Saturday, January 26, 2013

Rotator cuff repair - post operative ultrasound

This is a most interesting study demonstrating the ability of modern shoulder ultrasound (linear ML6-15 MHz transducer) to reveal anatomic details of the rotator cuff after surgery. The authors determined tendon thickness, thickness of the bursa, width of the footprint, tendon vascularity, and capsular thickness after rotator cuff repair, and attempted to correlate supraspinatus tendon thickness with pain in fifty-seven patients having arthroscopic cuff repair of torn supraspinatus tendons.

The postoperative rehabilitation program consisted of six weeks immobilization in a sling with an abduction pillow along with mobilization exercises. Strengthening started at six weeks. 

According to ultrasound imaging, the re-tear rate in this study was 8/57 (14%) at 6 months postoperation. Four patients re-tore their tendons at 6 weeks and 4 retore at 3 months.  In 2 patients having revision surgery for suspected re-tears, intra-operative findings did not correlate with that of ultrasound. The primary repairs were intact in both patients. 

Sequential ultrasounds revealed that repaired tendon thickness remained unchanged, bursal thickness decreased,  anatomical footprint increased, tendon vascularity decreased, and posterior capsule thickness decreased over the six months of the study. Pain did not correlate strongly with tendon thickness.

This investigation revealed the progressive changes in the shoulder after cuff repair as revealed by modern ultrasound.

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