Article

An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears

Sports Medicine Program, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 01/2013; 29(2). DOI: 10.1016/j.arthro.2012.06.024
Source: PubMed

ABSTRACT

PURPOSE: The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears. METHODS: An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data. RESULTS: Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77. CONCLUSIONS: Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair. LEVEL OF EVIDENCE: Level IV, systematic review Levels III and IV studies.

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Available from: Seth L Sherman, Feb 09, 2015
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    • "Since 14–63% of anterior dislocations are associated with rotator cuff tears [12], MRI should be performed when the patient has persistent pain or muscle weakness after reduction of the shoulder. Although Mall et al. reported that there was no indication that acute repair in traumatic injuries produced better outcomes [13], Simonich and Wright recommend proceeding with rotator cuff repair as soon as the diagnosis has been made in order to obtain the optimal results for terrible triad of injuries [14]. The tears of tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles. "
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    ABSTRACT: We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture-a "terrible tetrad." A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.
    Full-text · Article · Jun 2014

  • No preview · Article · Feb 2013 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: Background The increasing incidence of rotator cuff tears with increasing age indicates that rotator cuff lesions are naturally correlated with ageing and often present without clinical symptoms. Rotator cuff tears from extrinsic causes, i.e., repetitive microtrauma or even macrotrauma, are different entities. Because of the strong and stiff tendon tissue, direct injury mechanisms may not lead to a rotator cuff tear. Excentric mechanisms of tensioned tendons or shearing forces during dislocation may, on the other hand, result in traumatic rotator cuff tears. Evaluation For the decision from a legal point of view of whether it is a traumatic or degenerative rotator cuff tear, an individual- and patient-related analysis of all circumstances and information including radiographs or MRI is necessary. Therapy Reconstruction of the tear is indicated especially in younger patients as well with a history of relevant trauma or of dislocation. The operation should be performed early, if associated with concomitant neurologic lesions. Good to very good results are achieved using open or arthroscopic techniques in the short and long-term follow-up.
    Preview · Article · Apr 2013 · Trauma und Berufskrankheit
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