Sunday, October 2, 2011

Shoulder arthritis and rotator cuff articles from Sept issue of the Journal of Shoulder and Elbow Surgery

In the September issue of JSES a number of interesting articles appear.
Shidle et al sought evidence of inflammatory markers in tissue samples from shoulders with rotator cuff tears. They found that the amount of inflammation correlates with tear size and was greater in full thickness than in partial thickness tears. This finding of inflammation may help explain the achy pain at rest experienced by patients with full thickness cuff years as well as the relief of symptoms from anti-inflammatory medications as well as from a 'smooth and move' procedure that removes the inflamed bursal tissue, even if the cuff tear itself is not repaired.

Gulotta et al considered the prognostic factors for clinical and ultrasound determination of cuff integrity at five years after rotator cuff repair surgery. As Harryman et al demonstrared 20 years ago in a very similar study, larger tears in older patients are likely to fail to heal after repair. In fact, the risk of healing failure increased over five times when the tear involved more than one tendon. However, as Harryman et al pointed out previously, many patients were clinically improved even though the repair failed. These results suggest that an option for treating large tears in older patients may be the 'smooth and move' procedure, sparing the patient from the need to protect an attempted repair after surgery, especially if the prognosis for healing is unfavorable. This study points out that a 'successful' rotator cuff surgery needs to be carefully defined in clinical research: does 'success' refer to healing of the tendon verified by cuff tendon imaging or by improvement in the comfort and function of the shoulder?

Finally, Warrender et al reported that in patients having rotator cuff repair, obesity was associated with worse functional outcomes, longer operative times and longer hospital stays.


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