Effects of Sleeping Positions on the Rotator Cuff Pathology

Journal of Shoulder and Elbow Surgery, 2012

The purpose of this study was to investigate the etiology and the demographic and functional characteristics of rotator cuff tears (RCTs) in 100 paraplegic patients as compared with 100 able-bodied volunteers. The magnetic resonance imaging examination results of 200 shoulders in each group were analyzed. Clinical examination included the Constant score and a visual analog scale for pain intensity. The prevalence of RCTs was 63% in paraplegic patients versus 15% in able-bodied volunteers (P < .0001). All RCTs in the paraplegic group were associated with symptoms. Among the patients with RCTs, full-thickness tears were detected in 78% of cases in the paraplegic patient group versus 73% of cases in the volunteer group. The rate of partial-thickness tears was 22% in the paraplegic group versus 27% in the volunteer group. Paraplegic patients had a lower Constant score; Disabilities of the Arm, Shoulder and Hand score; and range of motion and a higher pain intensity than the volunteer cohort. The mean tear width in paraplegic patients was 14.4 mm (range, 8-28 mm) versus 9.9 mm (range, 8-14 mm) in the volunteers (P < .01). The etiology of RCTs in paraplegic patients seems to be based on wear-and-tear mechanisms rather than aging. These results are important for our understanding of shoulder pathology in long-term paraplegic patients and show the impact of this problem.

International Journal of Orthopaedics Sciences, 2021

Background: Rotator cuff has been a known entity for orthopaedic surgeons for more than two hundred years [1]. Rotator cuff disease is a common condition that causes shoulder pain and functional disability with a prevalence rate of 2.8-15%, affecting approximately 40% of population who are more than 60 years of age and substantially impacting on individual’s function [2]. Aims and Objectives: To study risk factors in patients with symptomatic atraumatic rotator cuff tear –Age, Obesity, Gender, Smoking, Diabetes mellitus, Hypertension, Hand dominance, Use of corticosteroid injections, Hyperlipidemia, Osteoarthritis of knee. Materials and Methods: Inclusion criteria § Pain in the shoulder of duration more than three weeks. § Normal range of motion of the shoulder. § One or more than one positive clinical tests for rotator cuff tear. Diagnostic imaging like ultrasound and magnetic resonance imaging pointing to diagnosis of rotator cuff tear. Exclusion criteria § History of trauma. § Hi...

Medicine and Sport Science, 2011

The rotator cuff has an important role in the stability and function of the glenohumeral joint. To understand the biomechanical proprieties of the rotator cuff, it is essential to understand the pathogenesis and effects of rotator cuff tears. The rotator cuff provides a stabilizing effect to the shoulder, because of compression of the humeral head against the glenoid cavity. The wide range of motion of the shoulder is allowed by the variety of rotational moments of the cuff muscles. Rotator cuff muscles action must be precisely coordinated to obtain the desired movement. Rotator cuff tendons are subjected to complex tension loads. The rotator cuff is also subjected to compressive loads. Upwardly directed humeral load squeezes the cuff between the humeral head and the coracoacromial arch. Extrinsic factors have always been considered among causes of cuff tears. However, evidence shows that acromial impingement is not the primary cause of rotator cuff tears. Tears of the rotator cuff change load distribution and determine a pattern that induces tear progression and extension. Progressive tears of the rotator cuff compromise glenohumeral stability and determine superior translation of the humeral head.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013

The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff-and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single-versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented.

National Journal of Clinical Anatomy

The rotator cuff is the prime stabilizer of the glenohumeral or shoulder joint. The last decade saw introduction of three components, namely, rotator cable, rotator crescent, and rotator interval of rotator cuff, which were being studied and published in dozen of literatures belonging to clinical specialties of orthopaedics and radiology. At times when these terms have helped the clinician to understand the biomechanics of the rotator cuff while improving the outcome of its repair, the knowledge of the same remains at large for the anatomists. The preoperative assessment of rotator cuff tear has helped surgeons to identify the structure and its functional deficits thereof. The rotator cable is a thick fibrous band that behaves like a suspension bridge. Tears of rotator cable result in partial loss of function or pseudoparalysis of shoulder joint. The rotator interval is a four-layered protective cover of ligaments and the capsule in the rotator cuff. The current knowledge of the rotator interval revealed that the minor underlying ligaments of the shoulder joint play a crucial role in maintaining the congruency of the rotator cuff. The rotator cuff injury is often misdiagnosed due to a lack of knowledge and identification of its recently reported components. This review intends to sensitize the anatomists to investigate further about rotator cuff anatomy and biomechanics of the shoulder joint.

