Ultrasound measurement and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis: a reliability study
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Introduction To determine the inter-observer reliability of ultrasound measurements and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis. Methods Both shoulders of 50 patients (56 ± 18 years, 39F:11M) with inflammatory arthritis, being treated with biologics, were scanned by two experienced radiologists. Rotator cuff and articular surface features in the shoulder joint were measured and graded using previously published ultrasound scoring methods. The inter-observer agreements for rotator cuff tendon, glenohumeral joint (GHJ) and subacromial subdeltoid bursal (SSB) measurements were obtained with intraclass correlation coefficients (ICC) for continuous data. Those for the grade of rotator cuff tendon tear, humeral head (HH) and acromio-clavicular joint (ACJ) appearances were analysed with kappa ( K) statistics for categorical data. Results Moderate inter-observer agreement (ICC = 0.58, P ≤ 0.01) was shown for the supraspinatus tendon thickness. Poor agreement (ICC < 0.49) was found for the thickness of the subscapularis ( P ≤ 0.01), infraspinatus ( P ≤ 0.05) and biceps tendons. There was excellent agreement for the SSB thickness (ICC = 0.88, P ≤ 0.01) and poor agreement for GHJ distance. Moderate agreement ( K = 0.57, P ≤ 0.01) for grading of a supraspinatus tendon tear was found while excellent agreement for the subscapularis ( K = 0.81, P ≤ 0.01), infraspinatus and biceps (both K = 1, P ≤ 0.01) tendons was noted. The most common agreement occurred for no tear or a complete tear. Poor agreement ( K < 0.49) was demonstrated for grading of HH erosions and ACJ appearances. Conclusion Ultrasound measurement of the subacromial subdeltoid bursa was reliable between observers, as was detection of the presence or absence of a complete rotator cuff tendon tear. Reliability was limited for measurements of rotator cuff tendon thickness, grading partial tendon tears or identification of subtle shoulder joint pathology.Keywords:
Bursitis
Kappa
Bursitis
X-Ray Therapy
Calcific tendinitis
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Arthroscopic examination was performed on 33 cases, 35 shoulders. Twenty were male and fourteen were female. The average age was 47.8 years. Examination was done under general anesthesia in 34 shoulders and epidural block in one shoulder. Subacromial bursa was examined through postero-lateral approach. Posterior approach was used for glenohumeral joint. The technique of arthroscopy of the shoulder joint has been studied.
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Electromyographic activities of the biceps during arm elevation in shoulders with rotator cuff tears
We investigated electromyographic activities of the biceps in 40 shoulders with full-thickness tears of the rotator cuff and 40 asymptomatic shoulders, with a normal rotator cuff on MRI, to determine the role of the biceps in cuff-deficient shoulders. Using surface electrodes, biceps activities were recorded during arm elevation in the scapular plane with and without a 1-kg load. The percentages of integrated electromyograms to the maximum voluntary contraction (%MVC) were obtained at 30 degrees, 60 degrees, 90 degrees, and 120 degrees of elevation. In the normal shoulders, %MVC of the biceps was always less than 10% through the arc of elevation both with and without load. Among 40 shoulders with rotator cuff tears, 14 showed increased activities of the biceps more than 10% in %MVC (p < 0.0001), whereas the remaining 26 shoulders had activities similar to the normal shoulders. The biceps activities in these 14 shoulders increased with load application and at higher angles of elevation. The muscle strength tended to be weaker in shoulders with increased biceps activities than in those without. Our findings suggest a potential supplemental function of the biceps in shoulders with rotator cuff tears.
