Bioavailability in rats of bound pesticide residues from tolerant or susceptible varieties of soybean and canola treated with metribuzin or atrazine

Percutaneous treatments are useful in two, frequent, painful conditions involving the shoulder. In frozen shoulder syndrome, distention arthrography with intra-articular injection of steroid is used to provide pain relief and to improve joint motion. In rotator cuff tendon calcifications, needle aspiration of calcific deposits is used to treat pain. Surgery should be restricted to failures of needle aspiration. The techniques of these procedures are described and their results are reported.     

Temperature-controlled release property of phospholipid vesicles bearing a thermo-sensitive polymer

The supraspinatus, infraspinatus, teres minor and subscapu?aris muscles form a musculotendinous rotator cuff that provides dynamic stability to the shoulder joint. Symptoms of rotator cuff injury include limitation of motion, weakness and pain that often radiates down the upper arm and is present at night. Examination may reveal deltoid and rotator cuff atrophy, tenderness, limited passive range of motion and weakness on abduction and external rotation. Radiographs may show degenerative changes of the acromion or acromioclavicular joint, cysts, sclerosis and spurs of the greater tuberosity, and calcific deposits within the supraspinatus tendon. In most patients with subacromial impingement, conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs and subacromial injections, is successful. Failure of conservative therapy after six to 12 weeks merits further evaluation with magnetic resonance imaging or arthrography, and consideration of surgery.     

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach

Calcific deposits located within the tendons of the rotator cuff are frequently seen in patients presenting with shoulder pain. The pathogenesis of calcific tendinitis and the optimum management of patients presenting with acute symptoms are unclear. This paper reviews the incidence, proposed etiologies, and a unique treatment approach of rotator cuff calcific tendinitis. A case report of a patient with acute calcific tendinitis and subsequent shoulder motion and strength deficits is presented. A rational evaluation and treatment plan is outlined, which includes management and posttreatment changes, and radiographic findings are discussed. A team-management approach by physical therapy and orthopaedics services is emphasized.     

Arthroscopic assessment of rotator cuff tear reparability

To evaluate the efficacy of arthroscopic techniques in determining the potential reparability of complete rotator cuff tears, a clinical investigation was performed. The parameters of tear size measurement, tendon quality, tendon mobility, and suture anchor placement were evaluated. These parameters were determined using both arthroscopic and open surgical technique. No statistically significant differences were noted when the arthroscopic findings were compared with the findings at open rotator cuff repair. Arthroscopic techniques can reliably assess rotator cuff tear size, tendon quality, tendon mobility, and suture anchor placement.     

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.     

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.     

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.     

Arthroscintigraphy in suspected rotator cuff rupture

AIM: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. METHODS: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. RESULTS: In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. CONCLUSION: Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.     

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.     

Ossification of the coracoacromial ligament: association with rotator cuff pathology of the shoulder

The objective of this study was to assess the association of ossification of the coracoacromial ligament (CAL) observed on conventional radiographs with the presence of rotator cuff pathology as demonstrated by magnetic resonance imaging (MRI), arthrography, and/or surgery. Conventional radiographs (internal and external rotation and outlet and axillary views) on eight patients showed ossification of the coracoacromial ligament. Rotator cuff integrity was assessed by physical examination in all 8 patients, by arthrography in 3 patients, and by MRI in 2 patients. Surgery was performed on four of the patients. Physical examination showed impingement findings and decreased rotator cuff strength suggestive of rotator cuff disease in all eight patients. The arthrograms and MRI examinations showed the presence of full-thickness rotator cuff tears. Four of these patients underwent surgery and the rotator cuff defects were confirmed and repaired. Identification of ossification of the CAL on conventional radiographs should be recognized as strongly suggestive of associated significant rotator cuff pathology.     

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.     

Using monoclonal antibodies to characterize a sequential epitope on the group I allergen of Bermuda grass pollen

We measured the incidence of cuff retear and injury to the suprascapular nerve after mobilization and repair of a massive rotator cuff tear. Of one hundred four rotator cuff repairs performed over a 5-year period, 10 patients (7 men and 3 women, age range 22 to 68 years) had primary repairs of massive rotator cuff tears requiring 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) after surgery. At follow-up electromyographic examination confirmed that 1 of the 10 patients had an iatrogenic suprascapular nerve injury, whereas ultrasound evaluation revealed that 2 of 10 repairs failed. Pain relief was achieved in the eight patients with intact repairs and not in the two with recurrent tears. All patients had some limitation of active motion or strength, especially in external rotation. Thus 7 of 10 patients had neither evidence of nerve injury nor recurrent rotator cuff tears yet still showed limited active motion or weakness. It appears that operative injury to the suprascapular nerve during cuff mobilization can occur, but other factors such as inadequate cuff muscle function are more frequently responsible for the poor functional outcomes seen after successful repairs of massive rotator cuff tears.     

