Rotator cuff tears and tendinopathy - Is platelet rich plasma (PRP) helpful? Read this important updated version.

A review of published randomized trials and meta-analyses indicates that non-operative treatment is effective for the majority of patients with conditions of the rotator cuff, including rotator cuff tears.

Local corticosteroid injections are sometimes used in non-operative treatment, however they apparently have no biologic effect in terms of regenerating or reversing the degenerative changes occurring in rotator cuff tendons and their clinical benefit usually wears off quickly.

It has been suggested that local injection of platelet-rich plasma (PRP) may promote stem and progenitor cell proliferation, modulate inflammatory responses, stimulate angiogenesis, enhance the proliferation of tenocytes, stimulate the production of extracellular matrix proteins, protect against oxidative stress, and inhibit inflammation (see Platelet-Rich Plasma in Orthopaedic Surgery: A Critical Analysis Review) and that these effects may benefit patients with rotator cuff tendinopathies before structural failure of the rotator cuff occurs. 

 The authors of Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1-year follow-up: a double-blinded randomized controlled trial attempted to answer this question in a randomized clinical trial of patients between 18 and 50 years old (mean age 28 years) who had both a clinical and magnetic resonance imaging diagnosis of supraspinatus tendinopathy refractory to conservative treatment. 

A total of 50 patients received a single subacromial injection of PRP, whereas 50 patients received a single subacromial corticosteroid injection. All the patients completed 12 months of clinical follow-up. 

At 12 months, in comparison to the those receiving cortisone, patients in the PRP group showed a significantly greater improvement in 

the VAS score: 1.68 vs. 2.3

the American Shoulder and Elbow Surgeons (ASES) score, 89.8  vs. 78.0 

the Single Assessment Numeric Evaluation (SANE) score, 89.2 vs. 80.5 

and the the Pittsburgh Sleep Quality Index (PSQI) score, 2.72 vs. 4.02 

The overall failure rate was significantly higher in the corticosteroid group (30%) than in the PRP group (12%) (P < .01).

It was particularly interesting to note that the difference in the course of the two groups was not evident until 6 months after the injection. As Michael Pearl pointed out, it is possible that the PRP folks would have gotten better anyway (i.e. the PRP may not have had an effect). We'd need a saline injected control arm to examine that possibility.

It does seem that the corticosteroid injected group tended to do less well with time and their greater failure rate may be related to the adverse effects of cortisone on tendons. As Dr Pearl says "An alternative explanation could be that cortisone is deleterious and the PRP less interfered with the natural history.  " 

It is notable that the ASES score difference between 3 and 12 months (85 to 90) does not exceed the minimal clinically important difference for ASES of 15. 

Comment: This double blinded randomized clinical trial showed that young patients with rotator cuff tendinosis having subacromial injection of PRP did better than comparable patients having subacromial injection of cortisone. It does not show that patients having subacromial injection of PRP would do better than those with no treatment or with a placebo control. Keep in mind that these patients had an average age of 28, folks who have a lot of potential for recovery with time and rehab.

A possible benefit of PRP in cuff tendinosis cannot be extrapolated to the treatment of cuff tendons with structural failure, as demonstrated by the authors of Subacromial Platelet-Rich Plasma Injections Produce Significantly Worse Improvement in Functional Outcomes in Patients With Partial Supraspinatus Tears Than in Patients With Isolated Tendinopathy who found that  improvement in the ASES score was significantly greater in the group without tears than in the group with partial cuff tears (PTRCTs) at all follow-up times. 94% of the patients in the isolated tendinopathy group but less than half of patients in the PTRCTs group achieved a substantial clinical benefit at 12 months follow-up. 

Furthermore, a review of published randomized controlled trials and meta-analyses failed to demonstrate a clinically significant benefit to the patient of the use of PRP in conjunction with surgical repair of a torn rotator cuff.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link). 

The value of the Regeneten bioinductive implant in managing rotator cuff disease: what does the literature say?

Recently a patient inquired about the value of Smith+Nephew’s REGENETEN◊ Bioinductive Implant (shown below) in managing her chronic rotator cuff tendinopathy. 

A PubMed search for "Regeneten" in the National Library of Medicine's database of the biomedical literature revealed the following articles:

Seven clinical reports did not compare patient-reported clinical outcomes for cuff repairs with Regeneten to those for cuff repairs without Regeneten.

Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up reported improvement from preoperative clinical scores. There was no control group having similar surgery without the implant.

Patient-Reported Outcomes After Use of a Bioabsorbable Collagen Implant to Treat Partial and Full-Thickness Rotator Cuff Tears reported improvement from preoperative clinical scores at one year. There was no control group having similar surgery without the implant.

Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study presented 33 patients with partial thickness cuff tears treated with the Regeneten patch. Two year clinical scores were improved from preoperative values. There was no control group having similar surgery without the implant

Tips and Tricks for Augmenting Rotator Cuff Repair With a Bio-inductive Collagen Implant presented a surgical technique for implanting the Regeneten patch. No patient outcome data were presented.

Arthroscopic rotator cuff repair with biologically enhanced patch augmentation presented 22 patients having revision massive rotator cuff repair using the Regeneten patch enhanced with cBMA and PRP. While short term followup (6 months) showed clinical improvement over preoperative scores, there was no control group having similar surgery without the implant

Isolated Bioinductive Arthroscopic Repair of Partial-Thickness Rotator Cuff Tears Using a Resorbable Collagen Implant reported improved 2-year scores in comparison to preoperative scores with this resorbable bovine collagen implant in the treatment of intermediate and high-grade partial-thickness rotator cuff tears. There was no control group having similar surgery without the implant

Treatment of Partial-Thickness Rotator Cuff Tears With a Resorbable Bioinductive Bovine Collagen Implant: 1-Year Results From a Prospective Multicenter Registry This registry analysis found improved one year scores after surgery in comparison to preoperative scores  for partial thickness cuff tears with a resorbable bovine collagen implant. There was no control group having similar surgery without the implant

Economic value. Two studies attempted to assess the economic value of Regeneten, but did not evaluate patient reported clinical outcomes.

Resorbable Bioinductive Collagen Implant Is Cost Effective in the Treatment of Rotator Cuff Tears Average cost of treatment $32,213 without Regeneten, $54,459 with Regeneten (additional cost 69%). Did not assess patient reported outcomes or revision rates for patients without or with the patch. While using "healing" as the study endpoint, the authors point out that there is lack of agreement on what constitutes healing or retearing after a cuff repair based on magnetic resonance imaging, ultrasound, or arthrogram. Evidence was not presented that "healing" by imaging correlated with better clinical outcomes .

Economic Evaluation of a Bioinductive Implant for the Repair of Rotator Cuff Tears Compared with Standard Surgery in Italy. Average cost of treatment €4650 without Regeneten, €7828 with Regeneten (additional cost 68%). Study limitations the same as those for the report above.

Complications: The one study that compared clinical outcomes of repairs without and with Regeneten found an eight-fold increase in postoperative stiffness in the Regeneten group. All reoperations were in the Regeneten group.

Increased stiffness and reoperation rate in partial rotator cuff repairs treated with a bovine patch: a propensity-matched trial found that postoperative stiffness was observed in the first 12 weeks in 8 of 32 patients in the patch group compared with 1 of 32 patients in the control group. Six patients in the patch group underwent reoperations compared with no patients in the control group. All 6 reoperations in the patch group were performed to address stiffness. The authors concluded that patients in the patch group had a significantly higher rate of postoperative stiffness. In the majority of patients in whom shoulder stiffness developed, reoperation was required. It seems possible that this stiffness may be related to overstuffing the subacromial space by the graft as well as associated scarring in the humeroscapular motion interface.

A report of revision because of bursitis and rice bodies in a Regeneten-treated cuff repair.

Subacromial-Subdeltoid Bursitis With Rice Bodies After Rotator Cuff Repair With a Collagen Scaffold Implant: A Case Report. reported a case of subacromial-subdeltoid bursitis with rice bodies after rotator cuff repair with a Smith + Nephew REGENETEN bovine-derived bioinductive collagen scaffold implant. After debridement, the patient recovered well and made a full return to work and recreational activities.

Report of revisions because of reactive bursitis.

Revision arthroscopic surgery after rotator cuff repair with a collagen graft: histologic evaluation of biopsy specimens from two patients

Comment: Rotator cuff surgery is the most commonly performed shoulder operation. Thus studies of factors affecting the patient outcomes is of importance both clinically and economically.

It is well recognized that healing of an attempted repair repair can be difficult to assess by postoperative imaging and may not correlate with the functional outcome realized by the patient. 

Well controlled clinical studies are needed to determine whether the substantial increase in cost associated with the Regeneten implant is offset by improved outcomes for the patient.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).

Rotator cuff repair - is acromioplasty a good thing?

