Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
J Shoulder Elbow Surg. 2021 Jul;30(7):1636-1646. doi: 10.1016/j.jse.2020.09.020. Epub 2020 Oct 16.
Anterosuperior rotator cuff tears with a displaced long head of the biceps tendon are most often trauma-related, and patients with these conditions often present with severe pain and shoulder dysfunction. Repair of the subscapularis and supraspinatus and a biceps tenodesis or a tenotomy are the recommended treatments based on retrospective studies. The aim of this study was to prospectively evaluate clinical and structural treatment outcome in a cohort of trauma-related anterosuperior injuries in patients with previously healthy shoulders.
Patients seeking care for a suspected rotator cuff injury after shoulder trauma were screened according to a protocol including clinical examination, baseline scoring with Western Ontario Rotator Cuff Index (WORC) and numeric rating scale of pain, ultrasound, and magnetic resonance imaging (MRI). Those with anterosuperior injuries were offered surgical treatment, structured postoperative physiotherapy, and inclusion in the present study with 1-year follow-up, including MRI, baseline scores, Constant-Murley score, and Patient Global Impression of Change. Thirty-three patients (78% men) with a mean age of 59 (40-76) years were included.
All patients had a biceps pulley lesion, a displaced biceps tendon, and incomplete full-thickness subscapularis and supraspinatus tears. Six patients declined surgery. At follow-up, the operated patients reached a median WORC score of 86% and a median change from baseline to follow-up of 50% (P = .0001). Pain decreased (P = .0001) at rest, at night, and during activity. The median Constant-Murley score was 86% of the contralateral nonoperated shoulder, 58% of the contralateral abduction strength recovered after surgery, and 86% reported that they were recovered or much improved. All repairs and tenodeses healed except for 2 supraspinatus tendons. The 6 nonoperated patients reached a median WORC score of 90, a change in the median value from baseline to follow-up of 31, but reported more pain, and a smaller proportion considered themselves as recovered or much improved. In all patients, the 1-year MRIs had signal changes in the upper muscular portion of subscapularis, consistent with fatty infiltration, regardless of operative or nonoperative treatment.
Anterosuperior rotator cuff injury with an associated pulley lesion and displaced long head of the biceps tendon may be treated successfully with surgery as the majority of patients in our cohort clinically recovered or were much improved without pain after a year. With a 1-year perspective, nonoperatively treated patients may also reach a reasonable clinical outcome. Independently of treatment or tendon healing, residual subscapularis muscle injury was seen, which may have long-term implications.
伴有移位的二头肌长头肌腱的前上肩袖撕裂通常与创伤有关，患有这些疾病的患者常伴有严重疼痛和肩部功能障碍。基于回顾性研究，推荐对肩胛下肌和冈上肌进行修复，并进行二头肌肌腱固定术或肌腱切断术。本研究的目的是前瞻性评估一组既往健康肩部创伤相关前上损伤患者的临床和结构治疗结果。
根据包括临床检查、Western Ontario Rotator Cuff Index (WORC) 和疼痛数字评分量表、超声和磁共振成像 (MRI) 的基线评分在内的方案，对因肩部创伤后疑似肩袖损伤而就诊的患者进行筛查。对前上损伤的患者提供手术治疗、术后结构物理治疗，并纳入本研究进行 1 年随访，包括 MRI、基线评分、Constant-Murley 评分和患者整体变化印象。33 名患者（78%为男性），平均年龄 59 岁（40-76 岁）。
所有患者均存在二头肌滑车病变、移位的二头肌肌腱和不完全全层肩胛下肌和冈上肌撕裂。6 名患者拒绝手术。随访时，手术患者的 WORC 评分中位数达到 86%，从基线到随访的中位数变化为 50%（P =.0001）。疼痛减轻（P =.0001），无论是在休息时、夜间还是活动时。Constant-Murley 评分中位数为对侧非手术侧的 86%，手术后对侧外展力量恢复 58%，86%的患者报告恢复或明显改善。所有修复和肌腱固定均愈合，除 2 例冈上肌腱外。6 名非手术患者的 WORC 评分中位数为 90，从基线到随访的中位数变化为 31，但报告疼痛更多，比例较小的患者认为自己恢复或明显改善。在所有患者中，1 年的 MRI 显示肩胛下肌上部肌肉信号改变，与脂肪浸润一致，无论手术或非手术治疗。
伴有滑车病变和移位的二头肌长头肌腱的前上肩袖损伤可以通过手术成功治疗，我们队列中的大多数患者在 1 年后没有疼痛且临床恢复或明显改善。从 1 年的角度来看，非手术治疗的患者也可能达到合理的临床结果。无论治疗或肌腱愈合如何，都可观察到残留的肩胛下肌损伤，这可能具有长期意义。