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Multidirectional shoulder joint instability alters the role of dynamic stabilizers, as a result of which the motion patterns of muscles surrounding the shoulder joint are also changed. The aim of this study was to compare the muscle activity of patients with multidirectional shoulder instability and the control group during pull, forward punch and elevation and during overhead throw. Fifteen subjects with multidirectional shoulder instability and fifteen control subjects with normal, healthy shoulders participated in the study. Both shoulders were tested in all subjects. Signals were recorded by surface EMG from eight different muscles during pull, forward punch elevation and overhead throw. The maximum values of normalized voluntary electrical activity, and the time span among peak muscle electrical activities in percent of total time of a movement cycle were compared with those of the healthy control group. Test results suggest that in the case of patients with multidirectional shoulder instability the different motions are performed in a different way. The results give rise to the assumption that the organism will attempt to ensure centralization of the glenohumeral joint and the reduction of instability is attempted to be ensured by the organism through increasing the role of rotator cuff muscles and decreasing the role of m. deltoideus, m. biceps brachii, and m. pectoralis maior. The analysis of time span shows that in the case of patients with multidirectional shoulder instability, the time difference between the peaks of normalized voluntary electrical activity of the patients is significantly greater than those of the control group. It can be established that the neuromuscular control and proprioception of patients with multidirectional shoulder instability differ from those of the control group.
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In an effort to elucidate the relationship of trauma, foci of infection and metabolic factors in the etiology of periarthritis of the shoulder and to determine the most efficacious treatment for this condition, we have analyzed a series of 200 cases that have come under our care during the last nine years. We realize that we may be treading on thin ice when we use the term "periarthritis of the shoulder," but it appears to us that this better describes the clinical entity than "painful shoulder," "subdeltoid bursitis," "subacromial bursitis" or "calcifications of the supraspinatus tendon," with which names all are familiar. Although Codman,1in his classic thesis of this subject, suggested the name "subacromial bursitis," he later demonstrated that when calcification occurred, the deposit was in the tendon of the supraspinatus muscle. This finding was confirmed by Brickner,2Carnett3and others. Calcification, however, does not explain
Bursitis
Etiology
Subacromial bursa
Supraspinatus muscle
Shoulder Impingement Syndrome
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The aim of this paper was to evaluate ultrasonographic picture of rotator cuff integrity after surgical reconstruction performed in 34 patients with mean follow-up 17.2 months (range 6-45 months). The lack of rotator cuff echo or hypoechogenic area were the criteria for diagnosis of re-tear. This occurred in 16% of shoulders with isolated supraspinatus tear and in 33.3% of shoulder with 2 tendons involved. Hyperechogenic changes were noted in 35.3% of shoulders, some thinning of the rotator cuff in 23.5%, while both of these changes in 14.7%. The thinning of the rotator cuff was classified as pathologic if there was difference between diameter of rotator cuff measured in 6th to 8th postoperative week and diameter measured at the time of follow-up. Ultrasonographic examination offers critical evaluation of both surgical result and postoperative physical therapy protocol.
Cuff
Rotator cuff injury
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Subacromial bursa
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Abstract Damage to the biceps tendon is often seen in conjunction with rotator cuff tears. However, controversy exists regarding its role in the shoulder and its optimal treatment. A previous study determined that biceps tendons were detrimentally affected in the presence of rotator cuff tears in the rat model and this damage worsened over time. However, whether this damage progresses at later time points to provide a chronic model is unknown. The objective of this study was to determine the changes in the biceps tendon in the presence of a cuff tear over time. Our hypothesis was that histological, compositional, organizational, and mechanical properties would worsen with time. We detached the supraspinatus and infraspinatus tendons of 48 rats and evaluated these properties at 1, 4, 8, and 16 weeks postdetachment. Properties worsened through 8 weeks, but improved between 8 and 16 weeks. We therefore conclude that biceps tendon changes in this model are not truly chronic. Additionally, it has been shown that infraspinatus properties in this model return to normal by 16 weeks, when biceps properties improve, indicating that earlier repair of one or more of the rotator cuff tendons may lead to resolved pathology of the long head of the biceps tendon. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:874–879
Biceps tendon
Rotator cuff injury
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