In his 1972 article , Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report, Charles Neer pointed out that "a characteristic ridge of proliferative spurs and excrescences on the undersurface of the anterior process [of the acromion] was seen frequently, apparently caused by repeated impingement of the rotator cuff and humeral head, with traction on the coracoacromial ligament" as shown in his figure





and his x-ray showing the traction spur in the coracoacromial ligament, but - notably - not encroaching on the rotator cuff space



Since this publication, numerous authors have tried to understand if these acromial changes are an effect or a cause of degenerative cuff disease.

The authors of Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder pointed out that acromioplasty for impingement syndrome of the shoulder is one of the most common orthopaedic surgical procedures. They sought high levels of evidence in the published literature related to five hypotheses pertinent to the concept of the impingement syndrome and the rationale supporting acromioplasty in its treatment:
(1) clinical signs and tests can reliably differentiate the so-called impingement syndrome from other conditions,
(2) clinically common forms of rotator cuff abnormality are caused by contact with the coracoacromial arch,
(3) contact between the coracoacromial arch and the rotator cuff does not occur in normal shoulders,
(4) spurs seen on the anterior aspect of the acromion extend beyond the coracoacromial ligament and encroach on the underlying rotator cuff, and
(5) successful treatment of the impingement syndrome requires surgical alteration of the acromion and/or coracoacromial arch.

 
They found that these hypotheses were not supported by high levels of evidence.


Recently, the authors of Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears Long-Term Outcomes of a Multicenter, Randomized Controlled Trial provided a longer term followup of their original study: Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: a multicenter, randomized controlled trial with the goal of determining the long-term efficacy of subacromial decompression in patients with full-thickness rotator cuff tears.

Eighty-six patients were randomized in the original trial, with 31 of 45 from the group without acromioplasty and 25 of 41 from the acromioplasty group returning for long-term follow-up (mean: 11 years).

There was no significant difference in WORC scores between the groups with and without acromioplasty at the time of the long-term follow-up (p = 0.30).

Seven (16%) of the 45 patients in the group without acromioplasty and one (2%) of the initial 41 patients allocated to acromioplasty underwent or were recommended to have reoperation.





Comment: Two experienced surgeons performed all the surgeries. The distribution of primary cases and the distribution of revision cases between these two surgeons is not presented.

The authors stated, "Tears of ≤4 in size of one or more tendons were included," however the tear sizes in the acromioplasty and non acromioplasty groups are not presented. Furthermore, the initial tear sizes in the revised and unrevised shoulders are not presented. Thus is not clear whether the cuff pathology was worse in the shoulders with type 2 or type 3 acromions.

The integrity of the cuff / retears in the two groups were not routinely evaluated by MRI or ultrasound. The operative findings - particularly the integrity of the cuff and the degree of subacromial scarring- in the revised cases are not presented. Thus the cause of symptoms leading to repeat surgery is not clarified. This study does not provide robust evidence to support the concept that acromioplasty has "a protective effect on the rotator cuff repair in patients with an amorphous acromion."


A few additional thoughts in closing.

We need to continue to think about the observation of Codman (The Shoulder 1934, p24), that the articulation between the cuff and the coracoacromial arch is an "auxillilary joint" (see his drawing below), providing stability of the humeral head against upward directed loads...

....as well as his admonition (p 13), that "the coracoacromial ligament has an important duty [restraining the humeral head] and should not be thoughtlessly divided at any operation."

The articulation between the coracoacromial arch needs - as is the case for any articulation - to be smooth and to provide a broad contact area. As Neer pointed out, acromial spurs arise within the coracoacromial ligament. As such these spurs rarely encroach on the cuff. If there is a prominence to palpation of the curvature of the CA arch (which is uncommon), it can be conservatively smoothed with a bur without transection of the ligament or a major acromial resection.

Finally, some techniques of rotator cuff repair can disrupt the smoothness of the subacromial articulation by adding "top knots" that protrude from the surface of the repaired cuff.









In performing cuff repair, it may be best to position knots so that they do not rub against the CA arch.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).

Platelet rich plasma (PRP) and the rotator cuff - what patients should know

While arthroscopic rotator cuff repair is one of the commonest of all shoulder procedures, the postoperative re-tear rate ranges between 9% and 94% despite intensive exploration of surgical techniques and adjunctive therapies. Investigators have explored the use of growth factors - in particular, platelet-rich plasma (PRP) - with the hope of inducing a faster and better healing of the repaired tendon tissue.

The authors of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: Clinical and Radiological Results of a Prospective Randomized Controlled Trial Study at 10-Year Follow-Up sought to compare, at 10-year follow-up, the clinical and radiological outcomes of arthroscopic rotator cuff repair with or without the addition of platelet-rich plasma (PRP) over the tendon-bone interface at the end of
the surgical procedure.

