. Outlet radiographs and magnetic resonance imaging are recommended for routine preoperative evaluation. A nonoperative treatment program for rotator cuff strengthening and stretching is appropriate as initial treatment; modification of activities and anti-inflammatory medication are often used as well. Operative management may be considered when nonoperative treatment fails. Arthroscopic evaluation is required to determine the true extent of the cuff lesion. Arthroscopic subacromial decompression is recommended when outlet impingement is present. Rotator cuff debridement or formal cuff repair is dependent on the size of the cuff defect and the age and activity level of the patient. The importance of recognizing the different causes of partial-thickness rotator cuff tears is emphasized in this review of pathogenesis, clinical diagnosis, imaging, and treatment.     

The chaperonin containing TCP-1 (CCT) displays a single-ring mediated disassembly and reassembly cycle

A prospective study of 40 shoulder arthroplasties in patients with rheumatoid arthritis was performed to evaluate the results of rotator cuff repair at the time of arthroplasty. A large cuff tear was present in 21 shoulders, and good repair of the cuff was performed in 9. In the other shoulders the repair was considered insufficient. All patients were clinically evaluated using the Hospital for Special Surgery 100-point scoring system. The minimum follow-up period for inclusion in this study was 2 years. The quality of the repair of the ruptured cuff at the time of surgery had a significant influence on the postoperative clinical score (linear regression model, P = .002). The clinical score of the shoulders with good repair of the rotator cuff improved considerably and continued to improve even after the first-year follow-up examination. Meticulous repair of the ruptured cuff at the time of arthroplasty is recommended.     

Prolonged survival in patients with advanced melanoma treated with neoadjuvant chemotherapy followed by resection

We conducted this cadaveric study to define a biomechanical rationale for rotator cuff function in several deficiency states. A dynamic shoulder testing apparatus was used to examine change in middle deltoid muscle force and humeral translation associated with simulated rotator cuff tendon paralyses and various sizes of rotator cuff tears. Supraspinatus paralysis resulted in a significant increase (101%) in the middle deltoid force required to initiate abduction. This increase diminished to only 12% for full glenohumeral abduction. The glenohumeral joint maintained ball-and-socket kinematics during glenohumeral abduction in the scapular plane with an intact rotator cuff. No significant alterations in humeral translation occurred with a simulated supraspinatus paralysis, nor with 1-, 3-, and 5-cm rotator cuff tears, provided the infraspinatus tendon was functional. Global tears resulted in an inability to elevate beyond 25 degrees of glenohumeral abduction despite a threefold increase in middle deltoid force. These results validated the importance of the supraspinatus tendon during the initiation of abduction. Glenohumeral joint motion was not affected when the "transverse force couple" (subscapularis, infraspinatus, and teres minor tendons) remained intact. Significant changes in glenohumeral joint motion occurred only if paralysis or anatomic deficiency violated this force couple. Finally, this model confirmed that rotator cuff disease treatment must address function in addition to anatomy.     

Arthroscopic subacromial decompression and postoperative management

Arthroscopic subacromial decompression is the arthroscopic equivalent of a standard open procedure. Although technically demanding, it facilitates early rehabilitation. The results in patients with stage II disease are equal or better than those achieved through open surgery. The procedure is also useful in selected patients with stage III disease in whom pain is the major complaint. Complete rotator cuff tears can be repaired into a bony trough through a small deltoid-splitting incision.