This Update looks at the anatomy, assessment and management of rotator cuff tears.
The rotator cuff is a set of tendons that surround the humeral head and seat the head in the glenoid which in turn allows overhead function. They are crucial tendons and commonly injured. The most commonly injured of the four tendons is the supraspinatus, particularly, at its insertion into the greater tuberosity on the humeral head.
This Update looks at the anatomy, assessment and management of rotator cuff tears.
Nearly a decade has passed since Lynne Robson’s first encounter with frozen shoulder. But she remembers in exquisite detail the limitations it imposed and the pain it caused her.
Pulling on a winter coat was excruciating. Robson could only wear clothing with front closures, because reaching behind her back to hook a bra, for instance, required a range of movement she no longer had.
Blow-drying her hair — pretty much a requirement for a TV reporter, which Robson was at the time — was impossibility.
A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively.
Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.
“Vegetarian athletes can meet their dietary needs from predominantly or exclusively plant-based sources when a variety of these foods are consumed daily and energy intake is adequate,” Ghosh wrote in his presentation.
Vegetarians should find non-meat sources of iron, creatine, zinc, vitamin B12, vitamin D and calcium because the main sources of these typically are animal products and could be lacking in their diets. Vegetarian women, in particular, are at increased risk for non-anemic iron deficiency, which may limit endurance performance. In addition, vegetarians as a group have lower mean muscle creatine concentrations, which may affect high-level exercise performance.
Almost everyone who runs (or has shopped for running shoes) has heard that how your foot pronates, or rolls inward, as you land affects your injury risk. Pronate too much or too little, conventional wisdom tells us, and you’ll wind up hurt. But a provocative new study shows that this deeply entrenched belief is probably wrong and that there is still a great deal we don’t understand about pronation and why the foot rolls as it does.
The incidence rate for stress fracture injuries among females was nearly three times greater when compared to males. Knee rotation and abduction angles when landing were both associated with the rates of lower-extremity stress fractures, as were reduced knee and hip flexion angles, and increased vertical and medial ground reaction forces.
“Lower extremity movement patterns and strength have previously been associated with stress fractures and overuse injuries; however, our study is one of the first to identify dynamic knee rotation and frontal plane angles as important prospective risk factors for lower extremity stress fractures.
Arthroscopic capsulolabral posterior reconstruction offers advantages in posterior shoulder instability, according to researchers.
More than 90% of athletes treated for the condition in this manner are able to return to sports, Dr. James P. Bradley told Reuters Health by email.
While glenohumeral instability is relatively common, affecting 2% of the general population, posterior instability is much rarer, affecting 2% to 10% of all unstable shoulders, according to a 2011 paper in Sports Medicine. Posterior glenohumeral instability is mainly seen in athletes.
In a June 26 online paper in The American Journal of Sports Medicine, Dr. Bradley of the University of Pittsburgh Medical Center and colleagues observe that there are few reports of arthroscopic treatment of unidirectional posterior shoulder instability.
Postmenopausal women may develop full thickness rotator cuff tears and not know it.
In a study of pre- and postmenopausal women, investigators from Italy found a nearly three-fold increase in asymptomatic rotator cuff full-thickness tears in the older women.
“Because asymptomatic tears have a great potential to evolve into symptomatic painful shoulder, a precocious discovery of this pathology may allow the planning of preventive and therapeutic measures,” they point out in a report online June 10 in Menopause.
Rotator cuff tendon tears increase with age, but no study until now has specifically addressed prevalence changes in women from premenopause to postmenopause.
Existing rehabilitation used for people undergoing tendon-bone repairs like rotator cuff repair perhaps partially to blame for the high rates of failed healing post-surgery suggests study by a new Hospital for Special Surgery. Experiments in a rat model of this injury suggest that immobilizing the limb for four to six weeks after surgery, rather than quickly starting physical therapy, improves healing.
“Before we did this study, we thought that delaying motion for a short period of time, seven to ten days, and then starting physical therapy would be the most beneficial to tendon healing. However, from the data in this study, it appears we should be immobilizing our patients for longer periods of time,” said Scott Rodeo, M.D., principal investigator of the study and co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS) in New York City.
For many people who have fibromyalgia, even the thought of exercising is painful.