Nonoperative management of secondary shoulder impingement syndrome

Shoulder pain secondary to impingement of the rotator cuff tendons underneath the coracoacromial arch is a common problem seen in athletes who perform repetitive overhead activities. Shoulder impingement has been classified into primary and secondary types. Several factors contribute to impingement, including rotator cuff weakness, posterior capsule tightness, and subacromial crowding. Recently, it has been proposed that scapulothoracic muscle weakness could be a factor that contributes to impingement. Traditional rehabilitation protocols for shoulder impingement syndrome stress individualized rotator cuff strengthening. The authors propose that individualized scapulothoracic muscle strengthening should be a part of any protocol for nonoperative treatment of secondary shoulder impingement syndrome.     

Sonography for the office screening of suspected rotator cuff tears: early experience of the orthopedic surgeon

This study examined the feasibility of orthopedic surgeons performing sonography of the shoulder at the initial office evaluation of the rotator cuff and assessed the sensitivity, specificity, and predictive value of sonography for the detection of tears in the rotator cuff. Initial results in 24 patients suggest that sonography by the orthopedic surgeon is feasible and that it detects tears in the rotator cuff with sufficient accuracy for clinical decision making.     

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.     

Antitumor effect of DT-5461, a lipid A derivative, against human tumor xenografts is mediated by intratumoral production of tumor necrosis factor and affected by host immunosuppressive factors in nude mice

PURPOSE OF THE STUDY: The purpose of this report was to study the repercussions of rotator cuff condition on unconstrained shoulder arthroplasty results. METHODS: Between 1986 and 1993, 40 unconstrained shoulder prostheses were performed (24 total and 16 hemiarthroplasties). At the time of the operation, rotator cuff condition was reported to be normal in 15 shoulders, atrophic in 10, scarred in 3, torn in 12. Clinical and radiographical results were analyzed and supplemented with a rotator cuff echography. Postoperative follow-up averaged 42.25 months (12 to 97 months). RESULTS: When the rotator cuff was intact at the time of operation, clinical results were the best at the time of review. Constant score, overall mobility, forward elevation, external rotation with the elbow along the side were better for intact than for atrophic, scarred or torn rotator cuffs (p < 0.01). Ruptures repaired by local tissue transfer or trapezo deltoidal flap substitution (3 cases) gave satisfactory results, whereas two dacron cuff prostheses failed. In the non repaired ruptures (7 cases), arthroplasty resulted in 3/4 fair or poor results. At the time of review, the total incidence of postoperative rotator cuff tears was high (12 cases), functional repercussions were variable. Among the 15 rotator cuff tears observed at the time of the review, the long head of the biceps was present and in place in 9 cases and ruptured in 6 cases. In these latter cases, Constant score (p < 0.01), the forward elevation (p < 0.01), external rotation with elbow along side (p < 0.05) and overall mobility (p < 0.05) were worse; moreover, humeral head superior migration was greater (p < 0.01). DISCUSSION: Our study confirms the superiority of clinical results when the cuff was intact at the time of the operation. The repair of rotator cuff tears seems to be justified. When the rupture has not been repaired, clinical results were fair or poor in 5 cases out of 7, the initial rupture spread to the other tendons in 3 cases out of 7. Secondary ruptures were frequent (12 cases). No predictive factor was identified, but an overlapping of the greater tuberosity appears to be detrimental. Among rotator cuff tears present at the time of review, long head of the biceps rupture jeopardized clinical results and was associated with a proximal migration of the humeral head which was significantly more severe than with an intact non displaced long head of the biceps. CONCLUSION: During unconstrained shoulder prosthesis implantation, it is therefore recommend to systematically repair any associated rotator cuff rupture, in order to avoid any greater tuberosity overlap relative to the prosthetic head and to preserve the long head of the biceps tendon which limits upward migration of the humeral head and improves prosthetic kinetics.     

Ultrasound diagnosis of the shoulder

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.     

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.     

Increased fetal nuchal translucency: possible involvement of early cardiac failure

The authors present the methodology and the results of a trial of 3D-reconstruction of the fibrous frame of the rotator cuff taken from high resolution MRI. The accuracy of the method used is discussed. A precise reconstruction of the soft tissues is possible and provides an interesting model to study the mechanical role of the rotator cuff muscles. An example of biomechanical application of the 3D images is given.     

Suprascapular nerve block for persistent rotator cuff lesions

The suprascapular nerve supplies sensory nerves to the posterosuperior aspect of the shoulder, including major portions of the rotator cuff. Suprascapular nerve block using steroid/bupivacaine is temporarily effective in reducing pain in rotator cuff tendinitis and tears, improving movement range in tendinitis and is possible in an outpatient setting with little or no complication risk.