Wednesday, September 28, 2011

Shoulder arthritis and rotator cuff articles from Sept issue of the JBJS - cuff muscle function, frozen shoulder

The September issue of JBJS contains an article by Mannaya et al entitled "evaluation of in vivo rotator cuff muscle function after acute and chronic detachment of the supraspinatus tendon".
The authors used a rat model to show that repaired supraspinatus tears had less endurance and generated less force than normal rotator cuff tendon. The loss of function was more severe when the tear was 12 weeks old than when the tear was 4 weeks old. They also found that increased tension in the repair (as may result from the fact that with tendon loss it is necessary to stretch the muscle to reach the attachment point) leads to inferior function. The message is that in acute tears, earlier repair of rotator cuff tears, before tendon loss occurs, is likely to lead to better functional results. Of course this does not mean that there is a hurry in repairing long standing chronic atraumatic cuff tears, as we've stated previously in this blog.

There is also an interesting article on adhesive capusulitis or 'frozen shoulder'. This is a systematic review of the literature which concludes that the existing publications show no significant difference in the long-term results of management of this condition with (a) intra-articular steriod injection, (b) manipulation under anesthesia, (c) intra-articular local anesthetic, (d) intra-articular saline injection, (e) oral steriods and  (f) physical therapy.
Basically, all treatments led to improvement in comfort and function. Perhaps this is a self limited condition that gets better with time, regardless of treatment. The authors do caution, however, that the methodology of the studies comparing treatments is 'poor', so that there may be differences that would be detected by better quality studies.
In my practice I consider manipulation under anesthesia and complete muscle relaxation for patients with refractory stiff shoulders who have normal x-rays, good quality bone, and no prior injury or surgery.


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