Use of Injections and Biologics for the Nonoperative Treatment of Rotator Cuff Pathology
This article contains a review of the current literature regarding the risks, benefits, and alternatives of the most common injections used in the treatment of rotator cuff pathology. Injection options covered include corticosteroids, biologics including platelet-rich plasma and stem cells, hyaluronic acid, and nonsteroidal anti-inflammatory drugs. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Alexander J. Johnson, Hannah Bradsell, Rachel M. Frank Source Type: research
Advances in the Treatment of Rotator Cuff Tears
Unique biomechanical factors in the overhead and throwing athlete lead to a spectrum of rotator cuff pathology, usually with progressive lateralization of the supraspinatus footprint. Initial comprehensive nonoperative management is indicated for all athletes. Progression to arthroscopic debridement, repair of concomitant injuries, and possible rotator cuff repair with a transosseous equivalent technique are the current management strategies for athletes when nonoperative management fails. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Anna K. Reinholz, Sara E. Till, Alexandra M. Arguello, Jonathan D. Barlow, Kelechi R. Okoroha, Christopher L. Camp Source Type: research
Arthroscopic Rotator Cuff Repair
Arthroscopic rotator cuff repair (ARCR) has become the gold standard management for rotator cuff repair. Double-row repairs have shown increased biomechanical strength and enhanced anatomic footprint coverage. The advancement of knotless techniques has led to decreased operating room time and reduced overall costs. We prefer a suture-bridging double-row repair for most rotator cuff repairs and incorporate a knotless medial mattress sutures (double-pulley technique) for additional support as needed. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Michael R. Mancini, Jeffrey L. Horinek, Cameron J. Phillips, Patrick J. Denard Source Type: research
Superior Capsular Reconstruction for Irreparable Rotator Cuff Tear
This article aims to critically evaluate the biomechanics, indications, procedural considerations, clinical outcomes, rehabilitation program, and complications associated with the SCR procedure. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Phob Ganokroj, Annalise M. Peebles, Matthew L. Vopat, Matthew T. Provencher Source Type: research
Failed and Revision Rotator Cuff Repair
With an increasing incidence of rotator cuff repairs (RCRs), and by extension, RCR failures, surgeons must be facile in the diagnosis and management of this complication. A detailed history and physical exam as well as familiarity with the patient-specific, anatomic, and technical variables that increase a patient ’s risk of RCR failure is critical. Modifiable factors should be addressed prior to revision RCR and non-modifiable factors should be examined as they may disqualify an individual from a revision attempt. A methodical surgical approach is critical. In general, outcomes following revision RCR are t ypically favo...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Ian S. MacLean, Stephen F. Brockmeier Source Type: research
Treatment of Massive Rotator Cuff Tears with Reverse Shoulder Arthroplasty
Most massive rotator cuff tears (MCTs) are often successfully treated with nonoperative treatment; however, various surgical treatment options are available if conservative management fails. Several joint preserving techniques for MCT are commonly used, but the options are limited if an MCT is irreparable. Reverse total shoulder arthroplasty (RTSA) is gaining popularity over hemiarthroplasty as a treatment option for irreparable MCT, especially if glenohumeral degenerative changes are present. RTSA has been shown to have improved functional outcomes and range of motion postoperatively, particularly in the elderly and patie...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Evangeline F. Kobayashi, Sameer R. Oak, Bruce S. Miller, Asheesh Bedi Source Type: research
Rehabilitation and Return to Work and Sport After Rotator Cuff
This review covers a systematic approach to rehabilitation following rotator cuff repair. Rates of return to work and return to a prior level of sports activity in patients that have undergone rotator cuff repair will be reviewed. Risk factors and predictors of a patient ’s inability to return to work or prior level of sports participation will be discussed. Overall, there is a high level of return to work and sports following rotator cuff repair. Heavy manual laborers are at higher risk of not returning to a prior level of work, whereas professional overhead athl etes are at higher risk of not returning to their prior l...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Adam Z. Khan, Kurt E. Stoll, Brandon J. Erickson Source Type: research
Update on Diagnostic Imaging of the Rotator Cuff
Understanding the anatomy, injury patterns, and surgical procedures is essential for image interpretation. While direct evaluation of the rotator cuff cannot be made, radiographs of the shoulder provide the initial evaluation of the osseous abnormalities associated with rotator cuff impingement. MR imaging is considered the study of choice for the evaluation of the shoulder because of the comprehensive assessment of both bone and soft-tissue abnormalities. MR can accurately evaluate the size and shape of tendon tears, tendon tear retraction, and tendon and muscle quality. Computed tomography is an excellent modality for th...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Jennifer Pierce, Mark Anderson Source Type: research
Augmentation of Arthroscopic Rotator Cuff Repair: Biologics and Grafts
Arthroscopic augmentation of massive and irreparable rotator cuff tears proves to be a valid and evidence-based treatment option to maximize healing and patient outcomes following rotator cuff repair. Integration of acellular dermal allografts as augment or interposition grafts demonstrates definitive benefit in patients with high risk of retear or individuals with severely retracted tears, respectively. Furthermore, these allografts have demonstrated benefit when used for superior capsular repair for chronic, atrophied tears in young, active patients who do not want to proceed with a reverse total shoulder replacement. (S...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Caleb N. Morgan, Kevin F. Bonner, Justin W. Griffin Source Type: research
Tendon Transfers, Balloon Spacers, and Bursal Acromial Reconstruction for Massive Rotator Cuff Tears
Several options exist for the management of irreparable rotator cuff tears without advanced arthritic changes. Tendon transfer poses technical challenges and has limited but promising outcomes data. Newer procedures such as balloon spacers and bursal acromial reconstruction are currently being investigated as a reproducible solution to this challenging problem. Ultimately the decision to continue with conservative measures, use one of the aforementioned techniques, or proceed with reverse shoulder arthroplasty remains a decision to be made in the context of patient ’s unique demands and provider comfort with the various ...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Samuel J. Mease, Kevin C. Wang, Frank S. Cautela, Bradford O. Parsons Source Type: research
Updates on Treatment of Rotator Cuff Tears
While the high prevalence of symptomatic rotator cuff disease remains constant, management strategies continue to evolve. Any practitioner treating patients with shoulder pain must be aware of the natural history, imaging workup, conservative treatment options, and surgical options for patients with rotator cuff tears. There have been numerous improvements in nonoperative management and new surgical options, which are some of the focus of this issue of Clinics in Sports Medicine. It is often clinically challenging to determine the appropriate time to obtain imaging, what the appropriate imaging modality is, how long and wh...
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Brian C. Werner Tags: Preface Source Type: research
The Evolution of Treatment for Rotator Cuff Tears
Few things have evolved in my surgical career as much as the treatment of Rotator Cuff Tears. As a resident, I had the opportunity to work with a true master shoulder surgeon, Dr Charles Rockwood. It wouldn't take too long for me to reach the point in a case in which he would proclaim: "Dr Miller, I think you've reached your level of incompetence." Many years later, as I was painfully ascending the Mount Everest of learning curves (arthroscopic treatment of cuff tears), I couldn't have agreed with him more. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Mark D. Miller Tags: Foreword Source Type: research
Advances in the Treatment of Rotator Cuff Tears
CLINICS IN SPORTS MEDICINE (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Authors: Brian C. Werner Source Type: research
Copyright
ELSEVIER (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Source Type: research
Contributors
MARK D. MILLER, MD (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 12, 2022 Category: Sports Medicine Source Type: research