Patients were randomly divided into 2 groups: 26 received PRP and 27 served as controls. 38 (71%) patients (median age 71 years) were re-evaluated at least 10 years after the index procedure performed by an individual highly experienced surgeon. The patients in the two groups were similar.

The clinical outcomes were not better for the shoulders receiving PRP



While the mean ASES score was higher for the PRP group (100) than for the non-PRP group (93), the difference did not approach clinical significance (see Establishing clinically significant outcome after arthroscopic rotator cuff repair).

On average, 37% of the operated patients had a re-rupture on ultrasound examination, regardless of whether PRP was used or not (PRP group: 35%; control group: 38%; P . 1.0000).

Interestingly, the clinical outcomes were essentially the same whether the repair remained intact or not.


While the average Constant score was higher for patients with intact cuffs in comparison to those with re-tears, the difference failed to reach clinical significance (see Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery).

The authors concluded that in comparison to patients not receiving PRP, patients treated with PRP did not have better clinical outcomes and did not have lower re-tear rates of the repaired tendons. These finding are similar to those reported by the authors of The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials in which the clinical effects of PRP failed to reach clinical significance.

Comment: PRP can be an expensive adjunct to rotator cuff repair and the expense may not be covered by the patient's insurance. Further evidence is needed to support the value (benefit/cost) of PRP as an adjunct to rotator cuff repair. 

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).

Depression affects the manifestations of rotator cuff pathology.

Rotator Cuff Tendinopathy: Magnitude of Incapability is Associated with Greater Symptoms of Depression Rather than Pathology Severity

These authors point out that most people develop rotator cuff tendinopathy during their lifetime, that it is often well accommodated by the patient without major functional loss, and that there is limited correspondence between symptom intensity and pathology severity. Furthermore they note mounting evidence that the ability to adapt to painful pathology, measured as symptom severity and magnitude of capability using patient reported outcome measures (PROMs), has notable inverse associations with unhelpful thoughts and distress (worry and despair) regarding symptoms.

They analyzed a retrospective cohort of 71 adults seeking specialty care for symptoms of rotator cuff tendinopathy, that had a recent Magnetic Resonance Imaging (MRI) of the shoulder, and completed the following questionnaires: PROMIS Global Health (a measure of symptom intensity and magnitude of capability, consisting of the mental and physical Health subscores), the Generalized Anxiety Disorder (symptoms of anxiety), and the Patient Health Questionnaire (symptoms of depression). 

They measured the sagittal length of the rotator cuff defect and tendon retraction in millimeters on MRI (excellent reliability) and rated the rotator cuff muscle atrophy and fat infiltration (more limited reliability) and we used the average of measurement or rating for each patient. 

They found that  lower scores on the PROMIS Global Health total score and physical health subscale were independently associated with greater symptoms of depression but not with measures of tendon pathology. 

Comment: The observation that the global health and physical health scores among people seeking care for symptoms from rotator cuff pathology is inversely associated with symptoms of depression but not with measures of the severity of the rotator cuff pathology is important because impaired global heath and physical health are often used both (1) as a major component of the indications for rotator cuff surgery and (2) as tools for evaluating the efficacy of treatment. If depression is a major driver of these metrics, the presence and severity of depression will confound analyses of treatment indications and outcomes.

An important implication of this study is that individuals with good mental health may be better able to maintain the functional capability of their shoulders in spite of the natural age-related deterioration in their rotator cuff tissue.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

PRP for Cuff Disease: Data Fragility of a Level I Study

Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease A Randomized Controlled Trial

These authors investigated the safety and efficacy of a fully characterized allogeneic pure PRP injection into the subacromial space of patients with "rotator cuff disease" in comparison with corticosteroid injection. Inclusion criteria: ≥18 years ofd age, unilateral shoulder pain for at least 3 months, a Neer or Hawkins impingement sign,  either a painful arc or a positive result on the Jobe test. Exclusion criteria included previous subacromial injections within the past 3 months, a history of shoulder trauma, a full-thickness rotator cuff tear as demonstrated with magnetic resonance imaging (MRI) or ultrasonography, and limitation of both active and passive movement of the glenohumeral joint of 25% in at least 2 directions as compared with the contralateral shoulder or with normal values.

60 patients with rotator cuff disease were randomly assigned to receive a subacromial injection of either 4 mL of allogeneic pure PRP or a 4-mL mixture of 1 mL of 40-mg/mL triamcinolone acetonide and 3 mL of 2% lidocaine under ultrasonographic guidance. 