“For many people with fibromyalgia, they will exercise for a week or two and then start hurting and think that exercise is aggravating their pain, so they stop exercising,” Ang said. “We hope that our findings will help reduce patients’ fear and reassure them that sustained exercise will improve their overall health and reduce their symptoms without worsening their pain.”
For tens of thousands of years, humans ran on bare feet. Then we developed an assortment of specialized shoes, including – particularly since the 1960s – a seemingly limitless variety of running shoes. Despite the perceived advantages of foot protection, some runners in recent years have returned to barefoot running, believing it is a more natural way to run and therefore less injurious to the feet and legs.
Children playing tackle football are more likely to sustain a concussion during games and not practice, according to recent study results published in The Journal of Pediatrics.
Soccer training makes the heart ten years younger
“We discovered that soccer training significantly improved the flexibility of the heart and furthermore, that the cardiac muscle tissue was able to work 29% faster. This means that after three months of training, the heart had become 10 years ‘younger’”, explains Medical Doctor, PhD Student, JakobFriis Schmidt, who co-authored the study alongside with PhD student, Thomas Rostgaard Andersen. He adds:
Sometimes innovative science requires innovative machinery, like a moveable, four-legged robotic sled that can wear shoes, a contraption recently developed and deployed by researchers at the University of Calgary to test whether grippy athletic shoes affect injury risk.
It’s well known, of course, that shoe traction influences athletic performance, especially in sports that involve sprinting or cutting, meaning abrupt rapid shifts in direction. In broad terms, more traction leads to better results.
Descriptions of fracture healing almost exclusively deal with shaft fractures and they often emphasize endochondral bone formation. In reality, most fractures occur in metaphysealcancellous bone. Apart from a study of vertebral fractures, authors have not found any histological description of cancellous bone healing in humans. The histology suggests that cells in the midst of the marrow respond to the trauma by direct formation of bone, independently of trabecular surfaces.
Following a complicated eight hour operation using a donor limb and matching tissue, the first successful hand transplant was completed in the UK on December 27, 2012.
The recipient was a 51-year-old man named Mark Cahill, a pub landlord from Halifax. His right hand became unusable after it was infected with gout. A surgical group at Leeds General Infirmary was led by Professor Simon Kay. The team removed Cahill’s hand at the same time as they replaced it with the donor hand. This is the first time this method has been used, permitting precise restoration of nerve structures.
While athletes suffer from traumatic forms of the injury, for many others age is to blame for torn rotator cuffs. It’s believed millions of Americans over 60 suffer from one. Every year 250 thousand people go under the knife for relief, but now there’s a surgery-free alternative you can do for free!
Just taking plates out of the cupboard was excruciating for Kay Subhawong.
She has a torn rotator cuff. The small muscles that hold the shoulder joint together have ripped apart.
The rotator cuff is made up of tendons and muscles in the shoulder. The tendons and muscles connect the upper arm bone with the shoulder blade and they hold the ball of the upper arm bone in the shoulder socket. The combination means greater range of motion of any joint in the body. A rotator cuff injury can include any type of irradiation or damage to the tendons and muscles. Causes of an injury can include lifting, falling, and repetitive arm activities (usually those that are done overhead like throwing a baseball). About 50 percent of rotator cuff injuries can heal with self-care or exercise therapy.
Reconstructive hand surgery can dramatically enhance the life quality and independence of those paralyzed by a cervical spinal cord injury. Despite this, the operation is not frequently performed, either in Sweden or elsewhere. Researchers at the Sahlgrenska Academy are now hoping to change that.
A cervical spinal cord injury entails paralysis in both arms and legs, severely limiting daily life for its victims. Previous studies have shown that the capability that those with cervical spinal cord injuries most wish to recover is a functioning hand.
A study at Hospital for Special Surgery (HSS) found that a surgical procedure known as the “docking technique” to repair a torn elbow ligament in teenage athletes yielded favorable results. The outcomes were better than those in previously published reports on reconstruction of the ulnar collateral ligament (UCL), also known as Tommy John surgery, in this age group and may be attributed to technique-specific factors, according to the study authors.
The paper, titled, “The Docking Technique for Elbow Ulnar Collateral Ligament Insufficiency: Two-Year Follow Up in Adolescent Athletes,” was presented at the annual meeting of the American Academy of Orthopaedic Surgeons in Chicago.