Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations (original) (raw)
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Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff-and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single-versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented.
Physiotherapy Practice and Research, 2019
Background: Disorders associated with the rotator cuff are regarded as the most common shoulder pain presentation. The range of diagnostic terms used to explain this problem reflect uncertainty in relation to causative mechanisms, diagnosis, prognosis, and the most effective treatments. The aim of this consensus exercise was to facilitate a shared understanding as a means of reducing mixed messages, informing clinical practice and providing a foundation for future research. Methods: Ten physiotherapists with clinical and academic expertise in shoulder pain participated in an online and face-to-face consensus exercise. Results: This consensus exercise suggests specific factors in the history and physical examination that might raise the index of suspicion of Rotator Cuff Related Shoulder Pain. The suggestions for non-surgical management include a minimal number of exercises prescribed to challenge the functional deficit of the patient over a minimum 12-week period. Apart from aiding exclusion of red flag pathology, imaging is not regarded as useful unless the patient does not respond as expected. Steroid injections wouldn't be considered a first-line intervention unless pain was severe and preventing engagement with exercise. Conclusion: This consensus exercise provides a benchmark for clinical reflection while highlighting areas of uncertainty that still exist and require further research.
Background: The purpose of the present study was to validate the Functional Shoulder Score (FSS), a new patientreported outcome score specifically designed to evaluate patients with rotator cuff disorders. Methods: One hundred and nineteen patients were assessed using two shoulder scoring systems [the FSS and the Constant-Murley Score (CMS)] at 3 weeks pre-and 6 months post-arthroscopic rotator cuff surgery. The reliability, validity, responsiveness and interpretability of the FSS were evaluated. Results: Reliability analysis (test-retest) showed an intraclass correlation coefficient value of 0.96 [95% confidence interval (CI) ¼ 0.92 to 0.98]. Internal consistency analysis revealed a Cronbach's alpha coefficient of 0.93. The Pearson correlation coefficient FSS-CMS was 0.782 pre-operatively and 0.737 postoperatively (p < 0.0005). There was a statistically significant increase in FSS scores postoperatively, an effect size of 3.06 and standardized response mean of 2.80. The value for minimal detectable change was AE8.38 scale points (based on a 90% CI) and the minimal clinically important difference for improvement was 24.7 AE 5.4 points. Conclusions: The FSS is a patient-reported outcome measure that can easily be incorporated into clinical practice, providing a quick, reliable, valid and practical measure for rotator cuff problems. The questionnaire is highly sensitive to clinical change.
The Journal of Bone and Joint Surgery (American), 2006
Background: Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain.
Optimizing the Management of Rotator Cuff Problems
American Academy of Orthopaedic Surgeon, 2011
Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal antiinflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery.
BMC Musculoskeletal Disorders, 2010
Background: Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator cuff disease. Methods: We performed analyses of data from 104 patients who had participated in a randomized controlled study. Socio-demographic, clinical and radiographic baseline factors were assessed for association with outcome at six-weeks follow-up evaluated by Shoulder Pain and Disability Index (SPADI) and patient perceived outcome. Factors with significant univariate association were entered into multivariate linear and logistic regression analyses. Results: In the multivariate analyses; a high SPADI score indicating pain and disability at follow-up was associated with decreasing age, male gender, high baseline pain and disability, being on sick-leave, and using regular pain medication. A successful patient perceived outcome was associated with not being on sick-leave, high active abduction, local corticosteroid injection and previous cortisone injections. Structural findings of rotator cuff tendon pathology on MRI and bursal exudation or thickening on ultrasonography did not contribute to the predictive model. Conclusions: Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. Sick-leave was the best predictor of poor short-term outcome. Trial registration: Clinical trials NCT00640575.