The authors concluded that " Constant score at 1 month did not significantly differ between the PRP and corticosteroid groups. At 6 months, the DASH (Disabilities of the Arm, Shoulder and Hand) score, overall function, and external rotation were significantly better in the PRP group than in the corticosteroid group, and the other clinical outcomes did not show significant differences. All pain measurements, the strength of the supraspinatus and infraspinatus, and 5 functional scores also improved slowly and steadily after injection, becoming significantly better at 6 months compared with those before the injection, whereas those in the corticosteroid group responded promptly but did not further improve. Allogeneic PRP injections for the treatment of rotator cuff disease are safe but are not definitely superior to corticosteroid injections with respect to pain relief and functional improvement during 6 months. The DASH score, overall function, and external rotation were significantly better in the PRP group than in the steroid group at 6 months. Generally, PRP slowly but steadily reduced pain and improved function of the shoulder until 6 months, whereas corticosteroid did not."

Comment: Let's take a look at the DASH data. Recalling that a lower DASH score is good, we can see that at later time points the average DASH scores for the available patients are lower (i.e. better).

A few blog posts ago we discussed data fragility (see this link). Fragility is an indication of how sensitive the result is to the loss of patients to followup. 

In this study, we see that the average DASH score for the patients available at each time point after treatment is related to the percentage of patients lost to followup. The best (lowest) DASH score is at 6 months when 24% of the original patients were not included. The conclusion that the DASH improved with time is fragile because it is possible that the missing 24% could have had higher (worse) DASH scores at 6 months - we just don't know. 

It is also of interest that the percent of patients lost to followup (especially at 6 months) is quite different for the PRR and the steroid groups as shown below.

This limitation is not discussed in the limitations discussion of the paper.

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Total shoulder and the rotator cuff

Preoperative partial thickness rotator cuff tears do not compromise anatomical total shoulder replacement outcomes: medium-term follow-up

Rotator cuff degeneration and osteoarthritis are two common age-related conditions of the shoulder.

 

These authors sought to determine the medium term results of anatomic total shoulder replacement (TSR) for OA in patients with established preoperative partial thickness rotator cuff tears demonstrated on MRI scans.

Thirty-six patients (14 Male, 22 Female), who underwent TSR had a partial thickness rotator cuff tears on MRI, preoperatively, all demonstrated mild to moderate fatty infiltration. The mean age of patients was 79.2 years (75-88); Mean follow-up was 5.8 years (4-9). Significant improvements in pain, ROM, were reported in all cases. At the final follow-up, the Oxford Shoulder Score was 42 (32-46) with minimum 14 points improvement (p=0.001). 

Lucencies were observed in 8 glenoids. 6 at Grade1 Lazarus score, 2 at Grade 2 & none seen at Grade 3. There were no cases of implant loosening.

Clinically four patients had rotator cuff weakness but only 2 showed evidence of proximal migration. One remained satisfied whilst the other, with a moderate grade Torchia classification for proximal migration, was revised for rotator cuff failure; one further patient had débridement, antibiotics, and implant retention for infection.

 

Comment:  While the authors concluded that “the presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomical TSR in the medium term”, this study did not compare the outcomes of total shoulder arthroplasty in patients with and without partial cuff lesions. 

 

Further clinical research is needed to determine the advantages and disadvantages of anatomic and reverse total shoulders in individuals over 75 years of age and to determine whether it is of value to assess the status of the cuff with a preoperative MRI in making this determination.

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Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Rotator cuff failure

Rotator Cuff Failure

This article published in the New England Journal of Medicine a few years back provides a useful perspective on the evaluation and management of the patient with suspected disease of the rotator cuff.

The diagnosis of rotator-cuff failure is suggested by a history of acute traumatic or progressive, insidious loss of shoulder strength. The physical examination of a shoulder with a rotator-cuff lesion should assess stiffness, pain on resisted motion, weakness, palpable tendon defects, crepitance, atrophy, and instability.

 

Plain radiographs may help rule out other diagnoses that may underlie shoulder pain (e.g., degenerative arthritis of the glenohumeral joint) and may help determine the degree to which the humeral head is aligned with the glenoid.

 

Ultrasonography or MRI is useful for evaluating the integrity of rotator-cuff tendons in patients when this information is needed to help guide treatment, but these imaging examinations may reveal tendon abnormalities even when the shoulder is asymptomatic. 

 

When an acute injury results in an abrupt loss of shoulder function, the evaluation of the rotator cuff should be expedited so that a traumatic rotator-cuff tear, if present, can be repaired before muscle and tendon atrophy occur.

Here we present some of the key figures and tables from this paper.

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Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'