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Fluoroscopic, magnetic resonance imaging, and electrophysiologic assessment of shoulders with massive tears of the rotator cuff.

Abstract：

BACKGROUND:It was the purpose of this paper to analyze structural, functional, and electrophysiologic variables that may determine preserved overhead function for patients with massive rotator cuff tears. METHODS:Nineteen patients (20 shoulders) were prospectively included in either the pseudoparalytic (n = 9) or the non-pseudoparalytic group (n = 11). Fatty infiltration was graded according to Goutallier, and anterior (subscapularis) and posterior (infraspinatus and teres minor) tear extension was graded 0 (no involvement) to 4 (full tear) on magnetic resonance imaging. Glenohumeral and scapulothoracic rhythm was assessed by fluoroscopic motion analysis, and electromyographic evaluation of the deltoid muscle was performed. RESULTS:We found no significant difference of fatty infiltration of the supraspinatus (3.9 vs 3.6), infraspinatus (3.9 vs 3.8), and teres minor (1.7 vs 0.6) or of the posterior tear extension (2.6 vs 2.0) between pseudoparalytic and non-pseudoparalytic shoulders. Global tear extension in the parasagittal plane (205° vs 163°) and subscapularis involvement (2.6 vs 1.2), however, showed significant differences between the two groups, and no patient with a full-thickness supraspinatus and infraspinatus tear with extension into the inferior half of the subscapularis was able to lift the arm to 90°. Fluoroscopic assessment revealed almost total loss of active glenohumeral abduction in the pseudoparalytic group. CONCLUSION:Despite global tear extension, the single most important predictor for preserved shoulder function is the integrity of the inferior subscapularis insertion. Furthermore, electromyographic evaluation identifies a well-differentiated deltoid innervation as beneficial for a well-preserved shoulder function, but it does not protect from pseudoparalysis.

journal_name

J Shoulder Elbow Surg

journal_title

Journal of shoulder and elbow surgery

authors

Wieser K,Rahm S,Schubert M,Fischer MA,Farshad M,Gerber C,Meyer DC

doi

10.1016/j.jse.2014.05.026

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

288-94

issue

2

eissn

1058-2746

issn

1532-6500

pii

S1058-2746(14)00323-1

journal_volume

24

pub_type

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