2020
A review was conducted to synthesize the available research literature on the pathogenesis of rotator cuff tendinopathy. Musculoskeletal disorders of the shoulder are extremely common. An understanding of the anatomy and biomechanics of the rotator cuff may provide some insight into the pathologic process involved in this tendinopathy. The patho etiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. A considerable body of research is necessary to more fully understand the etiology and pathogenic factors of rotator cuff tendinopathy Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. A considerable body of research is necessary to more fully understand the etiology and pathohistology of rotator cuff tendinopathy and its relationship with bursal pathology.
Management of rotator cuff disease: specific treatment for specific disorders
Best Practice & Research Clinical Rheumatology, 2007
Disease of the rotator cuff is common. It is responsible for a high proportion of patients with shoulder pain presenting to general practice, causing work absenteeism and claims for sickness benefits. Rotator cuff disease (RCD) can often be managed in primary health care services, although some cases may require secondary referral. Both extrinsic and intrinsic factors to the cuff tendon are thought to be involved in the pathogenesis leading on to a spectrum of conditions ranging from sub-acromial bursitis to mechanical failure of the cuff tendon itself. Careful history and examination followed by pertinent investigation are essential to establish the correct diagnosis. The main aim of treatment is to improve symptoms and restore function of the affected shoulder. The majority of patients suffering from RCD can be managed by conservative means, but a shift in attitude has led to a significant number benefiting from invasive procedures ranging from decompression of the sub-acromial space to large, open procedures reconstructing the tendon itself.
Evaluation of interventions for rotator cuff pathology: a systematic review
Journal of Hand Therapy, 2004
This review assessed the effectiveness of surgical and conservative management for rotator cuff pathologies. The authors concluded that there was insufficient evidence to draw definitive conclusions and that further research is required. The review excluded individual RCTs included in relevant Cochrane reviews. Much of the available evidence was of a poor quality and the authors' conclusions are appropriately cautious. Authors' objectives To assess the effectiveness of surgical and conservative management for rotator cuff (RC) pathologies. Searching MEDLINE, CINAHL, the Cochrane Library and PEDro were searched for studies published in English from 1966 to May 2003; the search terms were listed. The reference lists in retrieved reports were checked. Study selection Study designs of evaluations included in the review Meta-analyses, systematic reviews, randomised controlled trials (RCTs), cohort studies and case series were eligible for inclusion. The review excluded individual RCTs that had already been included in three Cochrane systematic reviews. Specific interventions included in the review Studies of surgical or nonsurgical treatment were eligible for inclusion. The included studies used electrotherapy, physiotherapy, acupuncture, shockwave therapy, laser therapy, needle aspiration, and surgical interventions such as open, miniopen and arthroscopic surgical repair. Participants included in the review Studies of adult patients with RC pathology were eligible for inclusion. Eligible pathologies included full and partialthickness tears of the RC, lesions, tendonitis and tendinopathy of supraspinatus, infraspinatus and subscapularis tendons, impingement syndrome, calcific tendonitis and bursitis. Studies of patients with RC pathology due to rheumatic disorders were excluded. Outcomes assessed in the review Studies that assessed pain, function, disability, strength, patient satisfaction and time to return to work were included. How were decisions on the relevance of primary studies made? Two reviewers independently selected studies for inclusion. Assessment of study quality The authors did not state that they assessed validity. They did, however, grade studies using a hierarchy of study design: level 1 studies were RCTs; level 2 studies were lower quality RCTs; and level 4 studies were case series. The authors did not state how this grading was peformed. Data extraction The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.
Rotator Cuff Syndrome and Current Approaches in Treatment
Namık Kemal Tıp Dergisi, 2021
Rotator cuff syndrome is a common health problem causing serious physical, psychological and material losses. Since the treatment process is long and difficult and the treatment costs are increasing, a lot of research is done especially on risk factors. Both intrinsic and extrinsic factors are among the underlying causes. Although some of these factors could be changed, most of them are unchangeable factors due to anatomical structure and functions. Therefore, it is very important to determine these factors in advance and apply preventive treatments. In this study, it is reviewed to give information about the studies on rotator cuff syndrome risk factors and treatment approaches.