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Fewer rotator cuff tears fifteen years after arthroscopic subacromial decompression
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Örebro University Hospital.
Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
2010 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 19, no 1, 111-115 p.Article in journal (Refereed) Published
Abstract [en]

Background: A successful clinical result is reported in 75% to 85% of impingement patients after arthroscopic subacromial decompression. The result is maintained over time, but few studies have investigated the integrity of the rotator cuff in these patients. Materials and methods: Using ultrasonography, we examined the integrity of the rotator cuff in 70 patients 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at the index procedure. Results: Tendons were still intact in 57 patients (82%), 10 (14%) had partial-thickness tears, and 3 (4%) had full-thickness tears. Discussion: The total number of 18% tears (partial and full thickness) in this study, including patients clinically diagnosed with subacromial impingement at a mean age of 60 years, is unexpectedly low compared with 40% degenerative tears reported in asymptomatic adults of the same age. Conclusion: Arthroscopic subacromial decompression seems to reduce the prevalence of rotator cuff tears in impingement patients. This appears attributable to elimination of extrinsic factors such as mechanical wear and bursitis. The potential effect of surgery on intrinsic cuff degeneration is unknown, but intrinsic factors may explain tears still developing despite decompression.

Place, publisher, year, edition, pages
Elsevier Science B.V., Amsterdam , 2010. Vol. 19, no 1, 111-115 p.
Keyword [en]
Impingement, long-term follow up, arthroscopic subacromial decompression, rotator cuff tear, rotator cuff degeneration, ultrasonography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-56522DOI: 10.1016/j.jse.2009.04.014ISI: 000277367800020PubMedID: 19556145OAI: oai:DiVA.org:liu-56522DiVA: diva2:320070
Available from: 2010-05-21 Created: 2010-05-21 Last updated: 2017-12-12
In thesis
1. Treatment of subacromial pain and rotator cuff tears
Open this publication in new window or tab >>Treatment of subacromial pain and rotator cuff tears
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Shoulder pain is very common, affecting 14-21 % of the population at some time during their lifetime. The aims of this thesis were to improve the understanding of various aspects concerning the pathogenesis and treatment of subacromial pain and rotator cuff tears. Patients and healthy individuals were examined and compared in five studies:

Study I) Seventy patients were retrospectively examined, clinically and with ultrasound, 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at surgery. Ultrasound showed significantly fewer rotator cuff tears compared to the prevalence of asymptomatic tears reported in the literature for the same age group. This indicates that arthroscopic subacromial decompression might protect the rotator cuff.

Study II) Forty-two patients were retrospectively examined, clinically and with ultrasound, 39 months (mean) after an acute rotator cuff repair. All patients had pseudoparalysis after trauma, a full thickness tear and no previous history of shoulder symptoms. A delay in surgical treatment of three months and the number of tendons injured did not affect the outcome. Age affected outcome negatively.

Study III) Plasma samples from 17 patients with cuff tears and 16 plasma samples from healthy age- and gender-matched controls were collected and analysed regarding the levels of matrix metalloproteinases and their inhibitors, TIMP1-4. Elevated levels of TIMP-1 were found in the patients with cuff tears compared to controls. Higher levels of TIMP-1, TIMP-3 and MMP-9 were found in patients with full-thickness tears compared to patients with partial-thickness tears.

Study IV) Ninety-seven patients with longstanding subacromial pain, on the waiting-list for arthroscopic subacromial decompression, were prospectively randomised to specific shoulder exercises or control exercises for three months. Thereafter they were clinically examined and asked if they still wanted surgery. The specific shoulder exercises focusing on eccentric exercise for the rotator cuff and scapula stabilisers were found to be effective in reducing subacromial pain and improving shoulder function, thereby reducing the need for surgery.

Study V) All patients including those operated, in Study IV were re-examined after one year using clinical assessment scores. The option of surgery was continuously available up to the one-year follow-up. Ultrasound and radiological examinations performed at inclusion were analysed in relation to the choice of surgery. The positive effects of the specific exercise programme were maintained after one year and significantly fewer patients in this group chose surgery. Surgery was significantly more often chosen by patients who had a low baseline shoulder score, and/or a full thickness rotator cuff tear.  All patients showed significant improvement in the clinical scores one year after inclusion or one year after surgery.

These results support the concept that subacromial pain has a multifactorial aetiology and that the first line of treatment should be specific shoulder exercises. When conservative treatment fails, an acceptable result can be achieved with arthroscopic subacromial decompression. The rotator cuff status is important to consider when treating and studying these patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 90 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1312
Keyword
Shoulder, rotator cuff tear, ultrasound, surgery, exercises
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-82094 (URN)978-91-7519-862-0 (ISBN)
Public defence
2012-10-26, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-10-02 Created: 2012-09-28 Last updated: 2013-03-15Bibliographically approved

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Björnsson, HannaKnutsson, AndersAdolfsson, Lars

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Department of Clinical and Experimental MedicineFaculty of Health SciencesDepartment of Orthopaedics LinköpingDepartment of Radiology in LinköpingOrthopaedics and Sports Medicine
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Journal of shoulder and elbow surgery
Medical and Health Sciences

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