HSS Journal ®, 2018

Background: Recent research from the American Board of Orthopaedic Surgery database indicates a decreasing rate of subacromial decompression (SAD) performed with rotator cuff repair (RCR) by younger orthopedic surgeons. Questions/Purposes: The purpose of this study was to determine the rate of RCR with and without SAD and whether the rate of RCR with SAD decreased over time. Further, we set out to determine if there was significant variation in the rate of RCR with SAD by state. Methods: Rates of RCR with and without open or arthroscopic SAD from 2010 to 2012 were determined based upon deidentified data from a national health insurance carrier. Data were normalized per 10,000 insured patients for comparative analysis. Results: Rates of RCR with concomitant SAD were higher than RCR without SAD in each year analyzed. In patients 50 years old and older, this same significant difference was also seen for each year. The rate of RCR with or without SAD did not decrease over the 3-year time period. The rate of RCR performed concomitantly with SAD was significantly higher than RCR performed without SAD in all patient age groups combined. There was wide variation in the rate of RCR with or without concurrent SAD across states. Conclusion: Disproving our hypothesis, the overall rate of RCR with or without SAD did not decrease over the period from 2010 to 2012. There was wide variation in the rate of RCR by state; however, this variation was not seen in the incidence of SAD performed concomitant with the RCR.

International orthopaedics, 2018

To evaluate the effects of rotator cuff tear (RCT) and its severity on shoulder proprioception. We studied 132 consecutive patients (67 M-65 F; mean age ± SD, 66.03 ± 9.04; range, 43-78) who underwent arthroscopic rotator cuff repair. Tear size was determined intra-operatively. The control group included 82 subjects (38 M-44 F; mean age ± SD, 65.87 ± 8.06; range, 41-75) with no RCT. All participants, wearing an eye mask, were submitted to the evaluation of the joint position sense (JPS) at 30°, 60°, 90°, 120°, and 150° of shoulder forward flexion during the sitting position, using a digital inclinometer securely attached to the subject's arm using hook-and-loop straps. The passive placement and active replacement method was used; the order of the tested angles was randomly selected. The entire test was repeated three times. The error score, by averaging the three trials, was measured as the absolute difference between the target angle and the observed angle. Statistics were perf...

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2020

The aim of this study is to evaluate the presence of significant differences regarding the lateral acromial angle, critical shoulder angle, and the acromial index between patients with and without rotator cuff tears. Method: The MRIs (Magnetic Resonnance Imaging) of 82 patients were studied. The rotator cuff tear group (RCT group) included 41 patients while the control group also included 41 patients without rotator cuff tears. Acromial parameters and demographical data were extracted for statistical analysis. Results: No statistical significant difference was found in terms of the studied acromial parameters between patients with and without rotator cuff tears. No correlation was found between age and any of the studied parameters. LAA (Lateral Acromial Angle) was found to be significantly different between males and females of the studied sample. However, no difference was found between patients with and without rotator cuff tears when both genders were studied separately. Moreover, no statistical significant difference was found in terms of the studied acromial parameters between males and females when the RCT group and the control group were studied separately. When gender was the covariate in the one-way MANCOVA test, gender was not significantly dependent on the type of groups (RCT group vs control group). Conclusion: The results obtained from this study suggested that the studied acromial parameters in patients with rotator cuff tears were not different from the parameters found in patients without rotator cuff tears. Moreover, gender was not found to influence the acromial parameters, with no subsequent effect on the development of rotator cuff tears. Further studies may be required for better understanding on the biomechanics, taking into consideration age, gender, and the given population.

Muscles, ligaments and tendons journal, 2013

Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease.

Polish Journal of Radiology, 2019

Purpose: There have been many studies that have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Rotator cuff tears (RCT) are the common aetiology of shoulder pain. We assessed the association of rotator cuff tears with commonly used radiographic parameters of acromial morphology and their different radiographic characteristics. Material and methods: From a retrospective study of 98 patients, we characterised acromial type and measured acromial thickness (AT), critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), and acromion index (AI) on a 1.5T MRI, from 68 patients with partial or full-thickness supraspinatus tendon tears and 30 controls without tears. Results: Out the 68 patients with rotator cuff tear, supraspinatus was the most commonly affected tendon, with 86% (59) cases showing abnormalities. The average age of the patients was 45.11 ± 21.45 years with male dominance (80%). Partial tears of rotator cuff were more common than complete tears. Forty-eight cases showed partial tears in supraspinatus as compared to 11 cases of complete tears. The acromial type did not show any correlation with any particular cuff lesion. The AT and AI of controls were significantly smaller than cuff-tear patients. The LAA of cuff-tear patients was significantly different from that of control patients. The impingement patients demonstrated a significantly greater acromial thickness, larger CSA, decreased AHD, and decreased LAA than their control counterparts. Conclusions: A higher prevalence of rotator cuff tears and impingement associated with low lateral acromial angle, larger CSA and decreased AHD was observed. AT and AI have a direct correlation with rotator cuff tear.